Mandibularandrifaisal Con

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165

 Int. J. Morphol.,

29(4):1189-1194, 2011.

Mandibular Fossa Depth Variations:Relation to Age and Dental State

Variaciones en la Profundidad de la Fosa Mandibular: Relaciones con Edad y Estado Dental

*Luis Ernesto allesteros Acu!a" **Luis Miguel Ra#ire$ Aristeguieta % *&erardo Mu!o$ Mantilla

ALLES'ER(S) L E" RAM+RE,) L M % M-.(,) & Mandibular fossa depth variations: Relation to age and dental state. Int.

 J. Morphol., 29(4):1189-1194, 2011.

S-MMAR/: A andibular fossa depth !orrelation "ith dental !ondition and age in huans. 120 fresh ale andibular 

fossas "ere easured fro the deepest area of the fossa to a hori#ontal referen!e line. $he saples "ere !lassified a!!ording to age

and dental state %dentate, partiall& dentate and totall& edentulous' and a ultivariate anal&sis "as eplo&ed. (ub)e!ts average age "as

41.1 %20-8*'. $here "ere ore partiall& dentate individuals %*9.1+' than dentate %0' or edentulous ones %10.8'. Average fossadepth "as +.9 %+.+-.1 9*/' "hi!h signifi!antl& de!reased "ith in!reased age and dental health deterioration %p0.01'. A

 period of five &ears edentulis in!reased the lielihood of andibular fossa flattening %+.9 ' b& 20.+ and .2 in dentate ones.

3ur findings found an asso!iation bet"een dental state and age as deterinant fa!tors in redu!ing andibular fossa depth.

0E/ 1(RDS: 'e#poro#andibular 2oint" Mandibular fossa" Dental condition" Articular tubercule" Agegroups

+3'R(D-4'+(3

$he teporoandibular )oint %$M' presents a

orpholog& in "hi!h the teporal surfa!e !onstituent has

an (-shape in adults sagittal !onfiguration, !onsisting of a proinent arti!ular tuber!le %einen!e' and a !on!ave

andibular fossa %5i!el et al., 1988'. $M subits

intra!apsular stru!tures %!ond&le, dis!, ligaents and

andibular fossa' to !onstant reodelling %adaptation' due

to in!reased e!hani!al load bet"een the $M6s osseous

stru!tures %Moffett et al., 19+47 aada et al ., 2004'.

ie"ise, su!h reodelling in the glenoid fossa and

!ond&le that also o!!urs throughout life %fro !hildhood to

adult' sees to respond to a variet& of !onditions %Meng

et al.,

2008'. isuse or lesser asti!ator& a!tivit& in edentulous

 patients %having less asti!ator& strength' and !hanges in

the !onsisten!& of their diets sees to generate it. Another 

 possible !ause !an be observed su!h as partial edentulis,

orthopaedi! aparatolog& and orthodonti! strengths,

Angle6s !lass and o!!lusions, over!losure, the

 presen!e of teporoandibular disorder s and

degenerative )oint disorders, oral habits, a!rotraua

and i!rotraua, andibular as&etr&, fa!ial

as&etr& and aging %$addei et al., 19917 asinevi!ius et 

al., 200+a, 200+b7 ;loridi < Matson, 1987 =ranados,

1997 =alante et al., 199*7

>irttiniei et al., 19907 ?atsavrias < @ala#onetis, 200*7

>irttiniei < ?antoaa, 19927 $our et al., 200*7

/arlsson

< 3berg, 1947 3berg et al., 191'.

ental erosion and total or partial edentulis see

to be !orrelated "ith flattened fossas. $he absen!e of teeth

and dental erosion are dire!tl& proportional to regressive

reodelling of the arti!ular tuber!le %/arlsson < 3berg7

Bla!"ood, 19++'. Mongini %19+8, 192' proved that

regressive reodelling "as present in the arti!ular tuber!le

and range in!reased fro !lini!al situations regarding den-

tal erosion %due to attrition' to total edentulis. (u!h

!hanges are signifi!ant "hen individuals have been

edentulous for periods lasting ore than three &ears%Moffett et al .'.

