Chinese Medical Journal 2010;123(7):917-921 917

Original article
Stress area of the mandibular alveolar mucosa under complete
denture with linear occlusion at lateral excursion
LÜ Ya-lin, LOU Hang-di, RONG Qi-guo, DONG Jian and XU Jun

Keywords: complete denture; linear occlusion; stress area distribution; finite element analysis

Background The rocking and instability of a loaded complete denture (CD) during lateral excursion reduce the bearing
area under the denture base, causing localized high stress concentrations. This can lead to mucosal tenderness,
ulceration, and alveolar bone resorption, and the linear occlusion design was to decrease the lateral force exerted on the
denture and to ensure denture stability. But it is not known how the bearing areas of linear occlusal CDs (LOCDs) and
anatomic occlusal CDs (AOCDs) differ. The purpose of this study was to analyze and compare the distributions of the
high and low vertical stress-bearing areas in the mandibular alveolar mucosa under LOCDs and AOCDs at lateral
excursion.
Methods Computerized tomography (CT) and finite element analysis were used to establish three-dimensional models
of an edentulous maxilla and mandible with severe residual ridge resorption. These models were composed of maxillary
and mandibular bone structure, mucosa, and the LOCD or AOCD. Lateral excursion movements of the mandible were
simulated and the vertical stress-bearing areas in the mucosa under both mandibular CDs were analyzed using ANSYS
7.0.
Results On the working side, the high stress-bearing (–0.07 to –0.1 MPa) area under the LOCD during lateral
excursion was smaller than that under the AOCD, while the medium stress-bearing (–0.03 to –0.07 MPa) area under the
LOCD was 1.33-fold that under the AOCD. The medium stress-bearing area on the non-working side under the LOCD
was 2.4-fold that under the AOCD. Therefore, the overall medium vertical stress-bearing area under the LOCD was 20%
larger than that under the AOCD.
Conclusions During lateral excursion, the medium vertical stress-bearing area under a mandibular LOCD was larger
and the high vertical stress-bearing area was smaller than that under an AOCD. Thus, the vertical stress under the LOCD
was distributed more evenly and over a wider area than that under the AOCD, thereby improving denture stability.
Chin Med J 2010;123(7):917-921

