Inuence of working side contacts on masticatory function

for mandibular distal extension removable partial dentures

S. SUEDA, K. FUEKI , S. SATO, H. SATO, T. SHI OZAKI , M. KATO & T. OHYAMA
Removable Prosthodontics, Department of Masticatory Function Rehabilitation, Division of Oral Health Sciences, Graduate School, Tokyo
Medical and Dental University, Tokyo, Japan
SUMMARY The aim of this study was to clarify the
inuence of working side contacts for masticatory
function for a distal extension removable partial
denture. Five subjects who had edentulous arches
from second premolar to second molar opposing
natural teeth participated. Working side contacts
were altered by using three types of articial teeth
attached to the denture base. A-form teeth made
contact with opposite teeth while acting as the
working side in a lateral excursion. The cusp angles
of B- and C-form teeth were decreased by 10 and
20, respectively compared with A-form teeth.
B-and C-form teeth discluded with opposite teeth
on the working side. Subjects were asked to perform
two kinds of masticatory performance test.
Obtained data were evaluated by the repeated-
measures ANOVA and the Tukey test for multiple
comparisons. Results revealed that there was a
signicant difference (P 0001) in the three types
of teeth in the mixing ability test and the value of
A-form teeth was statistically less value than those
of the other teeth. However, there was no signicant
difference in the comminuting ability test. These
results suggested that working side contacts
between articial teeth and opposite natural teeth
inuenced mixing ability, but not comminuting
ability.
KEYWORDS: removable partial dentures, mastication,
masticatory function, articial tooth, working side
contacts
Introduction
Abel & Manly (1953) and Yurkstas (1954) reported
improvement in masticatory function by replacement
of missing teeth with removable partial dentures (RPD).
In addition, many investigators (Carlsson, Hedegard &
Koivumaa, 1965; Bergman, Hugoson & Olsson, 1971;
Schwalm, Smith & Erickson, 1977) have performed
longitudinal clinical surveys of RPD. These studies
indicated that unsuitably constructed RPD might dam-
age periodontal tissues in the long term. In the case of a
distal extension RPD opposing natural teeth, functional
force distribution during mastication has a particular
signicance in this regard.
The principles, concepts, and practices in prostho-
dontics (PCPP), (Academy of Prosthodontics, 1995)
proposed rules regarding occlusion that should be
developed for RPD. In the article (i) contact only in
maximum intercuspation is usually required in RPD
opposing natural teeth and (ii) generally, no part of
RPD should interfere with complete closing contact or
eccentric movements of remaining natural teeth.
Unfortunately, no rules regarding working side contacts
were indicated in the PCPP.
McGivney & Castleberry (1995) and Henderson
(1972) stated that in case of distal extension RPD
opposing natural teeth, both remaining natural teeth
and articial teeth should occlude simultaneously to
opposite teeth on the working side. Contrary to their
opinions, Colman (1967) stated that in the case of
opposing natural teeth and remaining anterior natural
teeth available for lateral guidance, no contacts
between articial and opposing teeth should be
developed on the working side. Unfortunately, these
opinions were based presumably on the authors clinical
experiences as no research data was quoted.
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The aim of this study was to clarify the inuence of
working side contacts in distal extension RPD opposing
natural teeth on masticatory function. We examined
mixing ability and comminuting ability regarding mas-
ticatory performance when changing the cusp angle of
the posterior articial teeth.
The null hypothesis of this study was that working
side contacts between posterior articial and opposite
natural teeth did not affect masticatory function.
Materials and methods
Subjects
Five subjects (female, mean age 588, range 43
70 years) were recruited from patients who sought
treatments at the Removable Prosthodontic Clinic of
Tokyo Medical and Dental University. The inclusion
criteria were: (i) mandibular unilateral distal extension
edentulous arch from the second premolar to the
second molar and (ii) opposite upper arch, which was
intact or had replaced missing teeth by xed prostheses.
Exclusion criteria were: (i) below 20 lateral incisal
angle on either side, (ii) experience of using RPD for
less than a month duration, (iii) more than rst degree
of mobility in abutment teeth and (iv) acute or chronic
symptoms of temporomandibular disorders. All subjects
received a written description of the study, and
informed consent was obtained from each subject
before the onset of the study.
Denture design
Experimental RPDs of all subjects were designed as
similar as possible with each other. Figure 1 shows one
of the dentures used in the study. Each denture had
the following components: (i) a lingual bar or lingual
plate as a major connector, (ii) a back-action clasp and
a mesial occlusal rest on the rst premolar in the
edentulous side used as a direct retainer, (iii) an
embrasure clasp on the rst and second premolar
opposite to the edentulous side as an indirect retainer,
(iv) minor connectors and (v) an acrylic resin denture
base supporting interchangeable articial teeth. The
Fig. 1. Experimental distal extension removable partial denture used in the study and three types of articial teeth.
