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Introduction
The occurrence of complete denture malocclusion post
insertion has been reported by several authors, e.g.
Bergman, Carlsson & Hedegard (1964), Brigante (1965),
Tallgren (1969), Goebel (1980), Taege & Stoica (1982)
and Berg & Knudsen (1983). In theory, occlusai changes
occurring shortly after insertion could have two main
causes: first, the settling of the dentures into the
deformable denture-bearing tissues; and second, the
changes in the afferent input from the oral cavity. Tallgren
et al. (1980) provided evidence that the electromyogram
changes after the insertion of new dentures, which might
well lead to a different position of the lower jaw. On the
other hand, when dentures have been worn for many
* These studies are dedicated to Prof. Dr Lorenz Hupfauf on his 70th
birthday.
1996 Blackwell Science Ltd
: :
...
322
K.-H.
UTZ
Second session
2nd Session
1st Session
Registration 1
<
Measurement 1
<
<
Measurement 3
<
Occlusai equilibration 1
of terminal hinge position 1 ^j
in max. intercuspation 1
^
Measurement 2
Registration 2
in maximum intercuspation 1
19 days 4
Registration 3
<
Measurement 4
<
Measurement 5
in maximum intercuspation 1
<
^
=
=
Occlusai equilibration 2
in max. intercuspation
Fig. 1. Experimental set-up. Each individual measurement consisted of repeated recordings after loosening and tightening the
mounting plates.
Fig. 2. Dentures placed in the measuring device with the equilibrated terminal hinge position fixed with sticky wax.
1996 Blackwell Science Ltd, Journal of Oral Rehabilitation 23; 321-329
I N S E R T I O N OF C O M P L E T E D E N T U R E S . P A R T I
323
Method 1
Error of method
Method 2
Furthermore, the experimental set up allowed a comparison between the position of the condylar balls in
intercuspal position in the first and the second session
(measurements 5 and 2). Only after these measurements
were finished were the dentures equilibrated in the newly
registered central occlusion and reinserted in the patient.
Statistical analysis
Results
History and clinical examination
'
Session 1
'
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K . - H . UTZ
Table 1. Reproducibility of the position of the condylar balls after repeated mounting in two phases of the lower denture
(n = 42)
, , , , . , . _ ^ . , , :^.. . . , , , , ,.._,._,_.. ... .. -. ..,..
: ... . . . . . . . .
.. ..
. ..
. . .
Right
r-;^;:-.. ,
'
'
'
i^ir,:,-
.,^ - ..
Mean
Standard deviation
Minimum
Maximum
Left
Transversal
(mm)
Sagittal
(mm)
Vertical
Total displacement
Right + left
(mm)
Vertical
(mm)
(mm)
(mm)
0-21
0-16
0-02
0-68
0-22
0-16
0-00
0-57
0-12
0-11
0-00
0-37
0-23
0-18
0-01
0-72
0-22
0-14
0-02
0-64
Sagittal
0-37
0-19
0-10
0-96
Table 2. Differences between the position of the condylar balls with CBP registration and after equilibration in retruded
jaw relationship ( = 83)
Right
Mean
Standard deviation
Minimum
Maximum
Sagittal
(mm)
Vertical
0-39
0-33
0-00
1-25
Left
Sagittal
(mm)
Transversal
(mm)
(mm)
Vertical
(mm)
0 33
0-36
0-00
2-08
0-25
0-24
0-00
1-21
0-34
0-32
0-01
1-69
0-33
0-32
0-00
1-75
Changes in the
Gothic arch position
Discussion
(after 19 days
n = 37 out of n = 69)
Comments on method
_J 0-1 mm
0-1 mm
Fig. 3. The points indicate the position of the apex of the Gothic
arch on the registration plates in relation to the original CBP registration (cross-hair) 19 days before.
Total displacement
Right + left
(mm)
0-63
0-44
0-04
2-54
Right
Mean
Standard deviation
Minimum
Maximum
Sagittal
(mm)
Vertical
(mm)
0-53
0-43
0-03
2-14
0-55
0-48
0-00
2-94
Transversal
(mm)
0-40
0-36
0-00
1-56
H ^ - . . , .
Sagittal
(mm)
Vertical
(mm)
0-55
0-44
0-00
2-42
0-54
0-41
0-01
1-85
;;
- ^ : ; ; . '
Total displacement
Right -1- left
(mm)
;
v> 0-98
0 - 5 5
0-25
3-37
The data represent the shift between upper and lower dentures in a time period of 19 4 days (71 subjects, method 1;
50.
mm
General comments
.::;::'
The methodological reproducibility of the CBP registration (0-26 mm) and the reproducibility of mounting
325
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K.-H.
UTZ
lateral
-I-3
Horizontal plane
ventral
cranial
"
Transversal plane
2
3
medial
U'
l\
.\^
medial
2
2
3
caudal
Table 4. Differences in position of the condylar balls between the equilibrated occlusion in the first session and the
intercuspal position in the second session (not newly equilibrated)
Right
Mean
Standard deviation
Minimum
Maximum
Left
Sagittal
(mm)
Vertical
(mm)
Transversal
(mm)
Sagittal
(mm)
Vertical
(mm)
Total displacement
Right -t- left
(mm)
0-56
0-43
0-00
0-60
0-50
0-02
2-52
0-48
0-37
0-04
1-89
0-54
0-45
0-00
1-78
0-56
0-43
0-00
1-73
1-05
0-55.
