You are on page 1of 72

Terminology

Occlusion:
This words is used to describe the
static contact relationship between
the incising or masticating surfaces
of the maxillary or mandibular teeth
or tooth

Terminology
Articulation:
Refers to the static and dynamic
contact relationship of maxillary and
mandibular teeth as they move
against each other during function.

Terminology
Balanced Occlusion:
It refers to the bilateral, simultaneous,
anterior, and posterior occlusal
contact of teeth in centric and
eccentric position.

Terminology
Free Mandibular Movement:
Any mandibular movement without
interference.

Terminology
Occlusal Harmony:
A condition in centric and eccentric jaw
relation in which there are no
interceptive or defective contacts of
occluding surfaces.

Terminology
Occlusal Interference:
Any tooth contact that inhibits the
remaining occluding surfaces from
achieving stable and harmonious
contacts.

Terminology
Occlusal Pattern:
The form or design of the masticatory
surfaces of a tooth or teeth based on
natural or modified anatomic or non
anatomic teeth

Terminology
Maximal Intercuspal Position:
The complete intercuspation of the
opposing teeth independent of the
condylar position.

Introduction
Occlusion in complete denture must be
developed to function effeciently and
with the least amount of trauma to
the supporting tissues.

Objectives
Preservation of the remaining tissues
Proper masticatory efficiency
Enhancement of denture stability,

retention and support


Enhancement of phonetics and
esthetics

Difference Between
Natural and Artificial
Occlusion
1. The teeth in natural dentitions are
retained by periodical tissues that are
uniquely innervated and structured.
In complete artificial occlusion all the
teeth are on bases seated on slippery
tissues.
2. In natural dentitions the teeth receive
individual pressures of occlusion and
can move independently.

Difference Between
Natural and Artificial
3. Malocclusion of natural teeth may
Occlusion

be uneventful for years.


4. Non vertical forces on natural teeth
during function affect only the teeth
involved and are usually well
tolerated, whereas in artificial teeth
the effect involved all of the teeth on
the bases. It is usually traumatic to
the supporting structures.

Difference Between
Natural and Artificial
5. Incising with the natural teeth does not
Occlusion

affect the posterior teeth. Incising with


artificial teeth affects all of the teeth on
the base.
6. In natural teeth the second molar is the
favored area for masticating hard foods.
7. In natural teeth bilateral balance is
rarely found; If present it is considered
balancing side interference.

Difference Between
Natural and Artificial
8. In natural teeth proprioception gives
Occlusion
the neuromuscular system control
during function.

Requirement of Complete
Denture Occlusion
1. Stability of occlusion in centric relation.
2. Balanced for all eccentric contacts bilaterally

for all eccentric mandibular movements.


3. Unlocking the cusp mesiodistally to allow for
gradual but inevitable settling of the bases
due to tissue deformation and bone
resorption.
4. Control of horizontal forces by buccoligual
cusp height reduction according to the
residual ridge resistance and interridge
space.

Requirement of Complete
Denture Occlusion

Requirement of Complete
Denture Occlusion
5. Functional lever balance by
favorable tooth to ridge crest
position

Requirement of Complete
Denture Occlusion
6. Cutting and shearing effeciancy of
the occlusal surface (sharp cusps or
ridges)
7. Anterior clearance of teeth during
mastication. Minimum occlusal
contact between the upper and
lower teeth to reduce pressure
during function
(linguilized occlusion)

Requirements for
Incising Units
These units should be sharp in order to
cut effeciently. They should not contact
during mastication.
They should have as flat an incisal
guidance as possible considering
esthetics and phonetics. They should
have horizontal overlap to allow for
base settling without interference.
They should contact only during
prostrusive incising function.

Requirements for the


Working Occlusal Units
They should be effecient in cutting and
grinding. They should have decreased
buccal-lingual width to minimize the
work force directed to the denture
foundation.
They should function as a group with
simultaneous harmoniuos contacts at
the end of the chewing cycle and
during eccentric excursions.

Requirements for the


Working Occlusal Units
They should be over the ridge crest in
the masticating area for lever
balance. They should center the
work load near the anteroposterior
center of the denture.
They should present a plane of
occlusion as parallel as possible to
the mean foundation plane.

Fundamentals for
Artificial occlusion
The smaller the area of the occlusal
surface acting on food, the smaller
will be the crushing force on food
transmitted to the supporting
structures.
Vertical force applied to an inclined
occlusal surface causes non vertical
force on the denture base.

Fundamentals for
Artificial occlusion
Vertical force applied to a denture
base supported by yielding tissue
causes the base to slide when the
force is not centered on the base.
Vertical force applied outside (lateral
to) the ridge crest creates tipping
force on the base.

Balance occlusion
Balance as related to complete denture
occlusion:
Balance occlusion in complete dentures
can be defined as stable simultaneous
contact of the opposing upper and
lower teeth in centric relation position
and a continuous smooth bilateral
gliding from this position to any
eccentric position within the normal
range of mandibular function.

Balance occlusion
Balance in complete dentures is unique
and man made. The physical factors
that apply to the relationship of the
teeth to each other and that apply to
the position of the teeth in the
denture base as related to the ridge
must be understood. The
application of these physical laws
can be expressed by the
following:

Balance occlusion
1. The wider and larger the ridge and the

closer the teeth are to the ridge, the


greater the level balance.
2. Conversely, the smaller and narrower
the ridge and the farther the teeth from
the ridge, the poorer the level balance.
3. The wider the ridge and the narrower
the teeth buccolingually, the greater
the balance
4. The more lingual (inside) the teeth are
place in relation to the ridge crest, the
greater the balance

Balance occlusion
5. The more centered the force of the
occlusion anteroposteriorly, the
greater the stability of the base.

