Journal of Oral Rehabilitation
Journal of Oral Rehabilitation 2014 41; 177--183
Effect of complete and partial removable dentures on
chewing movements
T. M. S. V. GONC ALVES, L. S. R. VILANOVA, L. M. GONC
R . C . M . R O D R I G U E S G A R C I A Department of Prosthodontics and Periodontology, Piracicaba
University of Campinas, Piracicaba, Brazil
SUMMARY Partial or complete edentulism impairs
mastication. However, it is unclear how the
chewing cycle is affected by prosthetics. We
evaluated the chewing movements of patients
fitted with complete (CD) or removable partial
denture (RPD). A total of 29 subjects were
kinesiographically evaluated during chewing of
peanuts and Optocal portions in a random
sequence. The subjects were divided into two
groups according to prosthesis type. Group RPD
was composed of 14 partially edentulous patients
using a lower distal extension RPD (mean age
61  8 years), and group CD contained 15
completely edentulous patients using CD (mean
age 65
9  7
9 years) in both jaws. Opening,
closing, occlusal and masticatory cycle times,
movement angle (opening and closing), maximum
velocity (opening and closing), total area and
chewing cycle amplitudes were evaluated. The
Background
The main goal of mastication is to break food into
smaller particles, increasing the surface area of the
food and to facilitate the digestive process (1). How-
ever, the loss of natural teeth impairs the comminu-
tion process, and prosthetic treatments are not able to
completely restore masticatory function, particularly
in complete denture wearers (2).
Mastication is an intermittent rhythmic act in
which the tongue, facial and jaw muscles act in coor-
dination to position the food between the teeth, cut it
and prepare it for swallowing (1, 3). In humans, the
2013 John Wiley & Sons Ltd
ALVES &
Dental School,
results were subjected to ANOVA and Tukeys HSD
test at a significance level of 5%. The RPD group
exhibited shorter opening and closing phases and
masticatory cycle time (P < 0
05). Maximum
velocities were also higher in the RPD group,
irrespective of the test material (P < 0
05). The area
and amplitude of the chewing envelope was
smaller in the CD group (P < 0
0001). The test
material did not influence chewing cycles in any of
the parameters evaluated (P > 0
05). RPD wearers
use a faster chewing sequence with greater vertical
and lateral jaw excursions compared with CD
wearers.
KEYWORDS: removable partial denture, complete
denture, applied kinesiology, mastication, eating,
jaw motion
Accepted for publication 29 November 2013
mastication sequence may be readily elucidated using
electromyography and jaw tracking devices (1, 4).
Kinesiographic studies (3, 5, 6) have greatly advanced
our knowledge of the normal physiology of mastica-
tion, providing useful parameters for objectively eval-
uating chewing function.
The rhythmic chewing pattern consisting of open-
ing and closing jaw movements is maintained under
brain stem control, and the periodontal mechanore-
ceptors play a central role in encoding relevant
aspects of the chewing process (3, 6). The sensorimo-
tor control modifies the direction and magnitude of
the bite forces, regulating the intensity of the applied
doi: 10.1111/joor.12125
178 A L V E S et al.
T. M. S. V. GONC
force and continuously providing spatial information
concerning jaw action (3, 7). Chewing motion may
be modified by factors such as food type and consis-
tency, size of the food bolus, gender, age, dental
status, occlusion and prosthetic appliances (1, 3, 8,
9). As sensorimotor inputs are important for fine
regulation of mastication (3), it has been suggested
that partially edentulous patients who maintain peri-
odontal mechanoreceptors present better jaw control
and smother chewing patterns than completely
edentulous patients. In contrast, denture wearers
who no longer possess this peripheral sensitivity
have developed strategies to overcome problems
with chewing by choosing softer and easier-to-chew
foods and by preparing and chewing their food
differently (10). Moreover, denture wearers have
difficulties in centring and comminuting the food
bolus, probably due to the lower retention of the
mandibular denture, which allows the displacement
of the denture into the soft tissue (4, 11). Thus, an
extra function of the tongue and cheeks is required
to stabilise the prosthesis while positioning the food
bolus among artificial teeth, contributing to the
lower masticatory performance found in those
patients (2, 11). The remarkable differences in
chewing between partially and completely edentu-
lous patients could possibly lead to irregularities in
chewing movements (4), but it is unclear how the
masticatory cycle pattern is affected by the presence
of a few teeth and how prosthetic treatments influ-
ence the chewing pattern.
Previous studies (4, 5, 12) have revealed that
posterior occlusion plays a key role in coordinating
mandibular movement patterns. Partially edentulous
patients with missing post-canine teeth tend to chew
the bolus in the anterior region (5). On the other
hand, completely edentulous patients wearing full
dentures apparently use chopping movements to keep
the dentures more stable during chewing (4). Thus, it
is reasonable to hypothesise that chewing movements
could be affected by the type of prosthesis used. The
aim of the current study was to evaluate, by means of
a kinesiographic instrument, the mandibular move-
ments during chewing of complete (CD) and remov-
able partial denture (RPD) wearers. In addition, we
surveyed the influence of two test materials on chew-
ing movements: one natural (peanuts) and one
artificial (Optocal). Both materials are commonly used
in masticatory function analysis.
Material and methods
Experimental design
This cross-sectional study was designed to evaluate
the chewing movements of removable prosthesis
wearers and was composed of patients who received a
CD or distal extension RPD from the dental clinic in
the Piracicaba Dental School, University of Campinas.
A full explanation of the clinical trial was given to