$he !hara!teristi!s of the andibular fossa have

 been re!orded b& different eans: pantograph&,

toograph&, agneti ! resonan!e, panorai!

rad iograph&, and anteroposterior and lateral radiograph&.

/orrelation has been sought bet"een arti!ular orpholog&

and !hara!teristi!s su!h as dental state, !raniofa!ial

orpholog&, age and gender. Attepts have been ade to

!lassif& the andibular fossa based on its verti!al depth

%deep, ediu or flat', taing

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ALLES'ER(S) L E" RAM+RE,) L M % M-.(,) & Mandibular fossa depth variations: Relation to age and dental state. Int. J. Morphol., 29(4):1189-1194, 2011.

the perpendi!ular to a hori#ontal anatoi!al plane as

referen!e %>irttiniei < ?antoaa7 e Melo, 197 Gedel

et al., 1987 Huir!h et al ., 19++'.

(tru!tural variations in the $M related toandibular fossa depth in !adaveri! aterial reains a

topi! of interest %$sunoda et al ., 200'. $his stud& "as

aied at finding a !orrelation bet"een dental state and

stru!tural reodelling of the $M in different aged adult

ales. t "as eIpe!ted to find a !ausal relationship

 bet"een edentulis and regressive reodelling and

redu!ed andibular fossa depth.

MA'ER+AL A3DME'5(D

$M blo!s "ere eItra!ted fro un!laied fresh

ale !adavers %/olobian ;orensi! Medi!ine nstitute'

after institutional revie" board and Dniversit& Jthi!s

/oittee6s !onsent "as obtained. A bi-auri!ular in!ision

of the s!alp "as ade during ne!rops&, separating the

te- poral-frontal and teporal-o!!ipital flaps in anterior 

and posterior dire!tions, respe!tivel&. A !alvarial rese!tion

"as then done via a hori#ontal !ut through the

!raniu, follo"ed b& eItra!tion of the en!ephalus,

leaving the base of the !raniu eIposed. Ja!h $M blo! 

"as eItra!ted using an ele!tri! sa" in an approa!h

through the iddle !ranial fossa. $he saple obtained

fro ea!h )oint %together "ith ad)a!ent tissue' "as

reoved in a + I * I * !  blo! and left in 10

foraldeh&de for tissue fiIation and preservation. $he

fibers of the asetter and teporalis

us!les "ere rese!ted and the lateral !apsule side of the

$M "as also in!ised. A hori#ontal referen!e line "as

dra"n to easure the depth of the andibular fossa,

 )oining the aIiu height of the arti!ular tuber!le and

the  pre- auri!ular tuber!le lo!ated posterior andlateral to the sEuaous-t&pani! fissure %asinevi!ius et 

al ., 200+b7 :e Melo7 Gedel et al .7 Huir!h et al., 19++'.

A perpendi!ular line "as dra"n fro the deepest area of 

the fossa to this hori#ontal referen!e line %;ig. 1'. $he

verti!al easureent obtained represented the depth of 

the andibular fossa. 3ne resear!her too this

easureent "ith an ele!troni! !alibrator %Mituto&o'.

A!!ording to the in!lusionKeI!lusion !riteria,

saples "ere !olle!ted fro adult !adaveri! ales %aged

over 20' that la!ed an& signs of traua in the $M

region. $he saples being studied "ere !lassified

a!!ording to age using the follo"ing age-ranges: 20-29,0-9, 40-49, *0-*9 and

+0 or older. $he !adaveri! spe!iens dental state "as

!lassified as follo"s: dentate %having bilateral olar 

support and 28 or ore teeth', partiall& dentate %la!ing

olar support and the presen!e of + to 20 teeth' and

totall& edentulous %la!ing teeth' %arling, 1984'.

=M 4 "as used for ultivariate anal&sis, "here

the aIiu odel "as siplified b& the progressive

eliination of !onforant variables. Relative or absolute

!hange in residual deviation !aused b& su!h reoval "as

tested for signifi!an!e using the ;-ratio. A signifi!ant

!hange "as defined as that "hi!h had greater than 9*

 probabilit& of not having o!!urred b& !han!e.

;ig. 1. >arasagittal !ross-se!tion of 

the right teporoandibular )ointrepresenting the easureent of 

andibular fossa depth fro t"o

referen!e points: at: Arti!ular 

tuber!le, pgt: >ost-glenoid !rest, d:

is!, !: /ond&le, ee!: JIternal ear 

!ondu!t.

