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Bio Mechanics of Edentulous State.
Bio Mechanics of Edentulous State.
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.
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
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
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
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.
Force
Time
Controlled by
Controlled partially by
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)
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.
So Dentists role is to MOTIVATE the patients & make understand their NEEDS has proven to be of greatest clinical value
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.
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