Frush2 was to decrease the lateral force exerted on the

A complete denture (CD) is a type of
mucosa-supported prosthesis. Only with good
stability does a denture have a good border seal, which is
prerequisite for the retention and protection of the
residual ridge. A variety of factors can affect denture
stability, including the supporting tissues and the denture
itself. For the supporting tissues, a well-rounded residual
ridge with a large bearing area is important for denture
stability. The bearing area of an edentulous lower jaw is
about half that of the upper jaw,1 and will bear the larger
stress when each is loaded with an equal occlusal force.
This is particularly true after a mandibular residual ridge
has atrophied, which decreases the bearing area.
Therefore, research on the stress distribution on the
mandibular residual ridge is much more meaningful than
that performed on the maxilla. With regards to the denture
itself, properly arranged artificial teeth, good occlusion,
and a well-shaped polished denture base surface all
contribute to denture stability. The rocking and instability
of a loaded CD during lateral excursion reduce the
bearing area under the denture base, causing localized
high stress concentrations. This can lead to mucosal
tenderness, ulceration, and alveolar bone resorption,
which can further deteriorate denture stability.
The goal of the linear occlusion design described by
denture and to ensure denture stability. Many clinical
studies3,4 have shown that linear occlusal complete
dentures (LOCDs) are more stable and exhibit less bone
resorption than anatomic occlusal complete dentures
(AOCDs). Theoretically, the potentially larger bearing
area under an LOCD compared to an AOCD may allow a
more uniform distribution of stress, although this has not
been proven. Furthermore, it is not known how the
bearing areas of LOCDs and AOCDs differ.
Previous finite element analyses (FEAs) have typically
used the peak stress value for the stress distribution on the
DOI: 10.3760/cma.j.issn.0366-6999.2010.07.028
Center of Stomatology, Beijing Anzhen Hospital, Capital Medical
University, Beijing 100029, China (Lü YL and Dong J)
College of Engineering, Peking University, Beijing 100871, China
(Lou HD and Rong QG)
Department of Prosthodontics, School & Hospital of Stomatology,
Peking University, Beijing 100081, China (Xu J)
Correspondence to: Dr. XU Jun, Department of Prosthodontics,
School & Hospital of Stomatology, Peking University, Beijing
100081, China (Tel: 86-10-62179977 ext. 2347. Fax:
86-10-64416242. Email: xujundentist@gmail.com)
LÜ Ya-lin and LOU Hang-di contributed equally to this article.
This study was supported by a grant from the Beijing Natural
Science Foundation, China (No. 3073018).
918
Figure 1. Three-dimensional solid geometric models of denture of two occlusal schemes. A, B: AOCD. C, D: LOCD.
Figure 2. Three-dimensional solid geometric models of skull and denture of two occlusal schemes. A: AOCD. B: LOCD.
mucosa under the denture base. By now, no study has
determined what area of the mucosa under a CD base is
stressed. We hypothesized that different vertical stress
distributions are found in the mandibular mucosa under
LOCDs and AOCDs. To test this, we used computerized
tomography (CT) scans and FEA software to establish three
dimensional (3-D) FEA models of a maxilla and mandible
with severe residual ridge resorption (RRR). These models
consisted of maxillary and mandibular bone structure,
mucosa, and either an LOCD or an AOCD. Lateral
excursion was simulated and the vertical stress areas of the
mucosa under the LOCD and AOCD were analyzed.
METHODS
Establishment of 3-D FEA models
A 76-year-old female volunteer with an edentulous jaw
and a class IV mandibular residual alveolar ridge was
enrolled after informed consent was obtained.5 The
interocclusal record of the patient was taken and was
transferred to an articulator. An LOCD and an AOCD
were fabricated on the same articulator, using
interchangeable artificial teeth, so that the two dentures
were highly identical except for the occlusal schemes of
the artificial molars. The AOCD was composed of Gold
Nail porcelain teeth with a 30° cusp inclination (Shanghai
Dental, China), while the LOCD had linear porcelain
teeth (Geneva 2000TM, Switzerland).
After inserting the LOCD or AOCD properly, the subject
was asked to bite in centric occlusion. The patient laid in
a supine position with the orbitomeatal plane parallel to
the horizontal plane and with the cephalosome fixed.
Successive ultrathin transverse CT scans (AQUILION 64
slice spiral CT, Toshiba, Japan) were obtained from the
Chin Med J 2010;123(7):917-921
mandible inferior plane to the superior infratemporal fossa
plane. A 0.5-mm slice thickness and a 0.3-mm spacing
were used, and a total of 412 CT units were obtained.
Boundary information of the bone tissue was extracted
from the CT images, based on the threshold of the bone
tonal value. The data were transferred to the FEA
software ANSYS 7.0 (ANSYS, USA) and were processed
to establish 3-D solid models of the skull (with maxilla
and mandible, including the cortical and cancellous bones)
and the LOCD/AOCD. Using a Boolean operation, the
alveolar mucosa were modeled between the denture base
and the bone structure. The mandibular complex (Figures
1 and 2), including the mandible, alveolar mucosa, and
CD, was simulated to the lateral excursion position for
the AOCD or the LOCD. The geometric models were
utilized for meshing using the FEA 10-node tetrahedron
module, and were comprised of a number of nodes (LA:
255452; LL: 253475) and elements (LA: 167136; LL:
165629). The model materials were regarded as
continuous and isotropic linear elastic materials, with
mechanical properties (Table 1) obtained from literature.6
Table 1. Mechanical properties of materials
Materials Elastic modulus (MPa) Poisson’s ratios
Cortical bone 13700 0.30
Cancellous bone 1370 0.30
Mucosa 3 0.45
Denture base 2352 0.30
Porcelain tooth 82800 0.28
In ANSYS, the mandibular complex models were set to
the lateral excursion position, with the CD at a balanced
occlusion and the anterior artificial teeth not in contact.
The degrees of freedom of the maxilla’s upper nodes of
and the nodes at the rotation axis of the bilateral condyle
Chinese Medical Journal 2010;123(7):917-921 919

