Use of finite element analysis for the assessment of biomechanical factors related to pain sensation beneath complete dentures during mastication

Statement of problem: The pain commonly suffered by denture wearers during mastication is not documented in the objective biomechanical criteria for the pressure pain threshold.

Purpose: The purpose of this finite element analysis study was to determine whether the pressures developed beneath a removable mandibular complete denture during mastication would exceed the average pressure pain threshold in patients for whom the denture foundation had an acceptable load-bearing capacity.

Material and methods: A patient with an acceptable load-bearing denture foundation was modeled with finite element analysis. The denture/mucosa interface was modeled as a sliding or detaching interface. A convex mandibular residual ridge, resilient mucosa, and denture were modeled in computer-aided design (CAD) software using curves and cross sections. A unilateral vertical occlusal load of 100 N was assumed only for model verification, and an oblique mastication load of 141 N was assumed for simulated mastication with balanced articulation. The nonworking-side occlusal contact was simulated in 2 situations: prompt nonworking-side occlusal contact and delayed nonworking-side occlusal contact by setting an initial distance of 0.1 mm or 1 mm between the denture and a flat solid above the nonworking side.

Results: The denture was held to the mucosa under vertical force and a maximum pressure of 203 kPa. The denture was tilted under an oblique mastication load and achieved stability through nonworking-side occlusal contact. This means that the denture was supported not only by the denture foundation but also by the nonworking-side occlusal contact and had a downwardly directed stabilizing reaction force. The denture was weakly supported on the delayed nonworking-side occlusal contact compared with the prompt nonworking-side occlusal contact and weakly supported on the denture foundation. In delayed nonworking-side occlusal contact, the pressure beneath the denture was 783 kPa (>pressure pain threshold) compared with 484 kPa (<pressure pain threshold) in prompt nonworking-side occlusal contact. Despite the lower reaction force of the foundation in delayed nonworking-side occlusal contact, the pressure beneath the denture increased, indicating a reduction in the load transfer area due to the inclined position of the denture. Friction on the mucosal surface was over 14-fold higher for the delayed nonworking-side occlusal contact.

Conclusions: The pressure beneath a removable mandibular complete denture exceeded the average pressure pain threshold and was supported with a large slide, which produced friction. Although the value of the load on the occlusal side did not change, the pressure under the denture increased and the force of nonworking-side occlusal contact decreased because of increasing distance to nonworking-side occlusal contact.