The influence of the loss of teeth and attrition articular eminence

on the

Jose I. Granados, D.D.S., MS.* Roswell Park Memorial Institute, Buffalo, N. Y.

T

he temporomandibular joint (TMJ) has been of great interest to the dental profession, and especially to prosthodontists, becauseits anatomy and physiology are intimately related to the function of the masticatory apparatus and therefore to many kinds of prosthodontic treatment. A review of the dental literature indicates that there are still some aspects, such as changes in the angle of the articular eminence, that are somewhat obscure and in which there is disagreement among various authors.‘-26 There is no doubt that the TMJ is one of the most complex joints of the body. Its study is largely complicated by its intimate relationship with the dentition, muscles,and other oral structures. Due to this intimate relationship with the dentition, it is essential for the prosthodontist to have a sound understanding of the stomatognathic system. The purpose of this study was to determine if a correlation exists between changes in the dentition with tooth lossor extreme wear and changes in the angulation of the articular eminence. If a correlation can be found between such easily observed factors as tooth wear or tooth lossand the lesseasily observed changesin the articular eminence, these may be used as predictors of temporomandibular problems.

MATERIALS

AND METHODS

The material was provided by the Department of Physical Anthropology of the National Museum of Natural History at the Smithsonian Institution and consisted of 103 skulls with mandibles. The composition of the skulls was 41 prehistoric American Indians, 31 white Americans, and 31 black Americans. They were categorized according to age, sex, race, and type of dentition as follows: 1. C.D.-Complete dentition (natural), individuals with full complement of teeth with little wear *Resident,

Department

78

1979

IULY

of Maxillofacial

VOLUME

42

NUMBER

Prosthetics.

I

2. A.E.-Anterior edentulous, individuals without the six anterior teeth in either upper and/or lower arches 3. P.E.-Posterior edentulous, individuals without eight posterior teeth in orlk arch 4. T.E.-Total edentulous, all upper and lower teeth missing 5. A-Attrition, individuals with a compkte a almost complete complement of teeth, with at8ritlon (2 or 3 degreesby Leigh’s standards)*’ Early American Indian skulls and mandible fmm Kentucky and Illinois were chosen. They displaw l range of attrition of the teeth from modente to severe not occurring frequently in either SE the modern American cranial series,but comparibk to that found in the prosthodontist’s aged patie-. Modem white and black American groups *wed somedegree of attrition. However, partial and total edentulism were more common. This group of ah& belong to the Terry Collection,* which is coof 1,728 identified human skeletons. They are from around St. Louis, MO., having an age range from adolescence through old age. The skeleton8 span almost three generations, with birth dates from 1840. Individual data cards were made for each +ull; the information recorded consisted of cataloe Hn., race, age, sex, type of dentition, angulation 4 the right and left eminences, and the shape and ir.&ination of both eminences. Each skull was placed on a ring of cork, with the glenoid fossaefacing uprud. The midportion of the eminence was chose as a reference. This was done to eliminate the threedimensional aspect of the structures and to dd with only two dimensions. The fossa was filled with modeling clay and cut back at the midportioa level *Smithsonian Institution, Washington, DC. Natural History, Department of Phykal

0022-3913/79/070078

+ 0Lwo.80~0

National Mum Anthropol~.

0 1979 The c. v.

of

M&y co.

TOOTH

LOSS

AND

Fig.

1.

ATTRITION

ON ARTICULAR

EMINENCE

Placement of impression material.

Fig. 3. The impressiorl is painted ivith ink

Fig. 2. The Frankfort plane is transferred to the impression.

