Journal of Oral Rehabilitation, 1981, Volume 8, pages 457-462

Shortened dental arches and oral function

A. F. K A Y S E R Department of Occlusal Reconstruction, University of Nijmegen,

The Netherlands

Summary
To acquire more information concerning the changes of the oral functions in shortened
dental arches, a cross-sectional clinical investigation was carried out among 118
subjects. They were classified into six classes, according to the degree and the symmetry
of the shortened condition. The method was based on the measuring of variables
which were derived from the oral function. The results showed two patterns of change
in oral functions: oral functions that change slowly until four occlusal units are left
and then change rapidly, and oral functions that change progressively without a sudden
change. The preliminary conclusion is that there is sufficient adaptive capacity to
maintain adequate oral function in shortened dental arches when at least four occlusal
units are left, preferably in a symmetrical position.

Introduction
A shortened dental arch is defined as a dentition where the most posterior teeth are
missing (Fig. 1). This condition is frequently seen as molars are often lost by caries
and periodontal diseases. In nature biological systems have the ability to adapt to
changing circumstances. The phylogenetic reduction of the jaws and the teeth in the
human race is an example of adaptive capacity. However, this adaptation mechanism
lags behind due to the fact that 'civilized' people no longer live in their natural con-
ditions, but in an artificial environment. In the evolution of the human species the
hands took over the grasping and touching functions of the snout, and the brains took
over part of the chewing function by inventing and producing refined food. Com-
munication has become a more important function than chewing.
The question can be raised whether there is an optimal relation between form and
function of the dentition of modern man. Preventive removal of the third molar has
become an accepted procedure, which is in fact a shortening of the dental arch.
The traditional approach in prosthetic dentistry is to replace missing teeth. In
shortened dental arches this can only be done by fitting free-end removable partial
dentures, thereby introducing unfavourable conditions for the remaining dentition
etai, 1978).
Correspondence: Dr A. E. Kayser, Department of Occlusal Reconstruction, University of Nijmegen,
P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.

0305-182X/81 /0900-0457 $02.00 © 1981 Blackweli Scientific Publications

457
458 A. F. Kdyser

Fig. 1. A dental arch shortened till the second premolars.

It seems that the opinions regarding the influence of a shortened dental arch on the
masticatory systems are diverging from negative (Franks, 1967; Gerber, 1971) to
neutral (Carlsson & Oberg, 1974; Ramfjord, 1974). Figure 2 shows the hypothetical
relationships between oral function and shortening of the dental arch.
The purpose of this investigation was to acquire more information concerning
changes of oral functions in shortened dental arches.

Materials and methods

The investigated subjects were selected from the patients who attended the restorative
and prosthetic departments of the dental school in Nijmegen. The total number of
subjects was 118, of which ninety had had a shortened dental arch for more than 2
years and twenty-eight subjects were in possession of a complete dentition (control
group). The ages varied between 19 and 71 years. In 82% of the subjects the shortened
dental condition existed for more than 5 years. The subjects were classified into six
classes, according to the degree and the symmetry of the shortened condition. The
length of the dental arch in the premolar-molar area was expressed in occlusal units

oral function. %
100

12 2 0
occiusal units

Fig. 2. The theoretical relationships between oral function and shortened dental arches. Occlusal units
= pairs of antagonistic posteriors expressed in premolar equivalents. 1 = absence of adaptive capacity,
2=presence of adaptive capacity, 3 = adaptive capacity until a certain number of occlusal units.
 Shortened dental arches 459

Table 1. Definition of the six classes of shortened dental arches and

the distribution of the 118 subjects

Occlusal units
Class Shortening Premolars Molars Total* n

I None 3-4 4 11-12 28

n Asymmetrical
a. 3-4 1-2 6-8 19
b 2-3 1 4-5 18
in Symmetrical
a 3-4 2 7-8 18
b 3-4 — 3-4 16
IV Extreme 0-2 — 0-2 19

In premolar equivalents.

Fig. 3. Schematic representation of the six classes. - - - = variation in occlusal units within the
classes.

(OU). i.e. pairs of occluding posterior teeth, 1 molar unit being considered equal to 2
premolar units. Class I represents the control group (11-12 OU), class Ila and b the
asymmetric and class Ilia and b the symmetric groups, a and b indicating the number
of OU. Class IV is the extremely shortened group (0-2 OU; Table I and Fig. 3).
The distribution of subjects with respect to sex and age was comparable with the
exception of class Illb, which was a relatively young class.
The method was based on the measuring of variables which were derived from the
oral function. At the examination the subjects were questioned, representative teeth
and radiographs were measured and the subjects were submitted to a chewing test.
As representative teeth the teeth numbers 1, 2 and 3 from the upper front and 4, 5 and 6
from the premolar-molar area in the lower jaw were used.
The chewing test used in this investigation was based on the release of light-absorb-
ing material when chewing raw carrots (Kayser & van der Hoeven, 1977). The influence
460 A. F. Kdyser

of the shortened dental arch on the remaining dentition was measured with the follow-
ing variables; alveolar bone height, interdental contact relation within the dental arch,
attrition, overbite of the anteriors 21 and 31, and contact between the anteriors of upper
and lower jaw in habitual occlusion. The alveolar bone height was measured on radio-
graphs which were made according to the short cone technique, resulting in biased
measurements. This variable was used exclusively to compare the classes to each other.
A registration was made of the complaints the subjects raised over their remaining
dentition. •
The influence on the temporomandibular joint was investigated by registration of
the three main symptoms of the pain dysfunction syndrome; pain in the region of the
joints and/or the masticatory muscles, limited opening of the mouth and joint sounds.
The aesthetic evaluation of the remaining dentition was assessed by the patient.

