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Tooth mobility changes during treatment with partial denture prosthesis
TOOTH
MOBILITY CHATU’GES DURING TKEATMEKT PARTIAL I>ENTUICE PROSTHESIS
WITH
W. FENNER, I>r.med.dent., A. GERBER, l>r.med.dent., AND l-l. I<. M~~HLENANK;, L)r.metl., L)r.med.dent.*
lNX1SiG
A KlNU\‘tiHLE
l”XKTIAL
denture prosthesis of any type
W may be beneficial and/or detrimental to the remaining periodontal structures l’rosthodontics is one of the means of establishing conditions for the maintenance of periodontal health. Inadvertently, it may also contribute to the initiation and progress of periodontal disease. It is assumed that horizontal and lateral stress on abutment teeth, atnong other etiologic factors, may cause or favor the breakdown of periodontal structures. ;\s the case may be.
\‘XiWS
CkqS
hWC k!ll
&SigId
fcJI’
thC r~tfTItiOl1 aId
proper
~LUIdiOtI Of
partial denture prosthesis. It is not the intention of the authors to review and discuss the literature on the different modes of retention of removable partial denture prosthesis. The main principle of clasp construction is to direct the external masticatory and oral muscle forces along the long axes of abutment teeth. Urokenstress attachments are also used in order to avoid trauma by distributing the load of the denture between the teeth and the mucosa. The modified pattern of force distribution on abutment teeth due to the insertion of partial denture prosthesis has never been investigated under in vivo conditions. The mode of transmission of masticatory and other oral forces on the periodontium by various clasps is assumed on the basis of the laws of general mechanicsand laboratory experiments. This article is an attempt in the field of c~.rp~vi~rrcntol prosthetics. It has been shown in previous studies“3 that there is a close relationship between the degree of tooth mobility and undue periodontal stress. I.‘ndue mechanical stress induces an increase in the mobility of traumatized teeth. It seemedto be of some interest to study the mobility changes of abutment teeth oi patients being treated with lower partial denture prosthesis.
‘1‘00th nicJ,ilit~ ( T51 i measurements 0i tlic in~t:uitai~cous total crown esrursion (the crowns d abutment teeth being loadetl 2 to 3 seconds with a 500 Gin. force) nerr matl~ Irv ;I rrli~rodicll idifxlor ( Fig. 1,. I 1 with a special acrylic v6>silfIloldin{q apl)aratus ( Fig. 1.R 1: the. latter tisiri g the measuring gauge intrnorall!. I)ctails concerning the nlcasuring procedure have been reported elsewhere.’ Hewived for publication Lkr. G, 1955. *From the Department of Prosthetics and the Department of Opcratlve IJentistrg ant1 Periodontology, Dental Institute. University of Zurich, Snltzerlantl.
Volume 6 Number 4
TOOTH
MOBILITY
CHANGES
WITH
PARTIAL
DENTURES
521
One hundred and seventy-eight tooth mobility measurements were made during seven months on 8 abutment teeth (lower canines) of four male patients, 38 The remaining dentition of these to 73 years of age (A.H., B.H., W.E., T.K.). (pre-prosthetic) period of obpatients was 321-123. After a pre-experimental servation, all of the patients were treated with an upper complete denture and at
This tooth is moved to Fig. L-A, The dial-indicator adapted to the lower left cuspid. the labial and lingual with a known force (forcemeter) and the amount of instantaneous total acrylic resin holding apparatus. crown excursion is read on the dial. B, T*he individual
Fig. Z-A,
The clasp with a lug rest used during the first experimental period. wire clasp used during second experimental period.
B, The elastic
the same time with a lower partial denture prosthesis. During the jirst experimental period (1. exp.p.), the lower prosthesis was anchored to the canine abutments with nonelastic cast clasps with lug rests (Fig. 24). After two months the partial denture was removed for about seven days, during which time the nonelastic clasps were exchanged by elastic wire clasps without occlusal lug rests (Fig. 2,A). The partial denture was then reinserted for a second experkental period (2. exp.p.). Care was taken that both lower partial denture constructions were identical in all respects except clasp design. Tooth mobility was measured at regular intervals before and during the first and second experimental periods.
522
FENNER,
CERRER.
AND
J. Pros. July,
MiiHLEMANl’G
4
-0
-0
-P
-8
4
a
a
-8
-a
Den. 1956
Volume Number
6 4
d .9 F
TOOTH
MOBILITY
CHANGES
WITH
PARTIAL
DENTURES
524
I’ENNER,
GERBER.