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RES-L'S

120 blo!s of $M "ere evaluated fro individuals

having an average age of 41 %range 20 to 8*'. $he predoinant dental state "ithin the saple "as partiall&

dentate %*9.2', follo"ed b& dentate %0' and edentulous

%10.8'. $he dentate !ondition predoinated during the third

de!ade "hilst partiall& dentate individuals "ere ore

freEuent in the fourth de!ade and on"ards until dental

absen!e being evident in the group aged older than +0, the

edentulous !ondition predoinating in this group %;ig. 2'.

;ig. 2. $he distribution of the spe!iens dental state b& age-group. L

aIis: age %b& age group'7 aIis: Eualit& of dental state %per!entage'.

Average fossa depth "as +.9 %9*/: +.+-.1

'. =reater depth "as observed in the 20-29 age-group %-

1 ', be!oing signifi!antl& redu!ed "ith an in!rease in

age %$able '. Regarding dental state, depth in the + dentate

spe!iens "as .+ , +.94 in partiall& dentate ones

%1 saples' and + in toothless ones %1 saples'. $his

sho"ed a progressive redu!tion in the depth of andibular 

fossa related to deterioration in dental !ondition %; .7

2,11 .; K >

0.01'.

;lat fossas predoinated in edentulous sub)e!ts

%9.9' %$able ', "hilst deep fossas  predoinated

in dentate sub)e!ts %2.' having signifi!ant

differen!es %L211.*+, 2 ;=.7 p0.001'. Mandibular 

fossa depth presented a biodal distribution %flat and

deep' having an apparent !ut-off point at +.9 . (u!h

distribution led to arbitraril& defining the dependent

variable as being binar& in the odel. $he independent

variables "ere age %defined as !ontinuous variable'

and dental state %defined as being dis!rete "ith three

fa!tors: edentulous, partial and dentate'. Dnivariate

anal&sis revealed signifi!ant differen!es bet"een the

Eualit& of flattening, age and dental state. Average age

for spe!iens having flattened fossas "as 4+ %41.+-*0.4, 9*/' "hilst average age "as signifi!antl& less

%+. &ears' for those having deep fossas %2.9-9.+,

9*/'. entate freEuen!& "as signifi!antl& higher 

in the group having deep andibular fossas %p0.01'.

Both variables %age and dental state' "ere

signifi!antl& !orrelated "ith fossa depth in univariate

anal&sis. A aIiu odel "as !reated in

ultivariate anal&sis !ontaining age, dental state and

their intera!tion. $he latter "as the onl& variable

retained in the ad)usted iniu odel,  produ!ing

soe estiates having negative inter!ept %!21.,

;= K p0.01', allo"ing the probabilit& of the fossa be!oing flat tened in differing situations to  be

!al!ulated. $hus, the probabilit& of a **-&ear-old

 person "ith all hisKher teeth inta!t of having a flattened

fossa "as 8.4, "hilst for an edentulous person of 

the sae age su!h probabilit& in!reased b& alost

double %+.'. (u!h differen!e in!reased "ith age

%;ig. '. t "as found that edentulis lasting five &ears

in!reased the probabilit& of andibular fossa flattening

 b& 20.+ %+.9 ', "hilst this "as .2 in dentate

sub)e!ts.

$able . Mandibular fossa depth related to age.$able . istribution of dental state b& t&pe of andibular 

fossa flattening.

A ge6gro up   Mandib ular fossa bloc7    M easure#ent   D ental state Flat fo ssas Deep fo 

20 N 29  2 .1  entate 1 0 %2.' 2+ %2.'

0 N 9 2 8 .14 >artiall& dentate  8 %*.*' %4+.*'

40 N 49 2 * +.9+ J dentulous 1 0 %9.9' %2'

*0 N *9 1 9 +.+4 $ otal *8  +2 

+ 0 - %O' 1 + +.12

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χ8 9 ;<) 8 F&" p=>>>

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;ig. . Relationship bet"een age, dental state and fossa depth.

D+S4-SS+(3

Average depth "as +.9 in our findings, this being less

than prehistori! spe!iens having .* presented b& 3"en et al .