Fig. 4. The bony contours transierred to paper

of the eminence (sagittal view); this also provided a flat floor for the impression material. Alginate (irreversible hydrocolloid) was prepared and placed over the modeling clay, exerting minimal pressure, so the clay would not distort. The cavity and its surroundings were filled with sufficient material (Fig. 1). To measure the inclination of the eminence, two planes were necessary. One was formed by the anterior wall of the glenoid fossa and the other was the Frankfort horizontal plane. After the material had set, the skull was oriented in the Frankfort plane using a rigid ruler from the upper border of the external auditory meatus to the lower border of the orbit (Fig. 2). The impression material was then cut with a scalpel, following the direction of the plane. In this fashion the plane was transferred to the impression. The impression was then removed and cleaned of excess material. Next the contour of the eminence on the impression was

painted with ink (Fig. 3) and placed over the record card (Fig. 4) so that the ink was transferred to the card. During this procedure, the amount of pressure applied was minimal so as to record the contour without distortion, This was done as rapidly as possible to avoid errors from the shrinking of the irreversible hydrocolloid. Before removing the impression from the card, the upper border of the impression was transferred to the card by locating the posterior and anterior points of this border (Fig. 5). The impression was removed, and a line corresponding to the Frankfort plane was drawn connecting those points. The upper and lower points of the eminence were connected by a straight line which was continued until it intersected the horizontal plane (Fig. 6). The angle between these lines was determined with a protractor. Using this procedure, measuremenrs could be rechecked without the use of the skull. since record-

THE JOURNAL

OF PROSTHETIC

DENTISTRY

79

CRANADOS

i

Fig. 5. A, The method transferred to paper.

of transferring

Fig. 6. Establishment

the Frankfort

of the inclination

ing of data accompanied the ‘outline of the bony contours. After 206 impressionswere recorded, the information was coded and transferred to computer cards so that a univariant package could be run and the statistical analysis performed. RESULTS Using the angulation of right and left eminences, the mean and the difference, the mean, variance, standard deviation, sum of squares, degreesof freedom, and mean square were calculated for the entire population and its subdivisions according to age, sex, race, and type of dentition. Analysis of variance was performed as well as F-tests to estimate the significance of variation due to each of these factors. Table I describesthe mean angulation and standard deviation of the population distributed by race, age (Y, young up to 20 years old; M, mature up to 40 years old; 0, old more than 40 years old); sex (M, male; F,

80

plane to paper.

angle of the articular

B, Frankfort

plane

eminence.

female), and type of dentition, subdivided by the right and left eminence angulations. The mean of both angulations and their difference were determined. Table II showsthe level of significance of the four variables. Since only race and dentition reached and passed the accepted .Ol level established to determine statistical significance, these two variables are the significant factors affecting the angulation of the eminence. DISCUSSION Race and dentition are not independent, since the sampleswere chosenby type of dentition and not by race. American Indians displayed attrition in different degrees. Therefore attrition is related to this group, and it appears as a low-angulation racial group. A racial difference per se cannot be determined. Dentition is the significant factor affecting the

JULY

1979

VOLUME

42

NUMBER

1

TOOTH

LOSS

AND

A-ITRITION

ON

Table I. Eminence angulation

ARTICULAR

EMINENCE

(by sex, age, and race combined) Dentition

CD

Right angulation Indian

AE

Mean

SD

56.0 43.3

15.0 18.5

Mean

PE SD

Mean

TE SD

Mean

A SD

Mean

SD

17.5 I8.h 25.0 IS.8 25.0

11.42 20.10 14.00

47.0

4.20

44.3

4.00

(degrees) YM F MM oM

Black

F F

YM F MM

F

oM F White

YM F MM

F

47.0 52.3 33.0 74.5 76.0 48.5 50.0 -

16.9 8.3 39.5

13.4

15.0 47.5 23.0 29.5 29.5

55.0 59.0

2.1 51.0

38.3

10.9

27.0 51.5

i-

Left angulation Indian

9.50

43.0

oM r

19.0

46.0 10.0 31.0 28.3 30.8

24.7 3.5 12.8 24.2 10.5 4.9 12.8

25.0

(degrees)

