CASE

ANALYSIS

OF PARTIAL
JOEL FRIEDMAN, Brooklyn,

DENTURE D.D.S.
N. Y.

PROBLEMS

HEN A GROUP interested in a problem continually makes observations, collects data, and develops opinions, it is inevitable that they will evolve a concept. This concept then becomes a basis for the logical, coherent search for In forming a concept, certain known facts newer knowledge and understanding. and certain admitted statements are marshalled and declared to be related, in the mannerwhich common knowledge has shown to be consistent. Once these statements are allowed, they may not thereafter be changed or denied, and every result or conclusion drawn from them by logical process must be admitted as true, that is, as true as the original assumptions or statements. When we choose a method to represent our predictions, we base it on observed resemblance to similar problems and their solutions in the past. We commit ourselves to its use, and if the method is properly applied, the solution to the If we were to select a different set of statements problem should be forthcoming. and declare them to be basic, it is to be expected that entirely different results would be obtained. Therefore, if we accept responsibility for the verity of an established concept, we also accept responsibility for applying this concept directly to all the problems in its designated field and arriving at a direct solution. Wherein lies the necessity for a new approach to the problems of partial denture prosthesis? Diagnostic procedure aims at the elimination of as many doubts and variables as possible before a decision is made on objectives and treatment planning. The more accurately the diagnostic data is organized and evaluated, the more direct the treatment plan will be. Diagnosis of the biologic aspects of partial denture prosthesis has been fairly well correlated to elicit information on the state of oral health, the condition of the abutments, and of the supporting structures. There is need for a procedure of analysis, whereby the dentist may evaluate the anticipated stresses and strains which the partial denture and the dental arch will experience in function. The approach must be in terms of our clinical understanding of the problems of the restoration. It is important that we do not permit ourselves to stray from biologic functions in our thought. Theoretical, mathematical, and purely mechanical considerations may lead to abstractions which we could not relate to oral physiology. A systematic, guided procedure will enable the average practitioner to think through the problems of stress in a partial denture restoration in logical sequence.
Received

for publication

July 15, 1953.

82

SPECIFIC

STRESS

lRORl.EXIS

Stresses and strains are the basic considerations of partial denture ca>t. analysis. The major stresses originate irI the muscular activity of the oral al)paratus and are transmitted through the lower incising and occlucling surfaces oi the natural and artificial teeth to the upper masticatory apparatus and its supporting structures. IVhen a single chewing stroke has been completed, the sircssc:~ have been distributed and absorbed equally between the upper and lower archr!. The relatively minor stresses are the movements of the lips, cheeks, and tongue They are not severe in magnitude unless they are associated with abnormal habits. As a corollary, straim in partial denture problems nlay be defined as the r:-, sultants of the stresses applied by oral forces to the arch and its partial clent~lrc~ For analysis, we may isolate two types of strains : 1. Strains resulting from oral physiologic manifestations, largely muscular iorces, and other conditions present in the mouth, whether dentures are worn 17 not. Chewing movements and tongue and cheek actions are some of these factor-. Strains are magnified by abnormal tooth relations, abnormal ridge relations, anti oral habits. Their magnitude varies considerably from patient to patient. 2. Strains that are present only when the partial denture is in the mouth and functioning. These may be strains on abutment teeth, on saddle ~ILICOS~ under functional loads, unreciprocated strains produced by the partial denture frame, and strains resulting from the increased function attendant on the integratirjn of a satisfactory partial denture into a partially etlentulous arch. Intraoral forces, such as chewing and tongue movements, start the actions on partial denttire parts. These, in turn, act on the abutments and other oral tissues. The stresses encountered in an arch supporting a partial denture may lye divided, /or st~rd>t. into three groups : (1 ) \-ertical. (3) horizontal, and IC;i torsional.

Fig.

l.-Displacing

stresses.

1.