each subject, and a written informed consent docu-
ment was read and signed prior to enrolment. The
Ethics Committee of the Piracicaba Dental School,
University of Campinas (Piracicaba, Brazil), approved
the research (protocol # 094/2011). Chewing move-
ments were recorded during two sequences of 20
masticatory cycles for each test material, being the
mean values of both sequences used for analysis. All
evaluations were performed by a trained researcher
during a single appointment.
Sample selection
The study participants were divided into two groups
based on their dental state. The first group was com-
posed of 15 completely edentulous patients wearing
CDs, while the second group consisted of 14 partially
edentulous subjects provided with maxillary CD and
mandibular distal extension RPD.
Inclusion criteria included the continuous use of a
new and well-fitted prosthesis for at least 3 months,
no complaints, discomfort or pain during chewing,
bilateral contact with Angle Class I occlusal relation-
ship in artificial teeth and the presence of residual
edentulous ridges with normal volume and mucosal
resilience. Subjects describing a history or symptoms
of temporomandibular disorders, advanced periodon-
tal disease, mucosal trauma induced by the denture
resin base, fixed prosthetic treatments or systemic or
debilitating diseases that could interfere with muscle
control such as Parkinsons or central nervous system
diseases were excluded from the study. The number,
gender and age distribution of each test group
enrolled in the study were also provided in Table 1.
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 JAW MOTION AND REMOVABLE DENTURES
Table 1. Subjects profile according to the testing groups
Subjects
Age (mean,
Testing groups n Male Female maxmin)
CD 15 8 7 65
9 (5178)
Removable partial denture 14 4 10 61 (4879)
Total 29 12 17 63
5 (4879)
Chewing movement measurement
The chewing movements were recorded using a kin-
esiographic device (*) connected to a computer sys-
tem. Subjects were seated comfortably in a dental
chair with the Frankfort plane parallel to the floor. In
the CD group, a magnet was temporarily attached to
the lower denture at the artificial incisor teeth, while
in the RPD group, the magnet was adhered to the
lower incisor teeth with an adhesive strip according to
the manufacturers instructions. In both cases, the
magnet was positioned so that it did not interfere
with normal occlusion. A magnetic sensor device was
placed on the subjects head in accordance with the
instructions of the manufacturer. Jaw movements
were tracked during chewing and displayed and
recorded in a computer program as 3-D spatial coordi-
nates on the vertical, anteroposterior and lateral axes.
The chewing movements were evaluated using two
test materials administered in a random sequence,
being each of them evaluated twice. A natural (pea-
nuts) and an artificial (Optocal) test materials were
selected because both are comparable in texture and
consistency, but presenting different advantages (2).
For example, natural foods such as peanuts are nor-
mally consumed by subjects in their habitual mastica-
tory action (2), while artificial test materials such as
Optocal permit the control of several rheological food
properties, enabling standardised masticatory function
analysis (2).
A portion (approximately 3
7 g) of peanuts or Opto-
cal was given to subjects to chew in their habitual
way for 20 cycles. They were instructed to place the
test material on their tongue and to keep their teeth
together in the maximum intercuspal position until
the start signal was given by the researcher. The
chewing cycles were counted in silence by the single
*JT-3D; BioResearch, Milwaukee, WI, USA.
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179
calibrated researcher, who informed the subjects
when to stop chewing. Remaining food particles were
removed by repeated rinses with 200 mL of regular
water mouthwashes to remove all food particles, not
interfering on the chewing of the next test material.
The first masticatory cycle of each chewing test was
discarded because it involved the initial positioning of
the test material over the teeth (13). The chewing
traces were evaluated using the BioPack software
(BioResearch) (14), which provided parameters
including opening, closing and occlusal-phase dura-
tion (s), total masticatory cycle time (s), opening and
closing angle (frontal plane) and opening and closing
maximum velocity (mm s 1)(14, 15). These parame-
ters were obtained promptly in the Biopack (BioRe-
search) program.
A graphic image of each of the two sequences of 20
masticatory cycles provided the following parameters:
total area (mm2) in frontal and sagittal planes, vertical
and lateral amplitudes (mm) in the frontal plane, and
anteroposterior amplitude in sagittal planes (Fig. 1).
These graphic images were exported to the IMAGE
TOOL software () (1417), and values of the parame-
ters assessed were obtained for each sequence. A
mean value was calculated for each parameter consid-
ering both sequences. The reproducibility of the
chewing parameters was verified in a previous study
(18) in which intra-class correlation coefficients ran-
ged from 0
7 to 0
9, which was considered excellent.
Statistical analysis
The results were statistically analysed using the SAS/
LAB software package () with a significance level of
5%. Assumptions of the equality of variances and the
normal distribution of errors were checked. The data
sets were transformed as suggested by the software.
The chewing movement parameters of opening, clos-
ing and occlusal time, masticatory cycle duration,
angle of opening and closing movement, opening and
closing maximum velocity, and total area and ampli-
tudes of the chewing cycle were analysed using two-
way ANOVA followed by Tukeys HSD test, considering
the denture type and the test material as study
factors.
University of Texas Health Science Center, San Antonio, TX, USA.
SAS Software, version 9.0; SAS Institute Inc., Cary, NC, USA.
180 A L V E S et al.
T. M. S. V. GONC