Ah-D
Mi~HLEMIANN
J. Pros. Den. July, 1956
RESULTS
‘J’he charges in tooth mobility CT,,)* in all four patients are summarized in Figs. 3 to 6. Mobility values on the ordinate are plotted against time (days) on the abscissa. I. The J)re-exprimental TM-determinations on all eight abutment teeth showc~l mobility levels ranging between 0.05 and 0.12 mm. 2. During the pre-experimental or pre-prosthetic period there wcrc some mobility fluctuations, the greatest difference being 0.05 mm. 3. Treatment J,y partial denture prosthesis produced hoth arutc alln (r~rrdrrd TJf-chnqrs on k~lr OY ou only one of the tTI’o alwtnmzt tcrth. .drrrtc debility Chan~gcs.--:I. Insrrtimr of fuwtid prosthesis: In some but not all ahutment teeth, acute mobility changes occurred immediately after the insertion of the prosthesis. (See Figs. S and 6, Case \\‘.T<,.. 1. cxp.p., Case T.K.) Mobility increased as much as These initial mobility increments were either of short 0.1 1 mm. or 110 Jwr cent. duration (Case T.K.. 1. c~p.p.1, or oi long duration (Case \V.F3., I. exp.p., Case T.K.. 2. csp.p.). In many instances. the insertion of the prosthesis produced no immediate mobility increments. In those cases where the mobility Jew1 13. Rmovnl of partitrl prosfhcsis: was higher than in the pre-prosthetic period, removal of partial prosthesis was followed II? an immediate &crease in mobility (See Figs. 4. 5, 6. Case W.E.. T.K.. l?.H.. 1. cxp.p.). 111one case, the removal of the partial denture led to a consequent increase in n,ol)ility of the aJ)utment teeth (See Fig. 4, Case R.FT.. 2. exp.p.1. (‘. .-lcirte urohilit~ chmrgrs during prostlzfsi.~ zirrf?Yin(l: During treatment with partial dentrwct prosthesis, mnhility fluctuations were ohserved. They were, in snmc caws. llot greater than those during the Jw-experimental period. Tn other tcrth, thry wre more pronounced. In most instances thy coincided with the appearance of denture sores and witll rchasing proccdurcs.
A twnd to gradual mobility changes uxs found in other ahutment teeth. In cnscs \l’.T?. (2. esp.p.1, TI.11. (1. cxp.J~) rnnhility did not increase acutely hut y-:ttlrlallv during several weeks after tlcnturc insertion (Figs. 5, 6). Cast W.l?. il. c.sJ~,~~)showed a gratlual tlccrrasc of hi& mohilit!, values that had hccn pmcl~~~~llb\. the Jn-evious dcnturc inscrtinn iFig. 5). 4. No striking differences in mobilit! changes could be fnrmtl in comparing the first ant1 second esperimrntal Jwriocl. Tt appears that the patients treated with ~lonwttling lug rest clasps had somcwllnt snlallc~r mobility tlisturhnnces. hut the ~nl;~lJn(~.
Volume 6 Number 4
TOOTH
MOBILITY
CHANGES
DISCUSSION
WITH
AND
PARTIAL
DENTURES
52.5
SUMMARY
It has been shown that significant acute or gradual tooth mobility changes were produced by treatment with partial denture prosthesis. They were different in magnitude, in duration, in maintenance, and in localization to the abutment teeth during the total ZOO-day experimental period. It is assumed that future experiments in the suggested line may yield valuable scientific information about the periodontal reaction of abutment teeth to the forces produced and transmitted by prosthetic appliances. On the other hand, the changes in mobility testing consecutively different experimental prosthetic appliances on the same patient may be used as an indicator of the degree of periodontal trauma by prosthetic treatment. We wish to express our gratitude to Dr. C. M. E. Eugster, D.D.S., L.D.S., R.C.S., for assistance in translation. REFERENCES
1. 2. 3. 4.