were set to zero. The left and right masticatory forces in the stress range of –0.1 to –0.2 MPa was constituted by
(Table 2) were assumed to be unequal at lateral excursion. dispersed nodes from which the stress-bearing area could
Forces due to muscle attachment on the mandible area not be calculated (Figure 4). On the molar region of the
were calculated according to Rues et al7 and Schindler et working side, the AOCD and LOCD high stress-bearing
al8 in the anatomic direction (Table 3). (–0.07 to 0.10 MPa) areas were 38 mm2 and 0,
respectively. The LOCD medium stress-bearing (–0.03 to
Table 2. Muscle forces due to muscle attachment on the mandible 0.07 MPa) area was 1.33-fold compared with that under
area (n) the AOCD. On the non-working side, the LOCD high
Muscles Working sides (right) Non-working sides (left)
stress-bearing area was 0.92-fold that under the AOCD,
Masseter 30 15
Medial pterygoid 45 10
and the LOCD medium stress-bearing area was 2.4-fold
Temporalis 30 15 that under the AOCD (Table 4).
Table 4. Vertical stress-bearing area (mm2) of the mucosa under the
Table 3. Anatomic direction of muscle forces
base of complete dentures at lateral excursion
Muscles Starting positions Pointings
Ranges of stress (Mpa)
Masseter Angulus mandibulae masseteric Zygomatic arch margo Variables
tuberosity inferior median part 0 to –0.03 –0.03 to –0.07 –0.07 to –0.1 Total
Medial pterygoid Angulus mandibulae interior Descending lamina of Working side (right)
pterygoid tuberosity sphenoid bone interior AOCD 265 178 38 481
Temporalis Mandibular coracoid process tip Temporal bone surface LOCD 310 237 0 547
center LOCD/AOCD 1.17 1.33 0 1.14
Non-working side (left)
Model analysis AOCD 280 70 12 362
The vertical (Z-axis) stress distribution of the mucosa LOCD 305 167 11 483
LOCD/AOCD 1.09 2.39 0.92 1.33
under each denture base was calculated using ANSYS.
Both sides
The overall stress range was divided into eight successive
AOCD 545 248 51 844
intervals and was inputted as a parameter to search the LOCD 615 404 11 1030
nodes of each respective value. The nodular areas were LOCD/AOCD 1.13 1.63 0.22 1.22
calculated to obtain the stressed area in each specific
range. The mucosal surface was categorized according to Because the vertical stress-bearing area under the LOCD
different stress ranges, and the distribution areas of the was 0 on the working side, we compared the total vertical
different ranges were estimated. The vertical stresses on both the working and non-working sides. The
stress-bearing areas of the mucosa under both the LOCD total high vertical stress-bearing area of the mandibular
and the AOCD were analyzed. mucosa under the LOCD was 0.22-fold compared with
that under the AOCD, while the total medium vertical
RESULTS stress-bearing area under the LOCD was 1.63-fold
compared with that under the AOCD. Considering the
Three-dimensional FEA models (Figure 3), which total vertical stress-bearing area of the mandibular
incorporated the maxilla, mandible, alveolar mucosa, and mucosa under the CDs, the area under the LOCD was
LOCD or AOCDs at lateral excursion, were successfully 1.2-fold that under the AOCD.
established. The cranial bones were fixed by a constraint
at the upper areas, and the muscular forces were loaded DISCUSSION
on the mandible at the muscle attachment sites. The
occlusal force was generated by the contact of the Here, we compared the stressed mucosal areas under an
occlusal surface with the artificial teeth on the dentures. LOCD and an AOCD. At the working side of lateral
excursion, the high stress-bearing (–0.07 to –0.1 MPa)
The mucosal region under either the AOCD or the LOCD molar area of the mucosa under the AOCD was larger