RPD group compared with the CD group (P < 0
05)

when peanuts were chewed. Similar results were
noted only for the maximum open velocity when
Optocal was used as the test material (P < 0
05)
(Table 3).
Table 4 contains mean values for the area (mm2)
and amplitude (mm) of the masticatory cycles mea-
sured in the frontal and sagittal planes. Irrespective of
test material, the RPD group exhibited greater area
and vertical and lateral amplitudes in the frontal
plane (P < 0
0001). No difference was observed in the
sagittal area and the anteroposterior measurement of
the amplitude on the sagittal plane considering groups
and test materials (P > 0
05).

Fig. 1. Image of the peanut chewing envelope after a sequence
of 20 masticatory cycles regarding removable partial denture.
The red line represents the opening movement, while the blue
line characterises the closing movement. The white line is a ref-
erence, representing a regular chewing movement.
Results
Irrespective of the test material, the RPD group expe-
rienced faster chewing cycles with reduced opening,
closing and total cycle times when compared to the
CD group (P < 0
05) (Table 2). There was no signifi-
cant difference in the duration of the occlusal phase
between groups or test materials (P > 0
05).
There were no differences between groups in the
opening and closing angles for both test materials
(P > 0
05) (Table 3). In contrast, higher maximum
opening and closing velocities were observed in the
Discussion
Prior studies (3, 19) have demonstrated the impor-
tance of remaining teeth and consequently the peri-
odontal mechanoreceptors on the spatial control of
jaw movement during the chewing process. Signals
from periodontal receptors are responsible for the fine
motor control of jaw actions associated with biting,
intra-oral manipulation and the chewing of food (3).
It is clear from studies on partial and complete eden-
tulous patients that important sensory-motor func-
tions are lost or impaired when these receptors are
removed during tooth extraction (3, 20). However,
few researchers (4, 5) have examined the effect of
prosthetic treatments on chewing movements, even
though this could help to better understand why the
masticatory function is so impaired in subjects using
dentures. The current study evaluated several param-
eters of mastication performed by removable denture
wearers, revealing significant differences in chewing
mechanics between CD wearers and free-end RPD
wearers.