Results
The chewing tests showed a highly significant correlation between masticatory
capacity and number of OU (r= +0-69). With decreasing numbers of OU the numbers
of chewing strokes needed for swallowing increased. In asymmetrically shortened
dental arches chewing is done unilaterally on the longest archside, and in extremely
shortened arches it is done with the front teeth (42% of the subjects in class IV).
The subjects started complaining about their masticatory function when the number of
OU was less than 4 in symmetrically shortened tooth arches and less than 6 in
asymmetrically shortened arches.
The remaining dentition showed that in all shortened classes the contact between
the anteriors in habitual occlusion was higher and the number of interdental contacts
in the premolar area was smaller. In the extremely shortened class the alveolar bone
height was less, the number of interdental contacts in the upper front area smaller and
the attrition in the upper front area higher. An increase in overbite could not be deter-
mined in the shortened classes of this population. By means of analysis of variance it
was found that the decrease in bone height was partly due to an age effect and partly to
the effect of the shortened dental arch.
More complaints in the masticatory muscles were found in subjects chewing with
their front teeth. No correlation was found between temporomandibular joint problems
and unilateral chewing.
A shortened dental arch in the lower jaw did not raise appreciable aesthetic prob-
lems. In the upper jaw a shortening until the second premolar might result in a negative
but acceptable evaluation of the appearance. The first and second premolar have an
important aesthetic function: if one of these two teeth is missing the result is a negative
appraisal of the aesthetic situation and the subject wants prosthetic replacement. More
subjects raised complaints when the number of OU was decreasing (32 % of the subjects
in class IV) and these were mainly related to aesthetics and chewing capacity.
The results are summarized in Fig. 4. Two patterns can be distinguished in the
observed change of oral functions:
1. Oral functions that change slowly until 4 occlusal units are left and then change
rapidly (alveolar bone height, aesthetics, interdental contact).
2. Oral functions that change progressively without a sudden change (chewing
capacity, contact between the anterior teeth in habitual occlusion).
 Shortened dental arches 461

oral function, /o
too

80-

60-

40-

20-

2 0
occlusal units

Fig. 4. The relationship between oral function and shortened dental arches. 1 = adaptive capacity until
4 occlusal units, 2= progressively decreasing adaptive capacity. A = area of sufficient oral function,
B = turning range, C = area of insufficiant oral function.

Discussion
The correlation betweeen masticatory capacity and number of OU is in agreement with
the results of Helkimo, Carlsson & Helkimo (1978), though different methods were
used.
The differences in contact relation of the teeth (interdental contact within the arch
and contact of the upper and lower anteriors) are an indication of adaptive migration,
which takes place in the remaining dentition (Fig. 5). This migration is not necessarily
deleterious for the dentition. The boundary between physiological adaptation and
pathological effect is difficult to define. Only in the extremely shortened class IV the
alveolar bone height was less than in the other classes.
The importance ofthe aesthetic function ofthe upper premolars is in agreement with
the findings of Silness (1970) and Valderhaug & Karlsen (1976) concerning the location
and distribution of fixed partial dentures.
The results lead to the assumption that for a number of oral functions a turning
range exists in which they change rapidly. This range is located between 2 and 4 OU
(Fig. 4).

Fig. 5. Migration in a shortened dental arch.

4 6 2 A .F. K a y s e r '-•% '- ; ' . ' • , • • . • . ' . •••', .'^•''::;'' ";•;'

Conclusion
The preliminary conclusion is that there is sufficient adaptive capacity in shortened
dental arches when at least 4 occlusal units are left, preferably in a symmetrical position.
This suggests a point of reference for dentists when considering the need of free-end
partial dentures.

References
CARLSSON, G.E. & OBERG, T . (1974) Remodelling of the temporomandibular joints. Oral Sciences
Reviews, 6, 53.
FRANKS, A . S . T . (1967) The dental health of patients presenting with temporomandibular joint
dysfunction. British Journal of Oral Surgery, 5, 157.
GERBER, A . (1971) Kiefergelenke und Zahnokklusion. Deutsche Zahndrztliche Zeitschrift, 26, 119.
HELKIMO, E., CARLSSSON, G.E. & HELKIMO, M . (1978) Chewing efficiency and state of dentition.
Acta odontologica scandinavica, 36, 33.
KAYSER, A.F. & VAN DER HOEVEN, J.S. (1977) Colorimetric determination of the masticatory perfor-
mance. Journal of Oral Rehabilitation, 4, 145.
RAMFJORD, S.P. (1974) Periodontal aspects of restorative dentistry. Journal of Oral Rehabilitation,
1, 107.
SILNESS, J. (1970) Distribution of crowns and fixed partial dentures. Journal of Prosthetic Dentistry,
23, 641.
VALDERHAUG, J. & KARLSEN, K . (1976) Frequency and location of artificial crowns and fixed partial
dentures constructed at a dental school. Journal of Oral Rehabilitation, 3, 75.
ZARB, G.A., BERGMAN, B., CLAYTON, J.A. & MACKAY, H.F. (1978) Prosthodontic Treatment for
Partially Edentulous Patients, p. 60. C. V. Mosby Co., St Louis.

Manuscript accepted 12 November 1979