Effect of implant restoration on the condylar position of bilateral temporomandibular joints in patients with unilateral free-end multiple tooth loss

doi:10.19438/j.cjoms.2026.05.006

Abstract

Abstract: PURPOSE: To investigate the positional changes of the condyles in bilateral temporomandibular joints (TMJ) in patients with unilateral free-end edentulism before and after implant-supported fixed denture restoration. METHODS: A retrospective analysis was performed on 40 patients who received implant restoration for unilateral distal-extension tooth loss in Zhongshan Hospital, Fudan University from January 2024 to January 2025. Clinical data and CBCT images were collected and analyzed. Six joint space parameters of bilateral TMJ were measured on CBCT: anterior joint space (AJS), superior joint space (SJS), posterior joint space (PJS), lateral joint space (LJS), intermediate joint space (IJS), and medial joint space (MJS). Condylar cortical bone density, trabecular bone density, mediolateral length (MLL), anteroposterior length (APL) were also measured, and condylar morphological destruction and bone resorption were evaluated. RESULTS: Following implant-fixed restoration, a significant reduction was observed only in the SJS on the affected side (mean change: -0.29 mm, P=0.001), indicating a vertical repositioning of the affected condyle. On the healthy side, only the MJS demonstrated a significant decrease (mean change: -0.91 mm, P=0.001), suggesting a superomedial adaptive relocation. No significant differences were found in the other joint space parameters on either side(P>0.05). Furthermore, no significant changes were detected in bilateral condylar cortical and trabecular bone density, MLL, or APL(P>0.05), and no cases of new-onset condylar morphological destruction or bone resorption were identified. CONCLUSIONS: Implant-fixed prostheses can facilitate adaptive displacement of bilateral TMJ condyles, thereby restoring balanced joint relationships without causing pathological damage to condylar hard tissues. Precisely restoring the occlusal vertical dimension and establishing a stable three-dimensional occlusal balance are of significant importance for temporomandibular joint health.

Key words: Unilateral free-end edentulism, Implant-supported fixed denture, Temporomandibular joint, Condyle

CLC Number:

R782

Guo Ziwei, Liu Yi, Shen Xinran, Zheng Yaqing, Pan Yingdan, Bi Wei. Effect of implant restoration on the condylar position of bilateral temporomandibular joints in patients with unilateral free-end multiple tooth loss[J]. China Journal of Oral and Maxillofacial Surgery, 2026, 24(5): 477-482.