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denture base was attached to the RPD framework by a
minor connector. A framework, which consisted of a
major connector, a direct retainer, indirect retainer and
minor connectors, was made of cobaltchromium
alloy.
Interchangeable articial teeth
A custom made slide-attachment was used to alter the
articial teeth. The male component of the attachment
was attached to the denture base. Three types of
articial teeth were made of goldsilverpalladium
alloy casted on the individual female component of
the attachment.
The occlusal surfaces were: (i) A-form of which
articial teeth and remaining teeth made simultaneous
contact with opposite teeth in intercuspal position (ICP)
and also contacted while acting as the working side in
lateral excursion, (ii) B-form and C-form of which
articial teeth and remaining teeth made contact with
opposite teeth only in ICP and discluded with the
working side in 10 and 20 decrements from the A-form
cusp angle, respectively. Fig. 1 shows each articial
tooth in occlusal view and Fig. 2 an illustrated schema
of each articial tooth in frontal view.
The detailed procedures of making the interchange-
able articial teeth were as follows. In each subject a
maxillary cast was mounted to a semiadjustable artic-
ulator (Denar mark II) by using a face-bow. An
interocclusal record was made in an intercuspal posi-
tion with silicone material to mount the mandibular
cast to the articulator. Condylar guidance was adjusted
with check bite at the canine teeth tip-to-tip positions.
The incisal table was adjusted by performing excursive
movements on the articulator.
The experimental denture was replaced on the
mandibular cast. A wax record of occlusal surfaces of
opposite teeth was made on the female component of
the slide-attachment by occluding upper and lower
casts on the articulator. Next, the protrusive and lateral
movements were performed on the articulator so that
both remaining and articial teeth made contact with
opposite teeth simultaneously on the working side. This
wax record was used as A-form.
When making B- and C-form teeth, inclination angle
of the lateral wings of the incisal table was decreased
10 and 20 from the original angle, respectively. The
same carving procedure for the A-form teeth was
applied to make B- and C-form teeth. The wax pattern
of each articial tooth was attached to the female
component of the slide-attachment by casting into
goldsilverpalladium alloy.
Thus, we were able to change articial teeth ran-
domly by sliding each female component into the male
component attached to the denture base. We veried
the occlusal contacts at ICP and the working side with
Fig. 2. Occlusal relationship of interchangeable articial teeth with opposing natural teeth in frontal view in intercuspal position (ICP).
A-form: articial teeth and remaining teeth contacted simultaneously to opposite teeth in ICP and working side, B-form: articial teeth
and remaining teeth make contact with opposite teeth only in ICP and are discluded on the working side by decreasing A-form cusp angle
for 10, C-form: articial teeth and remaining teeth make contact with opposite teeth only in a centric relation and are discluded on the
working side by decreasing A-form cusp angle for 20.
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each articial tooth by using the articulating paper
before the masticatory performance test.
Masticatory performance test
The mixing ability test (Sato et al., 2002a) and the
comminuting ability test (Kato et al., 1995) were used
to evaluate masticatory performance.
Mixing ability test
Each subject was asked to chew test food, which was a
cube made of parafn wax dyed in two colours, for 10
strokes. The degree of colour mixing and deformation
of the test food were obtained from the digital image of
the chewed material using image analyser. We obtained
Mixing Ability Indexes (MAI) on both side of the
chewed test food by input of the parameters into the
formula determined from discriminant analysis.
Comminuting ability test
Each subject was asked to masticate ve grains 2-g
portion of the test food, made from vegetable oils, fats
and carnauba wax with a peanut-like texture and form,
for 10 strokes. Size distribution of crushed test food was
obtained from a digital image of the masticated test
foods remaining on a No. 10 mesh sieve by using the
image analyser. Comminuting Ability Index (CAI) was
obtained by input of the size distribution into the
formula determined from the discriminant analysis.
Statistical analysis
For each tooth, a median among six trials of each subject
was used as a representation for statistical analysis. The
Lilliefors test (Cembrowski et al., 1979) was used to test
the normality of the variables. The Bartlett test (Winer,
1962) was used to test the homogeneity of variance.
Differences of the MAI in three kinds of articial teeth
and those of CAI were tested by the repeated-measures
ANOVA, respectively. The Tukey test for pairwise multiple
comparisons were used as a post hoc test. A P-value of
<005 was considered signicant.
Results
Figure 3 presents mean and s.d. of the MAI and the CAI
of three types of articial teeth. The repeated-measures
ANOVA revealed signicant difference in the three types
of articial teeth for MAI (P 0001), but no signicant
difference for CAI (P 081).
