The remodeling of the edentulous mandible

Abstract

In a sample of mandibles having complete or nearly complete loss of dentition, the left half of each mandible was serially sectioned. The entire perimeter of each section was analyzed for the distribution of resorptive and depository periosteal surfaces, and from this information, the fields of remodeling were mapped for the mandible as a whole. The most common patterns of combined resorption-deposition and the range of variations were then determined. The over-all distribution of remodeling fields in the edentulous mandible differs markedly from that in the young, growing mandible. In most of the edentulous specimens, the surface of the basal bone on both the medial and lateral sides of the corpus is of a depository nature. The overlying alveolar regions on both the lingual and buccal sides, however, are characteristically resorptive. Significantly, the placement of the reversal line between the alveolar resorptive and the basal depository areas is much lower (i.e., at the level of the mental foramen) on the buccal side. Except for its inferior part, the lateral side of the ramus tends to be largely resorptive in character, and the posterior half of the lingual side also tends to be resorptive. Unlike the child's mandible, the posterior border of the ramus is resorptive, and the posteroanterior dimension of the ramus (not the whole mandible) becomes reduced and narrowed in conjunction with resorption along the anterior border. However, the amount removed from the anterior ramus is actually added to the dimension of the corpus, which becomes longer. Further, removal from the posterior ramus border does not affect the over-all length of the mandible unless condylar reduction is also involved. Also, over-all arch length is not decreased, because the surface of the mental protuberance is retained as a depository type of field (or at least does not become actively resorptive). The corpus-ramus angle (not gonial angle) is increased in the antegonial region. Because of the opening of this angle, over-all mandibular length as well as arch length is increased. In about half of the specimens, arch width was not decreased, because the lateral side of the corpus is usually of a depository nature. Notching of the anterior side of the condylar neck and the inferior part of the anterior ramus border is associated with resorptive fields in these regions, changes that are presumed to be a consequence of pressure contacts made with the articular tubercle and the maxillary tuberosity, respectively, in conjunction with a forward rotation of the whole mandible. The inferior direction of corpus realignment relative to the basal part of the ramus also increases the notching effect in the antegonial region, an effect augmented by the presence of the resorptive field in the notch itself. Certain specific variations commonly occur in several major regions of the mandible on both the lateral and medial sides...