Edentulous

position

Liu Hongchen,
Postgraduate

of the temporomandibular

MD, PhD,a Zhou Jilin,

Medical

College

and General

joint

DDS,b and Liu Ning, MScMC

Hospital

of Chinese

PLA,

Beijing,

China

Two bilateral
&hullers
position radiographs
were made of 10 edentulous
patients
with complete dentures. In one radiograph,
the complete dentures were in place in
centric occlusion. For the other radiograph,
the complete dentures were removed
and the maxillary
and mandibular
residual ridges approximated
as closely as
possible. This position is referred
to as the edentulous
position of the temporomandibular joint (TMJ). Findings indicate that in the edentulous
position the average
size of the upper and posterior
TMJ spaces and the distance from the center of the
condyle to the center of the glenoid fossa on the Y axis of the TMJ are smaller than
measurements
in the intercuspal
position. The size of the anterior
space and the
distance between
the two centers on the X axis are larger in the edentulous
position. Because vertical dimension
is reduced in the edentulous
position, the
mentum is in a superior
and protrusive
position. The study indicates that when the
maxillary
and mandibular
residual ridges are approximate
there is a pathologic
position of the TMJ and the mandible
caused by the loss of all teeth. The study
shows that the condyle has the potential
to move backward
and upward
excessively. As a result of the study, the concept of the edentulous
position of TMJ is
introduced.
This concept is important
in determining
the proper position of the
condyle in the glenoid fossa and the correct vertical
and horizontal
jaw relationship
of an edentulous
patient when complete dentures are made. (J PROSTHET DENT
1992;67:401-4.)

T he relationship between the

condyle and the

glenoid fossaof the temporomandibular joint (TM& has
usually been studied with natural teeth in place. This relationship has rarely been studied in edentulous patients
especially when the residual ridges are approximated.
The purpose of this study is to identify the spatial relationship within the TMJ in edentulous patients when (1)
a complete denture is occluded at the correct vertical and
horizontal position and (2) the maxillary and mandibular
residual ridges are approximated as closely as possible.
This study evaluates (1) the positional change of the
condyle in the glenoid fossa;(2) changesin the upper, anterior, and posterior joint spaces;and (3) the relationship
between the maxillary and mandibular residual ridges.
MATERIAL

AND

METHODS

Ten edentulouspatients, six womenand four men, 57 to

79years of age,were studied. Their teeth were absentfrom
5 to 33 years (average 10.1 years), and complete dentures
had beenusedfor 3 months to 33 years (average9.5 years).
In five patients, the residual ridges were markedly absorbed.
Schullers positional radiographs were made of each paaAssociate
Professor,
Department
of Stomatology.
bProfessor,
Department
of Stomatology.
CPostgraduate
student,
Department
of Stomatology.
10/1133878

THE

JOURNAL

OF PROSTHETIC

DENTISTRY

Line

Line

Line

Fig. 1. Location of anterior, upper, and posterior joint

spaces.

tient in the two positions, occlusalvertical and overclosed.

Schullers position adjuststhe head to place the midsagittal plane parallel to, and the interpupillary line perpendicular to, the plane of the film. The beamis placed at a 25
caudal angleto enter the upper parietal region and exit in
the TMJ areaadjacent to the film. The overclosedposition
wasreferred to asthe edentulousposition of the TMJ. With
the jaws maintained in this position, the relationship of the
central points of the residualridgeswere noted horizontally

401

HONGCHEN,

Center

of

Glenoid

Fosso

/Posterior

X Axis

JILIN,

AND

NING

perpendicular to the reference line at the point where the

reference line intersected the height of the fossa represented the Y axis. The point of intersection of the X and
Yaxes indicated the center of the glenoid fossa (Fig. 2). The
distance from the center of the condyle to the center of the
glenoid fossa on the X axis and the Y axis was measured
and recorded.
RESULTS

Y Axis

Fig. 2. Location of centers of condyle and glenoid fossa.