Tooth Mobility Changes Through Artificial Miihlemann, H. R.: Tooth Mobility (V). Trauma, J. Periodont. 25:202-208, 1954. Miihlemann, H. R., Hirt, H., and Herzog, H.: Tooth Mobility-Bruxism-Selective Grinding, Proc. Int. A.R.P.A. Congress, Venice, 1955. Hirt, H., and Miihlemann, H. R.: Diagnoses of Bruxism by Means of Tooth Mobility Measurements, Parodontologie 9:47, 1955. Miihlemann, H. R.: Tooth Mobility. The Measuring Method, Initial and Secondary Tooth Mobility. J. Periodont. 25:22-29, 1954. UNIVERSITY OF ZURICH ZURICHBERGSTRASSE 4 ZURICH 28, SWITZERLAND
MOBILITY CHATU’GES DURING TKEATMEKT PARTIAL I>ENTUICE PROSTHESIS
WITH
W. FENNER, I>r.med.dent., A. GERBER, l>r.med.dent., AND l-l. I<. M~~HLENANK;, L)r.metl., L)r.med.dent.*
lNX1SiG
A KlNU\‘tiHLE
l”XKTIAL
denture prosthesis of any type
W may be beneficial and/or detrimental to the remaining periodontal structures l’rosthodontics is one of the means of establishing conditions for the maintenance of periodontal health. Inadvertently, it may also contribute to the initiation and progress of periodontal disease. It is assumed that horizontal and lateral stress on abutment teeth, atnong other etiologic factors, may cause or favor the breakdown of periodontal structures. ;\s the case may be.
\‘XiWS
CkqS
hWC k!ll
&SigId
fcJI’
thC r~tfTItiOl1 aId
proper
~LUIdiOtI Of
partial denture prosthesis. It is not the intention of the authors to review and discuss the literature on the different modes of retention of removable partial denture prosthesis. The main principle of clasp construction is to direct the external masticatory and oral muscle forces along the long axes of abutment teeth. Urokenstress attachments are also used in order to avoid trauma by distributing the load of the denture between the teeth and the mucosa. The modified pattern of force distribution on abutment teeth due to the insertion of partial denture prosthesis has never been investigated under in vivo conditions. The mode of transmission of masticatory and other oral forces on the periodontium by various clasps is assumed on the basis of the laws of general mechanicsand laboratory experiments. This article is an attempt in the field of c~.rp~vi~rrcntol prosthetics. It has been shown in previous studies“3 that there is a close relationship between the degree of tooth mobility and undue periodontal stress. I.‘ndue mechanical stress induces an increase in the mobility of traumatized teeth. It seemedto be of some interest to study the mobility changes of abutment teeth oi patients being treated with lower partial denture prosthesis.
‘1‘00th nicJ,ilit~ ( T51 i measurements 0i tlic in~t:uitai~cous total crown esrursion (the crowns d abutment teeth being loadetl 2 to 3 seconds with a 500 Gin. force) nerr matl~ Irv ;I rrli~rodicll idifxlor ( Fig. 1,. I 1 with a special acrylic v6>silfIloldin{q apl)aratus ( Fig. 1.R 1: the. latter tisiri g the measuring gauge intrnorall!. I)ctails concerning the nlcasuring procedure have been reported elsewhere.’ Hewived for publication Lkr. G, 1955. *From the Department of Prosthetics and the Department of Opcratlve IJentistrg ant1 Periodontology, Dental Institute. University of Zurich, Snltzerlantl.
Volume 6 Number 4
TOOTH
MOBILITY
CHANGES
WITH
PARTIAL
DENTURES
521
One hundred and seventy-eight tooth mobility measurements were made during seven months on 8 abutment teeth (lower canines) of four male patients, 38 The remaining dentition of these to 73 years of age (A.H., B.H., W.E., T.K.). (pre-prosthetic) period of obpatients was 321-123. After a pre-experimental servation, all of the patients were treated with an upper complete denture and at
This tooth is moved to Fig. L-A, The dial-indicator adapted to the lower left cuspid. the labial and lingual with a known force (forcemeter) and the amount of instantaneous total acrylic resin holding apparatus. crown excursion is read on the dial. B, T*he individual
Fig. Z-A,
The clasp with a lug rest used during the first experimental period. wire clasp used during second experimental period.
B, The elastic
the same time with a lower partial denture prosthesis. During the jirst experimental period (1. exp.p.), the lower prosthesis was anchored to the canine abutments with nonelastic cast clasps with lug rests (Fig. 24). After two months the partial denture was removed for about seven days, during which time the nonelastic clasps were exchanged by elastic wire clasps without occlusal lug rests (Fig. 2,A). The partial denture was then reinserted for a second experkental period (2. exp.p.). Care was taken that both lower partial denture constructions were identical in all respects except clasp design. Tooth mobility was measured at regular intervals before and during the first and second experimental periods.
522
FENNER,
CERRER.
AND
J. Pros. July,
MiiHLEMANl’G
4
-0
-0
-P
-8
4
a
a
-8
-a
Den. 1956
Volume Number
6 4
d .9 F
TOOTH
MOBILITY
CHANGES
WITH
PARTIAL
DENTURES
524
I’ENNER,
GERBER.
