Hardys paper period in dentistry D R.

active participants, deals with isa with pleasure that and it cussion of nonanatomic posterior tooth forms.

in which we have both been I join him briefly in a dis-

The advent of new ideas very often inspires effusive reactions and I am sure that Dr. Hardy will agree with me when I say that this has been particularly true . in dentistry when anyone has been bold enough to present, or even support, the idea that nonanatomic typks of posterior tooth forms might better meet the requirements for artificial dentures than would the anatomic types. Progress does not usually result from strict adherence to tradition. It is fortunate that in most groups there are a few individuals who are willing to assume the roll of pioneers in an attempt to improve upon widely accepted concepts rcgardless of the immediate reaction of their associates. This has been particularly true of such men as Dr. \?ctor Sears and others whom Hardy has mentioned. Tt is my personal opinion that Sears made one of the really great contributions to dentistry when he brought out the chamiel posterior tooth, principally because of the influence which this tooth form had on our present day concepts of occlusion, bo?h in natural and artificial dentures. These teeth provided specific areas for centric occlusion and other specific ;ireas for the various tccentric occhlsions, and their use led to the idea of applying similar concepts to all tooth occlusions. As a result we began to think in terms of selective occlusions and selective spot grinding in the correction of malocclusions, instead of the hit+nd-miss tnethods which had previously been employed. \Vh\- should we concern ourselves about the occlusa! surface forms of artificial posterior teeth when nature has already given us posterior occlusal patterns which, in normal natural dentures, are admittedly superior in masticating efficiencv to any artificial substitute which we could hope to devise? The fact that ridges is fact that nrtifici:Ll answer which I would give to this question would be influenced l)]; the the support which is provided to artificial denture bases by edrntulous entirelv different from that provided to natural dentures, and also 1,~ the edentuious ridges undergo constant morphologic changes, whether or not tlenturcs art IGig worn. j\s prostliotlontist~, we are facet1 \vith the
City, N.J.. Octobel~. 19X

Read before the American Denture Society, Atlantic Receiwtl for publication, Dec. 16, 1950.

problem of constructing artiticial btti)stittttes for natural .*erve their intended ~~ttrl~ose under conditions which ttsttall\~ _ vet-1. ut~favoral~le.

cletttttres \\,hich \\31 best art Ixe-est;~l~lishetl ;t~~il

\\hen an engineer is called tt~)n tcl design a machine to accomplish :t sl)ecitic purpose it is expected that he will also design or designate 3 foundation for thr machine which will properly support its \vorking parts itt cbrder that they ma! accomplish their intended purpose. Natttrv tlitl jttFt that when she provided the human dental mechanism with \-cry efticient masticator!. tmits; she also provided a highly specialized txl)e of support for each of these \vorltittg units. ff it were not f&the fact that somewher!: along the line there has been a break in Satures plan, human beings N-ould retain their natural teeth, and there nould he no need for artificial dentures. The human dental mechanism is actually a tripod in \vhich the occluding dental arches constitute one leg and the tenlporomandibular joints the other two legs. In the presence rif natural dentures the intercuspation uf the teeth exerts a l)owerful influence upon jaw relationshil)s. even to the extent of causitq trattnta of the tem~~oroeutntlil~ular joint in some cases of occlusal disharmony : hut when the natural teeth are lost in one or both jaws it I)ecnmes advisable to accept the tet~~yoromai~dil,ular joints as the principal guiding factors if we are to minimize the shifting of artiticial denture bases. Artificial dentures cailnot and should not lbe expected to exert the 5:tnie directing influence upon jaw relation5 as did the natttral dentures. Time will not permit elaborating upon this point here, hut I recommend that ample time be devoted to the study of The Xatttre of the Temporo~~~andibul;ir Jointas it Affects Artificial Denture Construction. In effect the tetnporomarttlil)ttlar joint is comparable to a mechanical joint in which the condyle rests against a resilient-like pad, \vhile being maintained in this position by strong rtthber hantls, and with ntore or less freedom of trtoretnent in the horizontal plane. It is cask to visualize the multiplicity of changes, from the rest position of such a cotid~lc. that wi~ttld be possible when varying degres of strains are placed upon the condyle. \lthough such a comparison to the temporomandihular joint is to a degree a11 exaggeration, it does serve to indicate the nature of the guiding influences \vhirh are supplied to the mandil~ular ridge 1,. two legs of the dental tripod in the alwtw of rigid guiding influences from the dental arches. The centric I!aral)le to ;L I)all is the equivalent occlusal surfaces mechanism does artificial teeth. occlusion of unaltered anatontic-type ])osterior teeth is cwtresting part way down in ;I conical-like cup. Surli art r)cclttsioti of a point in space. and would result only when the approaching The human dental were directed 1)~ precision-like guidances. not furnish such precise closing guidances to either natural or