and the vertical dimension recorded between a point on the

chin and the junction of the philtrum and the columella.
A piece of acetate paper was placed over the completed
radiograph and a tracing of the condyle and the glenoid
fossa was made. All locations and measurements were recorded.
For measurement of the joint space between the condyle
and the glenoid fossa the method suggested by Zhang
Zhenkangl was used (Fig. 1). A reference line was drawn
parallel with the Frankfort horizontal plane and tangent to
the most superior aspect of the glenoid fossa. Through the
highest point of the glenoid fossa, line A was drawn
perpendicular to the reference line. Line B was drawn at a
45degree angle to the reference line across the thinnest
part of the anterior joint space. Line C was also drawn at
45degrees to the reference line passing through line A and
line B . Line C also passes through the posterior joint space.
The length of lines A, B, and C between the condyle and the
glenoid fossa represented the width of the upper anterior
and posterior joint spaces.
The center of the condyle and the center of the fossa were
located as suggested by Brewka,2 Willis,3 and Hatjigiorgis4
(Fig. 2). Line 1 was made parallel to the reference line and
tangent to the highest point of the condyle. Line 2 was
drawn perpendicular to line 1 and tangent to the most anterior aspect of the condyle. Line 3 was drawn parallel to
line 2 and tangent to the most posterior aspect of the
condyle. Line 4 was drawn parallel to line 1 and at a distance to line 1 equal to that between line 2 and line 3. The
four lines formed a square. The intersection point of the
two diagonals of this square represented the center of the
condyle.
Line E -F was drawn parallel to the reference line and
tangent to the crest of the articular eminence. The line
representing the X axis was then drawn midway between
and parallel to line E-F and the reference line. The line

402

Analysis of the data obtained in the study showed no

statistical difference (at the 5% level) between the values
of the left and right TMJs in all measurements (Tables I
and II). When the values of both sides were combined,
those in the intercuspal position and the edentulous position were compared.
The average values of upper and posterior joint spaces
and the distance from the center of the condyle to the center of the glenoid fossa on the Y axis were statistically narrower in the edentulous position than those in the intercuspal position. The average values of the anterior space
and the distance between the two centers on the X axis
were found to be larger in the edentulous position than
those in the intercuspal position. The statistical t-test of
these two independent values showed no statistical difference at the 5% level of significance (Table III).
In the intercuspal position, the vertical dimension was
6.75 * 0.55 cm (x f SD) and, in the edentulous position,
it was 5.50 f 0.34 cm (x f SD). At rest position in 17 patients, the relationship of the residual ridges did not show
protrusion of the mandible. In the edentulous position,
three of 17 residual ridges could be approximated tightly
without protrusion of the mandible and the other 14
patients showed protrusion of 3.36 + 1.86 mm (x + SD).
In seven patients, the maxillary and mandibular residual
ridges could be approximated tightly and, in another seven
patients, a space of 4.6 t 1.52 mm (x + SD) was noted
between the maxillary and mandibular residual ridges.
DISCUSSION
After the loss of all teeth in one or both dental arches, the
intercuspal position and the retruded contact position disappear. When the maxillary and mandibular residual
ridges approach, the position of the condyle in the glenoid
fossa may change. Because this changed condylar position
may be a pathologic one, it is referred to as the edentulous
position of the TMJ. In this position, the upper and posterior joint spaces are obviously reduced. The distance on
the Y axis between the center of the glenoid fossa and the
center of the condyle is shortened, indicating that the
condyle may move upward and backward after the loss of
natural occlusal stops.
The anterior joint space and the distance between the
center of the glenoid fossa and the center of the condyle on
the X axis does not increase significantly, indicating that

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EDENTULOUS

POSITION

OF THE

TMJ

I. Comparison between right and left average measurements

edentulous patients

Table

Right

Left
x

Anterior space
Upper space
Posterior space
X axis
Y axis

1.73
2.47
1.18

(mm) of the TMJ in the edentulous position of 10

SD

SD

0.713

1.51
2.58
1.50
-2.39
-4.65

0.137
0.820
0.499
1.245
1.163

0.848
1.173
1.328
0.314

0.618

-2.23

0.207
1.385

-4.13

1.480

0.110

>0.05
>0.05
>0.05
>0.05
>0.05

Table
II. Comparisonbetween right and left average measurements(mm) of the TMJ in the intercuspal position of 10
edentulouspatients
Right