%1992', =alante et al. have reported a +.8 depth and Meng et 

al., sho" in a stud& "ith /$ s!anner depths of .1 1.*+. $he

findings of ;loridi < Matson, "ere .1 in ales and +.2

in feales, no signifi!ant differen!es having been found bet"een

edentulous and partiall& edentulous sub)e!ts.

Jven though e Melo reported 8.8 depths in dentate

/au!asian individuals and 8.12 in toothless ones "ithout

signifi!ant differen!es, ultivariate !orrelation in our findings led

to signifi!ant differen!es being found bet"een age-groups and

dental Eualit&. A!!ording to the results then, the probabilit& of fossa

flattening "as 8.4 for an individual in "ho herKhis teeth had

 been !onserved and double %+.' for an edentulous !ondition.

Gith this in ind, edentulis lasting for five &ears in!reased the

 probabilit& %20.+' of andibular fossa flattening %+.9 ',

"hilst this "as .2 in dentate sub)e!ts.

$here sees to be a dire!t proportional relationship bet"een

age and arti!ular reodelling. Huir!h et al . %19+*' have sho"n that

fossa depth be!oes redu!ed "ith age. $he andibular fossa seesto be!oe reodelled in response to !hanges in arti!ular d&nai!s

asso!iated "ith bioe!hani!al behaviour during the fun!tion and

responds to for!es involved in noralit&, d&sfun!tionalit& and

disuse. Arti!ular reodelling studies !oin!ide regarding teporal

 bone, dis! and !ond&le adaptive !apa!it&, being greater in the latter 

%aada et al.7 @ardtann et al ., 1989'. A!!ording to $ourF et al.

and Bla!"ood the andibular fossa also be!oes reodelled in

response to ph&siologi!al reEuireents originating fro !hanges

in dentition throughout life %Meng et al.'. ental state is a fa!tor 

affe!ting arti!u- lar tuber!ule angulation and thereb& fossa depth7

thus, the saller 

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the tuber!ule angle, the lesser andibular fossa depth. ental

erosion %abrasion-attrition' and total edentulis generate flattened

fossas, !ontrar& to natural dentition or !oplete prostheti! state,

"hi!h have sho"n deep fossas %aada et al .7 =alante et al .7

asinevi!ius et al ., 200+b'. t is understood that posterior or anterior  partial edentulis generates less flattened andibular fossas than

those observed in total edentulous people "ho have had no

restoration %=ranados7 e Melo'.

ie"ise, verti!al diension and !ranio- !ervi!al ratios are

related to andibular positions, "hi!h a& genera te t"o possible

regressive reodelling s!enarios in edentulates %arling'.

>ossible e!hani!al overload on arti!ular tuber!ule and reodelling

due to disuse in patients having varied us!ular d&nai!s %due to

u!o-supported prostheti! situations' and in "hi!h us!ular 

strength be!oes redu!ed %@ardtann et al., 1989'. Redu!ed

verti!al diension %ver& !oon in patients having a total

 prosthesis' generates greater dorsifleIion %ventral-eItension' of 

the !ervi!al !olun, generating protruded andibular positions and

lesser dorsal !ranio-!ervi!al angle leading to probable e!hani!al

effe!ts on $M due to an in!rease in !ond&lar pressure on the

teporal tuber!le %=allo, 2000'.

Jven though less adaptive !apa!it& is re!ogni#ed during

an individual6s advan!ed age, arti!ular reodelling in su!h

 people has been proved to be !onstant, espe!iall& in edentulates

having total prosthes is %$addei et al .'. $he prostheti!