The multiple comparisons of the MAI indicated
signicant difference between A- and B-forms (P
0007) and between A-and C-forms (P 0002), but no
signicant difference between B- and C-forms
(P 048).
Discussion
The aim of our study was to clarify the inuence of
working side contacts on the masticatory function in
distal extension RPD opposing to natural teeth.
In this study, we used an experimental denture
having uniform design in all subjects to remove the
inuence of denture components except for articial
teeth. Regarding the direct retainer of RPD, Shohet
(1969) and Nally (1973) reported that the back-action
clasp used in distal extension RPD caused less displace-
ment of abutment tooth than that of the conventional
clasp. Their studies indicated that the back-action clasp
as used in our study was suitable for a direct retainer
with distal extension RPD.
Yurkstas & Manly (1950) recommended the use of
soft and tough food for evaluating the masticatory
function of denture wearers. Thus, we used two kinds
of masticatory performance test in which the texture of
the test foods were different.
In the results of the mixing ability test, the MAI of
B-form and C-form was signicantly higher than
A-form, but the MAI between B-form and C-form
Fig. 3. Mixing Ability Indexes (MAI) and Comminuting Ability
Indexes (CAI) of three kinds of articial teeth. Each closed circle
and open circle represents the mean of MAI and CAI, respectively.
Each vertical bar represents s.d. Each asterisk indicates the
signicant difference between the articial teeth in MAI
(P < 005).
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showed no signicant differences. These indicated that
the mixing ability, which was one of aspects of
masticatory performance, increased signicantly when
discluding on working side and that the degree to
which the cusp angle was decreased did not inuence
the mixing ability.
The bolus of the test food during mastication might
squeeze out through the gap between the articial and
the opposite teeth. Figure 4 illustrated schema in the
frontal view where the test food was chewed between
articial and opposing teeth near the ICP. The gap
between A-form articial teeth and opposing teeth was
less than other forms. Thus, the bolus made with B- and
C-form teeth might be more easily squeezed out than
with A-form teeth.
The mean difference of the MAI between A-form and
C-form was 04. Our previous study, Sato et al. (2002b)
reported that the average difference of the MAI
between natural dentate subjects and RPD wearers
was 05. These results indicated that the difference of
the MAI between A-and C- forms were considered to be
clinically signicant.
On the other hand, the results of the comminuting
ability test, the CAI indicated no signicant differences
with the three types of articial teeth. This indicated
that working side contacts did not affect food commi-
nuting.
Gunne (1985) used formalin-hardened gelatin and
almond as test food to investigate the effect of RPD on
objective masticatory performance and he reported
inconsistent results between the two tests. He explained
that the inconsistency of results was due to different
rheology of the test foods. Because the test food used in
the comminuting ability test was made from vegetable
oils, fats and carnauba wax, it was crushed into pieces
when a subject masticated it. On the other hand, the
test food used in mixing ability test was made from
parafn wax and preserved at 37 until the test was
performed so that the texture of the test food was the
same as chewed gum and it remained bolus after
mastication. Thus, the different rheology of the test
foods might cause inconsistent results in our study.
We concluded from these results that (i) working side
contacts in distal extension RPD opposing natural teeth
inuenced the mixing ability of masticatory perform-
ance, but not comminuting ability and (ii) disclusion on
the working side increased the mixing ability. However,
10 and 20 decrease of cusp angle did not have
different effects on mixing ability. These conclusions
supported the opinion that working side contacts
should not be developed for distal extension RPD
opposing natural teeth from a standpoint of masticatory
performance.
However, these conclusions have some limitations
for generalizing. These limitations were sample size,
gender distribution and type of the edentulous arch.
More important, our study examined masticatory per-
formance only when changing the articial teeth. Thus,
Fig. 4. Schema (illustrated in frontal view) shows the bolus of the test food between articial and opposing teeth near the ICP during
mastication.
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it is unknown how masticatory function might adapt
after changing the cusp angle. Thus, longitudinal
inuence of cusp angle on masticatory performance
should be examined in future studies.
We investigated the inuence of working side con-
tacts on masticatory function. However, the inuence
on the remaining oral structure is unknown. The
purposes of fabrication of RPD were to recover oral
function and to conserve remaining oral structures.
Thus, further investigations regarding the inuence of
working side contacts on abutment teeth or residual
ridges are needed in order to conclude whether such
contacts are signicant for distal extension RPD oppo-
sing natural teeth.
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Correspondence: Dr Shigeru Sueda, Removable Prosthodontics,
Department of Masticatory Function Rehabilitation, Division of Oral
Health Sciences, Graduate School, Tokyo Medical and Dental Univer-
sity, 1-5-45, Yushima Bunkyo-ku, Tokyo, 1138549, Japan.
E-mail: sue.rpro@tmd.ac.jp
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