Figure 3. Three-dimensional finite element models used here, including the maxilla, mandible, alveolar mucosa, and complete dentures.
Figure 4. Vertical stress distribution area of the mucosal surface under the base of a complete denture on lateral excursion. A: AOCD. B:
LOCD.
920
than that under the LOCD, suggesting that the AOCD
caused higher stress concentrations due to an uneven
pattern of mucosal stress. The medium stress-bearing
(–0.03 to –0.07 MPa) areas under the LOCD were
1.33-fold and 2.4-fold under the AOCD on the working
and non-working sides, respectively. This result indicated
that the stress distribution of the LOCD was evenly more
than that of the AOCD, and the LOCD could distribute
the stress to both sides of the CD, thereby enhancing its
stability.
Only with good stability does a CD have an integrated
border seal and is the stress even distributed across the
mucosa. Various factors influence the stability of a CD;
however, the residual ridge, as the primary stress-bearing
area, is one of the most important factors. The fullness of
a residual ridge influences the area of denture base, and
therefore potentially influences the capability of retention.
Low or bladed residual ridges are not good for the
retention, stability, or support of a CD. The retention and
stability are the structural and mechanical bases of
mastication and phonetic/aesthetic function of a denture.
The stability of a CD is enhanced when the primary
stress-bearing area, particularly the dynamic area, is
increased.
Abundant research has shown that there is a significant
correlation between the occlusal scheme chosen and the
resultant horizontal force, which influences denture
retention and stability.9-14 In order to maintain the health
of the supporting tissue and decrease RRR, a vertical
occlusal force on the residual ridge is sometimes made
using teeth with reduced cusp inclinations or using
cuspless teeth. Clinical research has also shown that CDs
with occlusion modified in such a way present better
stability.4 For cases with severe RRR, LOCDs exhibit
better stability and less bone resorption than AOCDs.
However, it has not been studied that to what extent the
AOCD and LOCD affect the stressed area.
Previous studies investigating the stress distribution on
the mucosa under a CD base have typically used the peak
stress value as the parameter for detecting focal overload,
which can cause mucosa lesions and bone resorption.15-18
However, singularities during FEA setup can interfere
with the definition of this peak value, thus result in
discrepancies between such models and the clinical
situation. Stress distribution characteristics are not
straightforward enough to describe the relationship
between an increased bearing area and the improvement
of denture stability when CDs with different occusal
schemes are being compared. In that sense, the
stress-bearing area, which has not been previously used,
could be a more straightforward quantitative parameter
for mucosal stress distribution under a CD.
Proper simulation is the key to a useful FEA model. In
this study, ultrathin CT images were used to obtain high
geometric similarity between the model and the clinical
Chin Med J 2010;123(7):917-921
situation. Loading through the muscle forces is much
closer to the actual clinical situation than loading through
the denture or alveolar residue, enhancing the predictive
accuracy of the calculation.
We used the dental arch switching technique to ensure
that the same tissue surface area was found under each
denture base. By efficiently increasing the functional
stress-bearing area under a mandibular CD, the total
stress is evenly distributed and the loading capability of
the supporting tissue is utilized sufficiently. This not only
protects the supporting tissue, but can also increase
denture stability. Although the AOCD used here showed
balanced occlusion, it also displayed a smaller
stress-bearing area on the non-working side of the
mucosa, indicating that this side did not sufficiently share
the occlusal burden. The total vertical stress-bearing
mucosal area under the LOCD was 1.2-fold compared
with that under the AOCD, indicating that the
stress-bearing area of linear occlusion was 20% larger
than that of anatomic occlusion. This is beneficial for the
simultaneous and even distribution of occlusal force on
the entire stress-bearing area. The results of this study
provide scientific data that supports former research on
LOCDs.
At lateral excursion, the vertical stress-bearing area of the
mandibular mucosa under an LOCD was larger and under
a lower stress than that under an AOCD. This indicated
that an LOCD can distribute stress more evenly and over
a larger area than an AOCD, which is beneficial for
improving denture stability and maximally utilizing the
loading ability of the supporting tissue.
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Edited by PAN Cheng