situation of edentulates "as non-eIistent in our saples, thereb&

seeing to !oin!ide "ith the findings of $addei et al. ie"ise, a

redu!tion in the height of the fossa "as observed in individuals"ho had reained edentulous for three &ears !opared to dentate

sub)e!ts %Moffett et al .7 >irttiniei et al.7 3berg et al .7 Mongini,

19+8'. (e"ard %19+' also found a relationship bet"een flattening

of the fossa and dental erosion and loss in a stud& of 1** Australian

aboriginal !ranius. ie"ise, Ri!hards %1990' found d&nai!,

!opleI degenerative-adaptive !hanges in $M asso!iated "ith the

degree of denta l loss, e rosio n and edentulis, espe!iall& in the

arti!ular !ond&le. Jven though Gedel et al., did not !oin!ide "ith

these findings, the& !ould not ephati!all& re)e!t the sin!e the

 population, "hi!h the& had studied, "as part ia ll& edentulate or 

had suffered re!en t edentulis7 ho"ever, their stud& !oin!ided

"ith

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3berg et al ., on finding that 2* of the arti!ular 

spe!iens sho"ed flattened fossas. @inton %1981' has

stated that the orphologi!al alteration of flattening in the

$M responds to the degree of dental erosion or 

 progressive edentulis and that su!h findings !an befound bet"een different ethni! groups %Jsios,

Australians' having different oral and dietar& habits.

3!!lusal !onditions thus see to deterine the degree of 

arti!ular reodelling.

Jvidentl& there sees to be a relationship bet"een

dental state, age and andibular fossa depth, "hi!h "as

!orroborated b& our results. ;uture investigations should

 be fo!used on seeing %b& anatoi!al or radiologi!al

ethods' ore eviden!e about the pathoph&siolog& of 

these findings sin!e it sees to have a ultifa!torial origin

!on!oitant "ith dental state. $he obtained results

have !lini!al signifi!an!e due to the !orrelation sho"ed.

/onsidering s&stei! disease and drug !onsuption

individual histor& in !lini!al iagenologi!al future studies

that ust be !arried out that perit "ider !orrelations.

$he liitations of this stud& are related to the

saple si#e, the absen!e of a edi!al s&stei! histor& and

a broader !lassifi!ation %!raniofa!ial, arti!ular and dental

o!!lusion relations' that a& odif& the interpretation of 

future results.

4(34L-S+(3

3ur findings led to pointing out the asso!iation

 bet"een dental state and age as being deterinant fa!tors

in redu!ing andibular fossa depth.

A403(1LED&EME3'S

Ge "ould lie to than the ;orensi! Medi!ine

nstitute %nstituto de Medi!ina egal' for its u!h-

appre!iated donation of saples.

ALLES'ER(S) L E" RAM+RE,) L M % M-.(,) M & Paria!iones en la profundidad de la fosa andibular: Rela!iones

!on edad & estado dental. Int. J. Morphol., 29(4):1189-1194, 2011.

RES-ME3: (e observQ la !orrela!iQn entre la profundidad de la fosa andibular !on la !ondi!iQn dental & la edad en los

huanos. 120 fosas andibulares fres!as de hobres fueron edidas desde la #ona s profunda de la fosa a una lFnea hori#ontal de

referen!ia. as uestras fueron !lasifi!adas de a!uerdo a la edad & el estado dental %dentados, par!ialente dentados & desden tados en

total' epleando un anlisis ultivariado. a edad edia de los su)etos fue de 41,1 %20-8*'. @ubieron s personas par!ialente

dentadas %*9,1+' Eue los dentadas %0' o desdentadas %10,8'. a profundidad edia de la fosa edia fue de +,9 %+.+ a .1

, / 9*' la !ual disinu&Q signifi!ativaente !on el auento de edad & el deterioro de la salud dental %p 0,01'. Dn periodo de!in!o aSos de edentuliso auentQ de la probabilidad de aplanaiento de la fosa andibular %+,9 ' en un 20,+ & ,2 en los

dentados. 5uestros halla#gos en!ontraron una aso!ia!iQn entre el estado dental & la edad !oo fa!tores deterinantes en la redu!!iQn

de profun- didad en la fosa andibular.

PALARAS 4LAVE: Articulaci?n te#poro#andibular" Fosa #andibular) 4ondici?n dental" 'ub@rculo articular"&ru6 pos etarios

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Dirección para correspondencia:

Dr. Luis Ernesto Ballesteros

Basic Science Department

Universidad Industrial de Santander Calle 10 !1"#1$% Bucaraman&a

C'L'(BI"

)el*+ono: 5,#0-,#6$000 e/t. $1!

a/: 5,#0-,#6556-$

Email: lallest5623a4oo.es

eceived: 1,#0$#!011

 "ccepted: 0!#0#!011