Black

YM F

45.0 50.0

M?;1

-

M OF

-

F

75.0 58.3 47.0 84.5 80.0 56.0 7Y.O -

F

-

YM F MM

F

oM F White

YM F MM oM

.\‘otet Y = Young

21.2 5.0

53.0

4.2 13.0 56.0

2.8

34.0 51.5 30.0 40.5 44.2

55.0 63.0

6.3 48.0

10. to 10.70 16.50 12.80

19.0

47.0

21.20

40.6

4.00

4.1 4.2

5.6 38.3

10.2

27.0 32.5

(up to 20 years);

OF PROSTHETIC

20.2 2b.9 25.1 24.8 8.0

44.0

M = Mature

(21-40

years);

0 = Old (more

angulation of the eminence. It is clear that attrition and total edentulism consistently show the lowest angulations as opposed to the complete natural dentition, which is the type of dentition that shows the highest angulation. Anterior or posterior partial edentulism indicates a lower angulation than complete dentition, but the number of samples probably is not significant. Attrition as well as total edentulism modifies the articular eminence so as to reduce angulation in the adult individual. These results are made from statistical analysis and point out that these two changes in

THE RURNAL

type

DENTISTRY

20.5 than

19.0 39.0 27.0 23.6 26.1

5.1 17.4 24.0 15.5

..

40 years)

the dentition correlate with low angulations of the articular eminence. This is contrary to those individuals who had complete natural dentitions with little or no wear and high eminence angulations. Obscrvations of the TMJ bony contours of those skulls displaying attrition and total edentuFsm indicate that osseous changes such as roughing, lipping, and bone erosion (Fig. 7) like those found in vsteoarthritis deformans are present. They cannot be found on those skulls with a complete dentitivn and high eminence angulations (Fig. 8). DS%mnces in eminence angulation exist among individuals with

81

CRANADOS

Fig. 7. A, Osteoarthritic changes. B, Osteoarthritic changes found on the articular eminence. C, Osteoarthritic changes in the glenoid fossa. D, Osteoarthritic changes on the articular changes. eminence. E, Osteoarthritic

Tab1le II. Le !vels of significance

of F ratios

-

obtained

by analysis Level

Variable

Right angnhtion

of variance

of significance

Left angulation

Mean

of variable Difference between right and left

angulation

Race

.OOl

Do1

Sex

Dentition

.292 .OOl

.I69 .CQl

.ool

.232

Age

.999

,999

.999

.999

sound TMJs and complete those differences are found angulation of the eminence.

dentitions. However, in skulls with a high

CONCLUSIONS 1. Osteoarthritic changes were TMJs of the skulls with attrition loss. 82

.ool .241

2. what 3. the hier.‘9.

evident in the or total tooth

.999 ,999

The TMJs are not unadaptable, was stated by McCollum.28 Changes in the dentition produce TMJ, contrary to what was 30

contrary changes stated

to in by

4. Attrition produces osteoarthritic changes in the TMJ with flattening of the articular eminence. Therefore its effects are deleterious to this joint (Fig. JULY

1979

VOLUME

42

NUMBER

I

TOOTH

LOSS

AND

ATFRITION

ON

ARTICULAR

EMINENCE

Fig. 8. A, High articular eminence angulation. with a complete natural dentition.

B, Preservation

of osseous structures on sM1

Fig. 9. A, Attrition of the maxillary teeth. B, Attrition of the mandibular teeth. C, Attrition of the anterior teeth. D, Attrition of the posterior teeth. E, Effects of attrition on the articulal eminence (arrow). F, Flattening of the articular eminence (arrozo).

9). For

this reason, attrition cannot be considered as the3 ideal form of occlusion of man, as was suggested and Murphy.“” by Begg,“’ Fishman,“’ 5. As tooth wear or tooth loss progresses, changes in the TMJ of the osteoarthritic deformans type will be produced (Fig. 10). TH E JOURNAL

OF PROSTHETIC

DENTISTRY

6. Loss of cusp height and anterior guidance displayed in severe attrition was accompanied resorption of the articular eminence, making it m ore shallow and in some patients completely flat. 7. Loss of all teeth and most likely loss of verti cal dimension produce similar effects as attrition does on

il;

83

GRANADOS

Fig. 10. articular the

eminence.

can

be

an

dentures

occlusion

during

8. The

loss that

eminence.

these

at the

proper

there

is

individuals

vertical

no

were

dimension

Loss

to the the

cusps

of posterior

inclination

of the

inclination

articular

will

teeth

is

articular

ments

of the

condyles,

be kept

for

produce

loss

such

as pantographic

a long

period

6.

