The phenomenon

of decreased

width

movements

in opening

Carl P. Regli, D.D.S.,*

University of California,

mandibular

and Ellsworth K. Kelly, D.D.S.**

School of Dentistry, San Francisco,

arch

Calif.

lthough from the clinical standpoint we think of bone as rigid and unyielding,
McDowell
and Reglil measured significant changes in the width of the mandibular
arch in extreme opening positions. DuBrul and Siche? and Weinmann and Sicher3
had previously
suggested that the obliquely
arranged external pterygoid
muscles
exerted a bending force on the mandible. They stated that the forceful contraction
of these two muscles pulled the condyles medially
and deformed the mandible.
More recently,
Osborne and Tomlin4 have corroborated
the work of McDowell
and Regli using an accurate intraoral
electronic measuring device. They obtained
somewhat smaller measurements
than McDowell
and Regli, but in principle
supported the original work.
EXPERIMENTAL

PROCEDURE

The results from sixty-two

patients in the series were determined
with the
help of three students working
independently.
Impressions
were made of each
patient, one with the jaw in the wide open position, and one with the mouth closed
as far as the impression tray would permit. Casts were poured in each of the impressions.
Occlusal templates of cold-curing
acrylic resin were constructed on one cast.
Four of the templates were made, one in the first bicuspid, and one in the second
molar region on each side. Fine measuring pits were made in the resin in each
template
before the resin cured. These pits received the measuring
stylus of a
specially constructed micrometer.
The cross-arch distance was recorded in the bicuspid region on one cast, and
the templates were transferred to the second cast, and the difference was recorded.
This procedure was repeated in the molar region (Fig. 1) .
Precautions
were taken in impression-making
and the pouring of the casts
to eliminate
variables. The water temperature
was controlled,
the water-powder
*Professor and Chairman of the Division of Denture Prosthesis.
**Associate Professor of Denture Prosthesis.
49

50

Regli

Table
Kecordrd

and Kelly

I
dirnmsional

Subject

changes
/ Contraction
in the wide op~?r
/ Contraction
in the wide open
position in the second
Ij position in the bicuspid re,gion
molar region
I
(mm.)
(mm .)
0.178
0.076
0.102

1
2
3
4

0.025
0.05 1
0.038
0.023

o.oou

0.1',2

0.0 I 9

O.lL7
O.I3:!
0.09

7
H
9
1(I
11
12
13
14
15
16
17
10
19
20
1
22
23
24
25
26
27
28
29
30
31
32
33
34
3 .i

36
37
38
39
40
41
42
43
44
45
46
47

0.02:3
0.04:i
0.035
0.042
0.043
0.02.i
0.0 1?I
0.025
0.048
0.036
0.02n
0.036
o.oi-I
0.079
0.064
0.048
0.025
0.025
0.025
0.025
0.025
0.025
0.015
0.038
0.025
0.025
0.05
0.0.51
0.025
0.05
0.025
0.025
0.013
0.03
0.025
0.025
0.01 3

0.076

o.ou 1

0.14;
0.1
0.2
0.18
0.127
0.048
0.06-l
0.165
0.1 73
0.1 1-b
0. I 49
0.1 78

0.178
0.155
0.089
0.05
0.076
0.1
0.05
0.076
0.05
0.076
0.05
0.05
0.076
0.089
0.076
0.102
0.05 1
0.014
0.051
0.076
0.025
0.076
0.051
0.089
0.076

Volume 17
Number I

Table

Decreased

mandibular

arch width

in opening

movements

51

I-Contd

Subject

48
49
50
51
52
53
54
55
56
57
58
59
60
61
62

Contraction
in the wide open
position in the bicuspid region
(mm.)

in the wide open

in the second
molar region

Contraction
position

0.015
0.025
0.025
0.025
0.051
0.051
0.025
0.025
0.051
0.025
0.051
0.025
0.05

ratio accurately measured, and the same batches of materials

the tests. The methods used followed clinical and prosthetic
and were not those of the physics laboratory.