Ah-D
Mi~HLEMIANN
J. Pros. Den. July, 1956
RESULTS
‘J’he charges in tooth mobility CT,,)* in all four patients are summarized in Figs. 3 to 6. Mobility values on the ordinate are plotted against time (days) on the abscissa. I. The J)re-exprimental TM-determinations on all eight abutment teeth showc~l mobility levels ranging between 0.05 and 0.12 mm. 2. During the pre-experimental or pre-prosthetic period there wcrc some mobility fluctuations, the greatest difference being 0.05 mm. 3. Treatment J,y partial denture prosthesis produced hoth arutc alln (r~rrdrrd TJf-chnqrs on k~lr OY ou only one of the tTI’o alwtnmzt tcrth. .drrrtc debility Chan~gcs.--:I. Insrrtimr of fuwtid prosthesis: In some but not all ahutment teeth, acute mobility changes occurred immediately after the insertion of the prosthesis. (See Figs. S and 6, Case \\‘.T<,.. 1. cxp.p., Case T.K.) Mobility increased as much as These initial mobility increments were either of short 0.1 1 mm. or 110 Jwr cent. duration (Case T.K.. 1. c~p.p.1, or oi long duration (Case \V.F3., I. exp.p., Case T.K.. 2. csp.p.). In many instances. the insertion of the prosthesis produced no immediate mobility increments. In those cases where the mobility Jew1 13. Rmovnl of partitrl prosfhcsis: was higher than in the pre-prosthetic period, removal of partial prosthesis was followed II? an immediate &crease in mobility (See Figs. 4. 5, 6. Case W.E.. T.K.. l?.H.. 1. cxp.p.). 111one case, the removal of the partial denture led to a consequent increase in n,ol)ility of the aJ)utment teeth (See Fig. 4, Case R.FT.. 2. exp.p.1. (‘. .-lcirte urohilit~ chmrgrs during prostlzfsi.~ zirrf?Yin(l: During treatment with partial dentrwct prosthesis, mnhility fluctuations were ohserved. They were, in snmc caws. llot greater than those during the Jw-experimental period. Tn other tcrth, thry wre more pronounced. In most instances thy coincided with the appearance of denture sores and witll rchasing proccdurcs.
A twnd to gradual mobility changes uxs found in other ahutment teeth. In cnscs \l’.T?. (2. esp.p.1, TI.11. (1. cxp.J~) rnnhility did not increase acutely hut y-:ttlrlallv during several weeks after tlcnturc insertion (Figs. 5, 6). Cast W.l?. il. c.sJ~,~~)showed a gratlual tlccrrasc of hi& mohilit!, values that had hccn pmcl~~~~llb\. the Jn-evious dcnturc inscrtinn iFig. 5). 4. No striking differences in mobilit! changes could be fnrmtl in comparing the first ant1 second esperimrntal Jwriocl. Tt appears that the patients treated with ~lonwttling lug rest clasps had somcwllnt snlallc~r mobility tlisturhnnces. hut the ~nl;~lJn(~.
Volume 6 Number 4
TOOTH
MOBILITY
CHANGES
DISCUSSION
WITH
AND
PARTIAL
DENTURES
52.5
SUMMARY
It has been shown that significant acute or gradual tooth mobility changes were produced by treatment with partial denture prosthesis. They were different in magnitude, in duration, in maintenance, and in localization to the abutment teeth during the total ZOO-day experimental period. It is assumed that future experiments in the suggested line may yield valuable scientific information about the periodontal reaction of abutment teeth to the forces produced and transmitted by prosthetic appliances. On the other hand, the changes in mobility testing consecutively different experimental prosthetic appliances on the same patient may be used as an indicator of the degree of periodontal trauma by prosthetic treatment. We wish to express our gratitude to Dr. C. M. E. Eugster, D.D.S., L.D.S., R.C.S., for assistance in translation. REFERENCES
1. 2. 3. 4.
Tooth Mobility Changes Through Artificial Miihlemann, H. R.: Tooth Mobility (V). Trauma, J. Periodont. 25:202-208, 1954. Miihlemann, H. R., Hirt, H., and Herzog, H.: Tooth Mobility-Bruxism-Selective Grinding, Proc. Int. A.R.P.A. Congress, Venice, 1955. Hirt, H., and Miihlemann, H. R.: Diagnoses of Bruxism by Means of Tooth Mobility Measurements, Parodontologie 9:47, 1955. Miihlemann, H. R.: Tooth Mobility. The Measuring Method, Initial and Secondary Tooth Mobility. J. Periodont. 25:22-29, 1954. UNIVERSITY OF ZURICH ZURICHBERGSTRASSE 4 ZURICH 28, SWITZERLAND