Left
x

Anterior space
Upper space
Posterior space
X axis
Y axis

SD

1.38

0.838
0.836

3.05

2.18

0.793
1.131
1.052

-2.02

-5.29

SD

1.47
3.18
2.45

0.603
1.104

-1.95
-5.39

0.842

1.011
1.216

t
0.341

0.279
1.096
0.217
0.808

>0.05
>0.05
>0.05
>0.05
>0.05

Table
III.
Comparison of the average measurementsof the TMJ between the intercuspal position (IP) and the
edentulous position (EP) of 10 Edentulous Patients (mm)
EP
TI

Anterior space
Upper space
Posterior space
X Axis
Y Axis

IP
SD

JOURNAL

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PROSTHETIC

SD

1.62

0.715

1.43

0.712

1.896

>0.05

2.63

0.709
0.406

3.12
2.32

0.955
0.895

3.795
5.866

<O.Ol
<O.Ol

1.39
-2.31
-4.48

1.284

-1.99

0.971

1.286

>0.05

1.307

-5.34

1.107

5.987

<O.Ol

the condyle and the mandible as a whole do not move upward and backward. In the edentulousposition of the TMJ,
the condyle may rotate upward and backward with the anterior mandible moving forward and upward. This rotation
is alsodemonstrated by the protrusive relationship of the
mandibular residual ridge to the maxillary residual ridge
by decreasingthe vertical dimension of occlusionin edentulous patients. The potential for rotation suggeststhat
the condyle has some adaptability to tooth abrasion or
loss.
This study suggeststhat it is important to correctly determine the vertical dimensionof occlusionand the intercuspalposition not only for the function and esthetic value
of a denture, but alsofor the proper position of the condyle
within the glenoid fossa to prevent TMJ disorders. This
study confirms that the mandible movesforward and upward as abrasion of the natural teeth or artificial teeth

THE

DENTISTRY

occurs. If an edentulous patient has not had a complete

denture for a long time, the symphysis may be somewhat
protrusive and the condyle may be in a backward and upward position. When a denture is madefor such a patient,
the position of the condyle in the glenoid fossaand the relationship of the maxilla to the mandible should be
improved.

SUMMARY

AND

CONCLUSION

When edentulous patients approximate maxillary and

mandibular residual ridges, the upper and posterior joint
spacesand the distance from the center of the condyle to
the center of the glenoid fossaon the Y axis will decrease.
The anterior joint spaceand the distance from the center
of the condyle to the center of the glenoid fossaon the X
axis doesnot increasesignificantly. The mandibular residual ridge is often found in a forward and upward position

403

HONGCHEN,

which is referred to as the edentulous position of the

TMJ. In this position, the mandible rotates, the condyle
moves upward and backward, and the symphysis of the
mandible moves upward and forward.
We thank Mr. Wang Zhaowu
of General
P.L.A., Dr. Alfred0
Rossi of George Eastman
Mrs. Margaret
Cappelli-Perciballi
for their

NING

Reprint requests to:

DR. LIU HONGCHEN
POSTGRADUATE
MEDICAL
HOSPITAL OF CHINESE
28 FUXIN ROAD
BEIJING

REFERENCES

COLLEGE

AND GENERAL

P.L.A.

CHINA

1. Zbang Zhenkang. A tomographic study of the temporomandibular

joint
in normal adults. Chin Med J 1975;2:130-132.
2. Brewka RE. Pantograpbic
evaluation of cepbalometric
binge axis. Am
J Orthod 1981;79:1-19.

for

AND

Willis BH. Tomographic

study of the relationship between the mandibular condyle and glenoid fossa in patients with temporomaudibular
joint dysfunction
[Masters thesis]. Washington DC: Georgetown University, 1982.
Hatjigiorgis CG. A tomographic study of the temporomaudibular
joint
of edentulous patients. J PROSTHET DENT 1987;57:354-358.

Hospital
of Chinese
Hospital
of Italy, and
help to this article.

Guides

JILIN,

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available

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404

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1992

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