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Changes in Morphological face height and the TMJ. Esthetic,Behavioural,and Adaptive responses.
Soft tissue=PDL
Highly organized and oriented. Highly vascularized (three sources). Highly innervated( touch, pain &pressure). Contain elastic fibers. Approximately uniform thickness.
Occlusion
The primary components of human dental occlusion:
1- the dentition. 2- the neuromuscular system. 3- the craniofacial structures.
Developing dentition
1- extensive sensory input 2-development of motor skills& neuromuscular learning. 3- dental , alveolar, craniofacial adaptability 1-dental adaptation (wear, drift, extrusion) 2-bone adaptation is reparative. 3-learned protective reflexes.
1-partial edentulism. 2-periodontal disease. 3-diminished dental reflex adaptation. 1-residual ridge reduction.. 2-compromised reflex. 3-increase in parafunctional movements.
Mastication
duration per stroke 0.3 sec.
1800 stroke/ day occur during meals stress transmitted through bolus of food increase steadily , abruptly to zero directed principally perpendicular to occ.plane with some horizontal component
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 that the parafunctions are prolonged ,excessive, both diurnal and nocturnal and with an undesirable direction.
Centric relation
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 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 theTMJs.
TMJ changes
Most of edentulous patients experienced 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.
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 in 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. Emotional and psychological factors also should not be neglected.