(mm.1

0.051
0.051
0.051
0.076
0.076
0.165
0.076
0.102
0.127
0.076
0.076
0.102
0.076

were used throughout

laboratory
procedures

RESULTS
Measurable
differences demonstrated
by our methods lead us to conclude that
the width of the mandible
changes during opening movements. The changes in
dimension are shown in Table I and may have clinical significance.
The average distortion
across the mandibular
dental arch from first bicuspid
to first bicuspid was 0.03 mm. (O.OOl+ inch) and that from second molar to second
molar was 0.09 mm. (0.0038 inch). This average includes two subjects that showed
no distortion
and five that showed distortion in only one of the two regions measured.
DISCUSSION
The amount of mandibular
distortion
demonstrated
is sufficient to affect the
fit of a removable partial denture and to put undue stresses on abutment teeth of
a bilateral
fixed partial denture. Perhaps this phenomenon
has not been noticed
clinically,
since a continuous fixed restoration in the lower dental arch is somewhat
rare. Also, the patient is usually relaxed with the mouth almost closed while the
impression material is setting. Recently, however, periodontal
prosthetics, wherein
restoration of the lost teeth is secondary to the splinting of all remaining teeth into
one solid unit, has become widespread.
Often proponents
of cross-arch bracing and splinting of teeth exhibit photographs and roentgenographs
of old-wrought
crown-fixed
partial dentures that restore the entire arch on very few remaining abutment teeth, often only the cuspids

52

Regli

and Kell)

Fig. 1
7he measuring instrument is adjusted over the cast so that pins on the legs of the instrument
fit into the pits in the templates. The micrometer dial on the instrument is then set at zerc~.
Then, after this set of templates is transferred to the second cast, the instrument is agairl
adjusted in the measuring- pits, and the dial records, in thousandths of inches, the difference
in the width of the dental arch. This procedure is repeated for the second stt of templates.

and second molars on each side. These restorations have lasted a long time with
little bone destruction
around the roots of the abutments. However, we have not
seen one of these restorations for the lower arch. Perhaps the phenomenon
of decreased mandibular
arch width in opening movements
creates enough stress on
abutment
teeth with a fixed partial denture to bring about its early failure. This
is an avenue for further investigation.
The measurements
of our tests, those by Osborne and Tomlin,
and those of
of the
McJ3owell
and Keglis
earlier study, record only the linear narrowing
mandible. However, the mandible is not only constricted but is also torqued because
the muscles causing the action are inserted near the condyles. Suc.h action would
be more destructive
to the tissue around the abutment teeth of a fixed restoration
than a simple linear force.
SUMMARY
Recent measurements indicate that deformation
of the mandible occurs during
opening movements.
This important
phenomenon
is of considerable
clinical significance.
Further
investigation,
with a measuring
apparatus
rigidly
attached
to the
teeth and possibly using strain gauges attached to fixed restorations,
is indicated.
Meanwhile,
it is advisable not to make mandibular
impressions with the mouth
wide open and to question the advisability
of rigidly joining the lower teeth together with a cross-arch splint.
We are indebted to Richard C. Jenninss, D.D,S., Reynold Dean Robinson, D.D.S., and
Arthur Rabitz, D.D.S., who worked on this project while they were student research assistants.

Volume 17
Number I

Decreased

mandibular

arch width

in opening

movements

53

References
1. McDowell,
J. A., and Regli, C. P.: A Quantitative
Analysis of the Decrease in Width of
the Mandibular
Arch During Forced Movements of the Mandible,
J. D. Res. 40: 118%
1185, 1961.
2. DuBrul,
E. L., and Sicher, H.: The Adaptive
Chin, Springfield,
Ill., 1954, Charles C
Thomas.
3. Weinmann,
J. P., and Sicher, H.: Bone and Bones, Ed. 2, St. Louis, 1955, The C. V.
Mosby Company.
4. Osborne, J., and Tomlin, H. R.: Medial Convergence
of the Mandible,
Brit. D. J. 117:
112-114, 1964.
UNIVERSITY
OF CALIFORNIA
SCHOOL OF DENTISTRY
MEDICAL
CENTER
SAN FRANCISCO,
CALIF. 94122