Table 2. Mean and standard deviation values of the duration (s) of the masticatory cycle according to the group and the chewing test
material

Group Material Opening time Closing time Occlusal time Cycle time

CD Optocal 231  34
6 Aa 305
7  60
1 Aa 152
2  38
9 Aa 673
1  111
5 Aa

Peanuts 212
7  48
6 Aa 306
8  75
4 Aa 173
5  41
7 Aa 677
4  137
2 Aa
Removable partial denture Optocal 192
2  36
3 Ab 244
7  46
7 Ab 136
3  46
9 Aa 573
4  100
4 Ab
Peanuts 174
4  37
2 Ab 221
4  48
3 Ab 141
3  48
6 Aa 534
8  113
5 Ab

Upper letters indicate differences between test materials.

Lower letters indicate differences between groups.
Proc Mixed, Tukeys HSD, P < 0
05.

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 JAW MOTION AND REMOVABLE DENTURES 181

Table 3. Mean and standard deviation values of angles and maximum velocity (mm s 1) according to the group and the chewing test
material

Groups Material Opening angle Closing angle Maximum open velocity Maximum close velocity

CD Optocal 83
9  19
8 Aa 84
9  27
7 Aa 128
2  43 Aa 92
8  26
7 Aa

Peanuts 82
4  21
7 Aa 81
4  38
6 Aa 112  44 Aa 77
1  31
3 Aa
Removable partial denture Optocal 91
2  23
8 Aa 90
1  39
9 Aa 157
4  35 Ab 132  21
1 Ab
Peanuts 81
5  21
7 Aa 65
6  23
5 Aa 156
8  32
1 Aa 132
2  37
5 Ab

Upper letters indicate differences between test materials.

Lower letters indicate differences between groups.
Proc Mixed, Tukeys HSD, P < 0
05.

Table 4. Mean and standard deviation values of area (mm2) and amplitudes (mm) according to the plane, group and chewing test
material

Amplitude

Area Frontal plane Sagittal plane

Group Material Frontal plane Sagittal plane Vertical Lateral Anteroposterior

CD Optocal 65  19
5 Aa 12
5  5 Aa 25  6 Aa 14  3 Aa 3  1 Aa

Peanuts 58
5  32
5 Aa 12
5  2
5 Aa 23  5 Aa 14  2 Aa 2  1 Aa
Removable partial denture Optocal 159
2  66
3 Ab 12
5  5 Aa 37  4 Ab 29  5 Ab 1  1 Aa
Peanuts 160
6  52 Ab 17
5  7
5 Aa 38  4 Ab 29  4 Ab 2  1 Aa

Upper letters indicate differences between test materials.

Lower letters indicate differences between groups.
Proc Mixed, Tukeys HSD, P < 0
05.