Tn the case of artificial dentures, especially, it is logical to assume that the use Uf occlusal patterns, which offered centric occlusion areas instead of centric occlusion points only, would result in less denture base movement on the edentulous

ridges. Clinical experience proves this assumption to be true, and no doubt accounts for the fact that a growing number of prosthodontists are using nonanatomic posterior tooth forms on artificial dentures. It has been my esperience that the use of certain nonanatomic posterior tooth p;:tterns and arrangements have resulted in better denture base stability and comfort to the patient over a longer period of time than I have been a.hlc to ol)tain with conventional anatomic types. .Uthough many dentists adhere rigidly to the use of anatomic occlusal patterns, has been my observation that many artificial dentures, in which anatomic type posteriors have been used, present posterior occlusal surfaces which are definitely nonanatomic in form by the time the dentures have heen adjusted to the functional rquirements of the patient.
it

;I11 artificial dentures seem to fmiction better when their posterior occlusal surfaces offer centric occlusion contacts \vhich are not limited to one specific Unaltered anatomic posterior static jaw relation at a given vertical dimension. It would, however, he a comparatively simple teeth do not meet this requirement. nlatter for tooth manufacturers to improve the present anatomic types. in this regard. with a very slight alteration of their manufacturing molds. 1 have stressed the centric occlusion feature of artificial teeth hecatlse, anti T believe that most prosthodontists will agree with me, the majority of full denture patients develop the habit of depending primarily upon centric occlusion for the mastication of food. This is, no doul)t, due to the facr that, in most cases at least, the! crperience less clrnture I)ase movement in the centric occlusion range. \Ye sl~oultl, therefore, plan the centric occlusion of artificial teeth so that it offers areas instead of limited point contacts, while at the same time offering a reasonable degree of masticator\- efficiency in the centric occlusion range of the artificial dentures. In addition to this function, artificial occlus:~l patterns should contribute to denture base stability and retention, as well as contribute to the fa~orabk distribution of forces which result from masticatory function. In this regard 1 have fomltl that a slight modification of the general principles of artificial denture occlusion as advocated 1)~ Pleasure. 13oswel1, and Kurth to he ver! adv:mt:tgeous, not only because it contributes to mandibular base stability and retentioir, hit also hecause it tends to direct functional masticatory forces onto those areas of the mandibular ridge which seem best aide to receive and resist them. 1 am glad to find that Hardys posteriors are applicable to this type of occlusion. Although Hardys posteriors are a bold departure from conventional concepts, They not only provide a wide they do seem to offer many desirable features. range of centric occlusion contact hut they also offer a high degree of masticating efficiency within this area, with a minimum of closing force being required. I have not as l-et used Hardys posteriors on da so as soon as they are available in the desired to note that Hardy made special relerence to the from these teeth. T would suggest that he keep practical cases, hut T shades and molds. I possibility of tongue the cutting blades a expect to was glad irritation sufficient

tlis;tance from the lingual surfaces of the t&l1 to guarantee against ftittlrr c~spg.,r~~ of the cutting hlatles in the lingual area as woiild occur ironI the weariljg ;~u;~j , I( tlw plastic material in this arm. lhose of IIS who have usrtl plastic posterior teeth k.nr~~ that they (10 ,IXA;LI away quite rapidly- in some mouths. This wear would, of cow-se, 1~: advantagruu5 in the areas between the cutting Hades because it would tend to inipvc their cutting efficiency, as occurs \vith the incisors of rodents. It would not he desirahk in the lingual areas because oi tht. possil)ilitv of future tollpe irritation. This iz especially true in the mouths of those patients who do not return to the psi-hodentist for periodical examinations, as all artificial denture wearers should. It has heen my observation and experiedce that we dentists are p-one to theorize new ideas out of existence, so far as \ve are concernetl at least, hut T have learned that this is a very pm- policy. \I7e must not forget that, accortliil~ II) themy alone, the l~mlk bee lmitively cannot fly, but 1 am sure th:lt there xc those of iis who can testify to the fact that he actually tl4-m so with vet-y itnprezsi\ I. efficiency. Clinical experience still rrnlains one of our best sources of iniorination r(.garding new ideas. The best of artificial dentures are actually the result of man! comprot~lisrs, hut conqmmises which have been made ia the most favoraltlc directions. Let us, therefore, as members of the American Denture Society, assmle the roll of researchers, in the interests of the patients whom \ve are privileged to serve.
1801 EYE %TEET, N.W

\ir.ci~r~~~~o~, D.C.