(decreased

angulation)

in the

my gratitude

to Lucile

St. Hoyrne,

Ph.D.,

7. a. 9.

articular

eminence. The population consisted of 103 adult skulls and mandibles of both sexes and three different races. They included partial and total edentulism, mild to severe attrition, and complete dentitions in good condition. An impression of each of the 206 articular eminences was made and the angulation established. The data were transferred to computer cards and a statistical analysis performed. The level of significance for each of the variables was established and conclusions were made.

84

3.

5.

A review of the literature revealed that changes in the articular eminence associated with changes in the dentition were usually overlooked in most reports. An attempt was made to determine whether changes in attrition and loss of teeth would correlate

I express

2.

4.

SUMMARY

a change

1.

tracings,

of time.

10. Maintenance of dentition integrity and facial dimensions are necessary to maintain healthy TMJs; otherwise, irreversible changes may take place.

with

the Department of Physical Museum of Natural History, cooperation in this study.

eminence.

9. Since the TMJs are able to change due to loss of tooth or tooth substance, no record of the moveshould

of total

tooth

loss on the

Anthropology Smithsonian

of the Institution,

National for her

REFERENCES of the

of cuspal in

B, Effects

of

life.

related

of angulation

deformans.

dimension

because

telling

inclination

intimately

to osteoarthritic

of vertical

assumption,

available

wearing

similar

eminence.

However,

only

record

A, Changes

Curator

of

10. 11.

12.

13.

14.

Angel, J. L.: Factors in temporomandibularjoint form. Am J Anat 83:233, 1948. Avant,. F. G.: Changes in the temporomandibular joints of rats caused by alterations in the intermaxillary relationships of the teeth. J Dent Res 31:5OO, 1952. Baume, J.: Growth and transformation of the temporomandibular joint in an othodontically treated case of Pierre Robin’s syndrome. Am J Orthod 45:910, 1959. Breitner, J.: Bone changes resulting from experimental orthodontic treatment. Am J Orthod Oral Surg 26:521, 1940. Brown, T.: Physiology of the temporomandibular joint. Aust J Dent 10:27, 1965. Corbett, N. E.: Relationship of the condylar path to the articular eminence in mandibular protrusion. Angle Orthod 44:286, 1971. Frustman, J.: The effect of loss of occlusion upon the mandibular joint. Am J Orthod 51:245, 1965. Guichet, N.: Principles of Occlusion. California, 1975, The Denar Corp. Koritzer, R.: Arthritic change of the temporomandibular joint related to the dentition. Geor U Dent J Winter, 17, 1973. Komfeld, M.: Mouth Rehabilitation. St. Louis, 1974, The C. V. Mosby Co. Koyoumdjisky, E.: Correlation of the inclined planes of the articular surface of glenoid fossae with the cuspal and palatal slopes of teeth. J Dent Res 35:890, 1956. Lawther, L.: A roetgenographic study of the temporomandibular joint using special head positioner. Angle Orthod 26:22, 1956. Lang, B., and Kelsey, C.: International Prosthodontic Workshop on Complete Denture Occlusion. Ann Arbor, Mich., 1972, University of Michigan, School of Dentistry, University Press, p 274. Lysell, L.: Qualitative and quantitative determination of attrition and the ensuing tooth migration. Acta Odontol Stand l&267, 1958.

JULY

1979

VOLUME

42

NUMBER

1

TOOTH

15.

LOSS

MO&t,

AND

B.:

ATTRITION

ON

Articular

ARTICULAR

remodeling

temporomandibular

joint.