The opening and closing phases of the masticatory
cycle and the total length of the chewing cycle were
significantly shorter in the RPD group (Table 2). Stud-
ies evaluating masticatory movements are difficult to
compare due to variations in methodology and analy-
sis. In spite of this, the findings of the present study
are in agreement with previous study (21), which
revealed reductions in masticatory cycle duration fol-
lowing replacement of conventional CD with implant-
supported prostheses (21). Only few workers (4, 5)
evaluated chewing movements in partially edentulous
patients. Jemt et al. (5) compared the chewing cycle
length between partially edentulous patients with and
without distal extension RPDs and found no differ-
ences related to RPD use. These results (5) in combi-
nation with our findings support the premise that the
presence of teeth and sensory input from mechanore-
ceptors present in the periodontal ligament of the
remaining teeth play a key role in the control of jaw
motion, even when posterior contacts are missing. It
is important to highlight that subjects in the CD group
may have experienced different problems during
chewing related to denture instability (11). The
majority of CD wearers complain about denture
displacements during chewing, especially for chewy
foods, which could require an extra function of the
tongue and cheeks to retain the dentures apart from
positioning the food bolus (4, 11). This limited ability
to manipulate food, in addition to the longer chewing
cycles presented by CD wearers, could explain why
the masticatory capacity of this patients is so impaired
faced up to partially edentulous and complete dentate
subjects (2). Furthermore, a previous study (21) com-
paring the chewing movements before and after the
stabilisation of conventional CD with implants
revealed a shorter duration of the chewing cycle dur-
ing the occlusal phase. Besides, they also found a
higher mandibular velocity, greater displacement of
the jaw during chewing and more rhythmical chew-
ing pattern after the implant fixed dental prostheses.
Thus, it seems that the denture retention and stability
plays a crucial role in chewing motion impairments.
Differences between groups were also observed
with respect to maximum velocity, which was greater
among RPD wearers particularly during peanuts
chewing (Table 3). Similar results were reported by
Jemt et al. (5), despite the different test material (hard
bread) applied in the former study. In addition, it has

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182 A L V E S et al.
T. M. S. V. GONC
been reported (2, 9) that subjects using CD generally
increase the number of chewing cycles and reduce
the velocity of chewing movements. Chewing move-
ment and masticatory performance are closely related
(6, 21), and higher chewing efficiency is obtained
with faster chewing cycles (6), supporting the higher
chewing velocity found in the RPD group.
Greater chewing movement area and amplitudes
were recorded in the RPD group (Table 4). These
results are in accordance with reports (4, 11) that
the chewing pattern of CD wearers is characterised
by smaller vertical and lateral excursions compared
with subjects with natural teeth. The comminution
of consistent foods such as peanuts or Optocal
requires specific skills related to the selection and
breakage process, which could be difficult for CD
wearers (2). Thus, to keep dentures more stable dur-
ing mastication, subjects wearing CD apparently used
more chopping movements and avoided lateral jaw
motions, explaining the results founded in the CD
group.
Chewing motions were evaluated using two test
materials (peanuts and Optocal) in the present study.
Our purpose was to verify whether natural (peanuts)
and artificial food substances (Optocal) would differ-
entially influence mandibular movements. Standar-
dised artificial materials such as Optocal are
commonly used in masticatory function evaluation
due to their repeatable consistency and texture (2, 8).
However, these materials are not normally consumed
as are natural foods, and people may be somewhat
hesitant to chew them in a normal manner, influenc-
ing the results. Thus, both analyses are important
when studying chewing movements, and according to
our results, chewing patterns were similar for both
natural and artificial materials.
The current study has a cross-sectional design and
limited conclusions may be drawn with respect to the
long-term influence of prosthetic treatments on the
chewing process, which could be a focus of future
research. Despite the limitations, remarkable differ-
ences were observed between the CD and RPD
groups, demonstrating the importance of retaining
natural teeth for proper masticatory function.
Conclusion
Remarkable differences were found between groups,
with a faster chewing sequence, higher maximum
chewing velocity and greater vertical and lateral jaw
excursions observed in RPD wearers compared with
CD wearers. These results were probably a conse-
quence of the higher retention and stability of RPD,
revealing the importance of the natural remaining
teeth for masticatory function.
Acknowledgments
The Ethics Committee of the Piracicaba Dental School,
University of Campinas (Piracicaba, Brazil) approved
this research (protocol # 094/2011). Authors declare
no conflict of interests. This research was carried out
without funding.
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Correspondence: Renata C. M. Rodrigues Garcia, Department of
Prosthodontics and Periodontology, Piracicaba Dental School, Uni-
versity of Campinas, Av. Limeira, no. 901, Bairro Arei~
ao, Piracicaba,
SP, Brazil, CEP 13414-903. E-mail: regarcia@fop.unicamp.br
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