0-15
2-82
225
The data represent the shift between upper and lower dentures in a time period of 19 4 days (71 subjects, method 2).
\996B\acky>ieVLSc\enceUd, Journal of OralRehabilitation 23; 321-329
ventral
medial
3
Horizontal plane
dorsal
Fig. 5. (continued)
327
328
K . - H . UTZ
denture-bearing tissues, which adapt to the fitting surface
of the denture (Boucher, 1940; Lytle, 1962; Stephens,
Cox & Sharry, 1966), the settling of the post dam (Nergiz,
Proschel & Niedermeier, 1992) and any further slight
shifts of the denture position that are not due to
resorption (Hanau, 1929; Brigante, 1965; Niedermeier,
1980; Tuncay et al., 1984; Sassen, 1989). However, it
seems out of the question that the amount of shift
observed in the present study is due exclusively to the
above-mentioned phenomena. It is therefore most likely
that neuromuscular adjustments of the masticatory
system contribute. With the insertion of new dentures,
the stimuli to peripheral receptors in the mucosa, the
muscles, the tendons and the temporomandibular joints
change (Brill, 1957; Tallgren et al., 1980). For example,
if the patient had an eccentric occlusion for many years,
the new dentures will first lead to disorientation. Through
the altered peripheral input the muscles relax and the
mandible changes position as it is held and moved by
the muscles. Altered pressures on the joint might result
in a change in condylar position. The effect of the new
dentures on the stomatognathic system is therefore
similar to a splint (Jarabak, 1956; Calagna, Silvermann
& Garfinkel, 1973; Kowaleski & De Boever, 1975; Roura
& Clayton, 1975; Tallgren et ai, 1980; Serrano, NichoUs
& Yuodelis, 1984; Singh & Berry, 1985; Akerman,
Nordstrom & Hansson, 1986; Carossa etal., 1990). However, the results of the present study do not relate only
to changes in mandibular position. If one assumes that
the position of dentures in relation to denture-bearing
tissues, and therefore to the bone, does not change,
condylar deviations and the displacement of the mandible
must occur in the same room direction. Consequently, a
gothic arch, which is in the second session recorded
further dorsally than in the first session, would be
identical to a ventral shift of the mandible. In a nonarcon articulator this is identical to a dorsal shift of the
upper part. However, a dorsal displacement of the upper
part of the measuring device did not coincide with a
Gothic arch located further distally. Nor could this
correlation be found for the other room directions of
articulator displacement, as would have been the case
when the measured shifts in denture position were due
exclusively to an altered mandibular position. It can
therefore be concluded that the measured denture shifts
are based on a combination of the mentioned reasons.
Direct comparisons with other studies are not possible
because of methodological differences, but clinical
hints that the relation between upper and lower dentures
Conclusions
Within the first weeks after insertion of complete dentures
adaptive processes in the area of the denture-bearing
tissues and the masticatory system lead to a change in
relation of the upper to the lower denture.
The amount of occlusal changes in the course of time
varies considerably between individuals. Complete
dentures should be inserted.with clinically even occlusal
contacts, and sophisticated remounting should be
compulsory after only 1-3 weeks.
Acknowledgments
This study is part of the habilitation thesis of the author
and was supported by the 'Deutsche Gesellschaft fiir
Zahn-, Mund- und Kieferheilkunde'. The author is deeply
indebted to DipL- Math. Wolfgang Huntebrinker for
comprehensive data analysis and graphical display (Figs
4 and 5). Statistical advice was gratefully received from
DipL- Math. Dr Konrad Oettershagen. Many thanks are
due to Ms Gabi Reppert for fabrication of the registration
plates. Dr Axel Malchau designed Figs 1, 3 and 4.
Numerous fruitful discussions with Dr Norbert Bernard
and Professor Dr Lorenz Hupfauf as well as critical
comments on the manuscript from Dr Frauke Miiller and
Dr John Besford are greatly appreciated.
References
& HANSSON, T.L. (1986) Okklusales
Einschleifen und Muskelaktivitat. Phillip Journal fUr Restaurative
Zahnmedizin, 3, 136.
BERG, E. S-KNUDSEN, G. (1983) Observer variability of and comparison
between visual and central-bearing-point methods of evaluating
denture occlusion. Scandinavian Journal of Dental Research, 91,
391.
BERGMAN, B., CARLSSON, G.E. & HEDEGARD, B . (1964) A longitudinal
two-year study of a number of full denture cases. Acta Odontologica
Scandinavica, 22, 3.
BOUCHER, CO. (1940) Studies of displacement of tissues under
dentures. Journal of the American Dental Association, 27, 1476.
BRIGANTE, R.F. (1965) A cephalometric study of the settling and
migration of dentures. Journal of Prosthetic Dentistry, 15, 277.
329
Prothetische
Stomatologie, 3 2 , 2 4 3 .
Correspondence: Priv.-Doz. Dr K.-H. Utz, Zentrum fiir Zahn-, Mundund Kieferheilkunde, Poliklinik fiir Zahnarztliche Prothetik I der
Universitat Bonn, Welschnonnenstrasse 17, 53111 Bonn, Gerniany.