References

[1] Ribeiro JAM, de Resende CMBM, Lopes ALC, et al. Association between prosthetic factors and temporomandibular disorders in complete denture wearers[J]. Gerodontology, 2014, 31(4): 308-313.
[2] AlKhairAllah HA, Mohan MP, AlSagri MS. A CBCT based study evaluating the degenerative changes in TMJs among patients with loss of posterior tooth support visiting qassim university dental clinics, KSA: a retrospective observational study[J]. Saudi Dent J, 2022, 34(8): 744-750.
[3] Brazão-Silva MT, Guimarães DM, Andrade VC, et al.Do dental implant therapies arouse signs and symptoms of temporomandibular disorders? a scoping review[J]. Cranio, 2023, 41(6): 508-517.
[4] 任娟,武秀萍,刘宁,等. 颞下颌关节紊乱病咬合特征的初步临床研究[J]. 现代口腔医学杂志, 2022, 36(4): 231-234, 238.
Ren J, Wu XP, Liu N, et al.Preliminary clinical study on occlusal features in temporomandibular disorders patients[J]. Journal of Modern Stomatology, 2022, 36(4): 231-234, 238.
[5] Smirani R, Chantler JG, Endres J, et al.Clinical outcomes of single implant supported crowns utilising the titanium base abutment: a 7.5-year prospective cohort study[J]. J Dent, 2024, 149: 105306.
[6] Gallucci GO, Hamilton A, Zhou W, et al.Implant placement and loading protocols in partially edentulous patients: a systematic review[J]. Clin Oral Implants Res, 2018, 29(Suppl 16): 106-134.
[7] Kattadiyil MT, Alzaid AA, Campbell SD.The relationship between centric occlusion and the maximal intercuspal position and their use as treatment positions for complete mouth rehabilitation: best evidence consensus statement[J]. J Prosthodont, 2021, 30(S1): 26-33.
[8] 刘吉玥,刘奕. 咬合调整对颞下颌关节紊乱病的影响[J]. 中国实用口腔科杂志,2023, 16(2): 147-151,155.
Liu JY, Liu Y.Effect of occlusal adjustment on temporomandibular disorders[J]. Chinese Journal of Practical Stomatology, 2023, 16(2): 147-151,155.
[9] Braun MJ, Rauneker T, Dreyhaupt J, et al.Dental and maxillofacial cone beam CT-High number of incidental findings and their impact on follow-up and therapy management[J]. Diagnostics (Basel), 2022, 12(5): 1036.
[10] dos Anjos Pontual ML, Freire JSL, Barbosa JMN, et al. Evaluation of bone changes in the temporomandibular joint using cone beam CT[J]. Dentomaxillofac Radiol, 2012, 41(1): 24-29.
[11] Hilgers ML, Scarfe WC, Scheetz JP, et al.Accuracy of linear temporomandibular joint measurements with cone beam computed tomography and digital cephalometric radiography[J]. Am J Orthod Dentofacial Orthop, 2005, 128(6): 803-811.
[12] Sakai R, Yamashita S.Influence of simulated loss of posterior occlusal support on three-dimensional condylar displacement[J]. Bull Tokyo Dent Coll, 2021, 62(3): 137-150.
[13] Berzaghi A, Testori T, Scaini R, et al.Occlusion and biomechanical risk factors in implant-supported full-arch fixed dental prostheses-narrative review[J]. J Pers Med, 2025, 15(2): 65.
[14] 王冉. 单侧后牙游离缺失患者颞下颌关节形态的锥形束CT观察[D]. 上海:上海交通大学,2019.
Wang R.Observation of the morphology of the temporomandibular joint in patients with unilateral free posterior tooth loss using cone-beam CT[D]. Shanghai: Shanghai Jiao Tong University, 2019.
[15] Bischof FM, Mathey AA, Stähli A, et al.Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years[J]. Clin Oral Implants Res, 2024, 35(12): 1640-1654.
[16] Zhang R, Ge Z, Lang X, et al.A CBCT study of changes in temporomandibular joint morphology with immediate implant placement and immediate loaded full-arch fixed dental prostheses[J]. BMC Oral Health, 2024, 24(1):1392.
[17] Alkaya B, Duyan Yüksel H, Evlice B, et al.Ultrasound analysis of the masseter and anterior temporalis muscles in edentulous patients rehabilitated with full-arch fixed implant-supported prostheses[J]. Clin Oral Investig, 2024, 28(5): 288.
[18] 郑慧云, 刘志超, 王慧明. 偏侧咀嚼对颞下颌关节结构的影响及其与颞下颌关节紊乱的关系[J]. 浙江大学学报(医学版), 2023, 52(3): 386-393.
Zheng HY, Liu ZC, Wang HM.Research progress in effect of chewing-side preference on temporomandibular joint and its relationship with temporo-mandibular disorders[J]. Journal of Zhejiang University(Medical Sciences), 2023, 52(3): 386-393.
[19] Segall I, Finkelstein M, Kalim S, et al.Dental implantation changes the bone morphology and mineral density of human mandibular condyle: a pilot study[J]. J Funct Biomater, 2026, 17(2): 99.
[20] Weiss R, Read-Fuller A.Cone beam computed tomography in oral and maxillofacial surgery: an evidence-based review[J]. Dent J(Basel), 2019, 7(2): 52.
[21] Karakis D, Bagkur M, Toksoy B.Comparison of simultaneously recorded computerized occlusal analysis and surface electromyographic activity of masticatory muscles between patients with unilateral TMD[J]. Int J Prosthodont, 2021, 34(5): 554-559.