VERTICAL

STRESS

PROHLE11S

Vertical stresses are subdivided into two opposing types : (a) Displacing stresses are those forces which are the result of downward stresses along the long axis of the teeth in a crown-to-apex direction (Fig. 1 j , and the relatively vertical stresses directed at the edentulous ridge mucosa. The origin of these stresses muscle. is the closing thrust of the mandible, activated bv the mandibulocranial

84

FRIEDMAN

J. Pros. Den. January, 1954

The dentist should make an evaluation of the displacing stresses, after clinical examination and study, and record the magnitude as mild, average, or severe, with any additional relevant data. (b) Disladging stresses are the forces tending to lift a partial denture or section from its passive position in the arch (Fig. 2). Lip, cheek and tongue movements are dislodging influences. Magnitude varies with the bulk and distribution of buccal soft tissues, muscle tonus, and tongue activity. Reciprocal dislodging action occurs where wide spaces interrupted by a few natural teeth invite anteroposterior tilt, diagonal tilt, or lateral tilt. From the distribution of spaces and natural teeth, rocking action may be anticipated when displacing stresses are brought to bear on an anterior or posterior denture segment (Fig. 3).

Fig. 2.-Dislodging

stresses.

These forces are estimated and the magnitude noted, together with any other The displacing and dislodging forces data relating to problems of dislodgement. comprise the relatively vertical stresses.

Fig. 3 .-Displacing stress A produces reciprocal at B across the fulcrum of the intervening 2. HORIZONTAL STRESS

dislodging teeth.

stress

PROBLEMS

Horizontal stresses originate as a component of the normal rhythmic chewing stroke. The forces are effective in mesiodistal and in bucco- and labiolingual directions (Fig. 4). These lateral stresses are among the most damaging components of chewing physiology, and special care must be exercised in, their evaluation. Horizontal strain is a component of simple closure as well as of chewing, and becomes a severe factor where the patients history or clinical evidence indicates a grinding

Volu1ue 4 Number 1

CASE

ANALYSIS

OF

PAKTlAL

DtDlIjKtl

IHOHl.EXl

8s

or clenching habit. Interarch malrelations and horizontal stresses near the oc clusal surface tend to aggravate the horizontal burden, hll pertinent horizontal stress data on the case should be studied and rccorde(l.

Fig.

4.-Lingually

applied

horizontal

stress,

A. STRESS

blesially

applied

horizontal

stress.

3.

TORSIONAL

PROBLEMS

Torque is a twisting, rotational type of stress. It is usually found to be a. combination of vertical and horizontal stresses. Straight-line forces are relatively infrequent in oral function. Most of the stresses include some element of torsion. The purpose of classifying the vertical and horizontal stresses separately in this outline is to enable the dentist to isolate these elements for analysis and evaluation.

Fig.

5 .-The

long cantilever segment exerts torsional the first abutment it engages.

stress

on

Torsion is noted most frequently where a long segment (especially a free-end type of partial denture) acts upon the first abutment it: engages (Fig. 5). It is present in typical bilateral extension saddle dentures as reciprocal tilt, and in dentures where a single isolated abutment tooth divides two long edentulous segWhere ments. It is severe in dentures with a long anterior edentulous segment. the ridge mucosa is of more than average resilience, torque is of greater magnitude. It frequently acts in combination Torque implies rotation about a fixed center. with a shifting of the denture base, a translatory movement which occurs where there is flexibility in the connection between the partial denture frames and the abutment teeth. Torsional stresses must be visualized and evaluated, and a record made of their nature and magnitude.

86

FRIEDMAN

J. Pros. January,

Den. 1954

SUMMARY

The specific stress considerations encountered in a partial denture problem are : ( 1) Vertical stresses a) Displacing thrust b) Dislodging force (2) (3) Horizontal stresses Torsional stresses

The procedure of partial denture stress analysis is intended to supplement the diagnostic procedures preparatory to treatment planning. It is an aid in the meticulous step-by-step approach to the exposure of the problems for study. The more accurately the dentist organizes and evaluates the diagnostic considerations, the more precise the treatment plan and denture design will be. Stress analysis is performed in conjunction with the clinical studies, and with the aid of mounted study casts, prior to surveying the casts and planning the partial denture parts. Biologic and technical considerations have been largely excluded from this article to maintain integrity in the presentation of the procedure, for the sake of clarity. It is a correlative procedure for integrating some of the most important stress problems for study. As the technical means become available, we may increase the accuracy of our estimates.
biologic 499
LINCOLN PL. BROOKLYN

38, N. Y.