Am

Moffett, B.: The morphogenesis joint. Am J Orthod 52:6, 1966.

17.

Mongini, partial

18.

Mongini, mandibular Mongini,

19.

21.

Posselt, Oxford

adult

of the

human

Physiology Edinburgh,

of Occlusion 1965, Blackwell

articulation

22.

Schwartz,

23.

age. Periodontics Shafer, W.: Oral

in the

L.: Changes

Co., p 657. Shore, N.: Occlusal Joint Dysfunction.

report

joint

human

29.

Dent

in the temporomandibular

Equilibration Philadelphia,

and 1976,

Acta

its

Anat

30.

Cos

with

26.

B.: A Research

Report

of Indian

tribes

Am

.J Phyv

of varied Antropol

Variations

la

perte

des

Begg,

32.

1954. Fishman,

P. R.: Stone L.: Dental

occlusion.

Angle

l’angle

gomatlue

en fonction

dents.

1965. Dorier, M.: Variations de la cavite glenoide

Murphy, attrition.

de

mandibulaires

Calit~rmia,

Schweiz

and Orthod

dentition.

skeletal 46:51,

diedres

dentaire

Zahn

75:201,

de 1% paroi anterieurr en function de I’age,

dentaire et de la perte Zahn 77:109, 1966 age man’s

Scien-

et des

de I’abrasion Mnnnts

de I’inclinaison de 1’0s temporal

1955.

An

relationships

totale

des

J Orthod

du

dents. 4Ot298.

to attritional

1976.

J.: The progressive reduction Dent Pratt 19:8, 1968.

of tooth

cusps

in

W. B. Saunders

Temporomandibular J. B. Lippincott

Reprint requests to: Co.,

Sicher, R.: Temporomandibular articulation in mandibular overclosure. J Am Dent Assoc 36:131, 1954. Thompson, H.: Occlusion. London, 1975, John Wright Sons,

McCollum, tific Press. Dorier, M.:

31.

33.

p 213. 25.

conditions.

sexe, de I’abrasion Schweiz Monats

60:505,

pathology food

1925.

et de and

joint

1974,

Dental and

condylines

of the

the temporoman-

type.

3: 184, 1965. Pathology. Chicago,

in

and Rehabilitation, Scientific Publicaupon

R. W.:

8:179, 28.

arches.

Leigh,

environmental

temporomandibular

of the dental

tions, p 94. Prentiss, H. J.: A preliminary

27.

1964.

F.: Dental abrasion as a factor in remodeling condyle. Acta Anat 92:292, 1973. F.: Remodeling of the mandibular condyle

U.: and

dibular 1918.

24.

the 116:119,

F.: Changes in the temporomandibular edentulism. Min Stomat 17:850, 1968.

relationships to the condition 82:437, 1972. 20.

in

J Anat

16.

EMINENCE

Da. JOSE I. &ANADOS MONTES CELESTES No. LOMAS

&

MEXICO, MEXKO

101

DE CHAPULTEPEC

10 D.F.

p 20.

INFORMATION

FOR AUTHORS

Most of the provisions of the Copyright Act of 1976 became effective on January 1, 197X. Therefore, all manuscripts must be accompanied by the following written statement, signed by one author: “The undersigned author transfers all copyright ownership of the manuscript (title of article) to The C. V. Mosby Company in the event the work is published. The undersigned author warrants that the article is original, is not under consideration by another journal, and has not been previously published. I sign for and accept responsibility for releasing this material on behalf of any and all co-authors.” Authors will be consulted, when possible. regarding republication of their material.

THE JOURNAL

OF PROSMETIC

DENTISTRY

85

The influence of the loss of teeth and attrition on the articular eminence.

The influence of the loss of teeth and attrition articular eminence on the Jose I. Granados, D.D.S., MS.* Roswell Park Memorial Institute, Buffalo,...
4MB Sizes 0 Downloads 0 Views