Types of Balance
(a) Lever Balance This is present when there

is equilibrium of the base on its supporting


structures when a bolus of food is
interposed between the teeth on one side
and a space exist between the teeth on
the opposite side. This state of equilibrium
is encouraged by the following:
1. Placing the teeth so that the resultant
direction of force on the functioning side is
over the ridge or slightly lingual to it.

Types of Balance
2. Having the denture base cover as
wide an area on the ridge as
possible.
3. Placing the teeth as close to the
ridge as other factors will permit.
4. Using as narrow a buccolingual
width occlusal food table as
practical.

Types of Balance
(b) Occlusal Balance
Bilateral occlusal balance this is
present when there is equilibrium on
both sides of the denture due to
simultaneous contact of the teeth in
centric and eccentric occlusion. It
requires a minimum of three contacts
for establishing a plane of equilibrium.

Types of Balance
c)Protrusive occlusal balance this is
present when the mandible moves
essentially forward and the occlusal
contacts are smooth and simultaneous
in the posterior both anterior teeth. It
is slightly different from bilateral
balance in that it requires a minimum
of three contacts, one on each side
and one anterior, and is dependently
on the interaction of the same factors.

Types of Balance
This total concept of balanced
complete denture occlusion must be
considered in terms of the following:
1.The tooth size and position in relation
to the ridge size and shape.
2.The extent of denture base coverage.
3.Occlussal balance with stable
contacts at the retruded border
position and in an area (long centric)

Types of Balance
N.B. In both natural and artificial

dentition, when centric relation and


centric occlusion do not coincide, it is
desirable to create an area within the
fossae that will allow freedom of
tooth movement from centric
relation to centric occlusion (this is
called long centric or freedom in
centric)

Types of Balance
4. Right and left eccentric occlusal
balance by simultaneous contacts at
the limit of functional and
parafunctional activity.
5. Intermediate occlusal balance for all
positions between centric occlusion
and all other functional or
parafunctional excursion to the right,
left and protrusive.

Advantages of Balanced
Occlusion
1. Distribution of load
2. Stability
3. Reduced trauma
4. Functional movement
5. Efficiency
6. Comfort

Factors Affecting the


balanced occlusion (Laws
of Articulation Hanau
There are five factors involved in
quint)

eccentric occlusal balance in complete


dentures.
Condylar guidance
Incisal guidance
The occlusal plane
The compensatory curves
Cusp angulation

1. Condylar guidance it is definite anatomic

feature that depends on the inclination of the


floor of the glenoid fossa. It should be
determined on the patient and set on the
articulator by eccentric records so that the
patients TMJ is in harmony with the occlusion
programmed on the articulator. If the condylar
angle (angle between the path of condyle and
the Franfort horizontal plane) is steep, its
difficult to produce balance occlusion because
when the condyle travel downward and
forward large space is created posteriorly
when the anterior teeth are edge to edge. So
compensation should be made by altering the
other factors to otain the desired balanc.

2. Incisal guidance Incisal guidance is the


effect of the contact of the upper and
lower anterior teeth on the movement of
the mandible. It is usually expressed in
degrees of agulation from the horizontal
by a line drawn in the sagittal plane
between the incisal edges of the upper
and lower incisor teeth when closed in
centric occlusion. If the incisal guidance is
steep, it requires steep cusp, a steep
occlusal plane, or a steep compensating
curve to effect an occlusal balance.

Factors affecting the incisal


guidance angle.
1. Vertical overlap (over bite): the
vertical overlap is directly
proportional with the incisal angle.
For complete dentures the incisal
guidance should be as flat as
esthetic and phonetics will permit.

For the following reasons:


1. To guard against loss of posterior teeth
contact during prostrusive movement.
2. To allow the use of posterior teeth with
reduced cusp angle and this will reduce
the lateral stresses transmitted to the
ridge.
3. To reduce the downward movement of
the mandible during edge to edge
position.

The incisal guidance is reduce by:


Setting the upper anterior teeth
outside the ridge
Setting the lower anterior teeth
inside the ridge without encroaching
on the tongue space
Shorten the upper and lower
anterior, if esthetics and phonetics
allows.

When the arrangement of the anterior


teeth necessitates a vertical overlap,
a compensating horizontal overlap
should be set to prevent anterior
interference.

3. Plane of Occlusion the occlusal


plane is established in the anterior by
the height of the lower cuspid, which
is nearly coincident with the
commissure of the mouth, and in the
posterior, by the height of the
retromolar pad. It is also related to
the related to the ala-tragus line. Its
role is not as important as are the
other determinants.

4. Compensating curves -- Compensating


curve is one of the more important factors in
establishing a balanced occlusion so that
the occlusal surface results in a curve that is
in harmony with the movement of the
mandible as guided posteriorly by the
condylar path. A steep compensating curve
for occlusal balance. A lesser compensating
curve for the same condylar guidance would
result in a steeper incisal guidance (anterior
interference), which would cause loss of
molar balancing contacts.

Height of cusps on teeth or inclination of cusp


less teeth.
Cusp angle the angle made by the slopes of a
cusp with a perpendicular line bisecting the
cusp, measured mesio-distally or
buccolingullay.
Cusp Height the shortest distance between
the tip of a cusp and its base plane. Altering
the cusp height by widening or narrowing a
tooth alters the length of the cusp incline but
does not change the relationship to the mean
occlusal plane, i.e. cusp angle is not affected
by a change in cusp width.

when we select a tooth with a certain


xusp height or angle, it doesnt mean
anything until the tooth is positioned
in the denture. For example, a
particular tooth may be manufactured
with a 30 degree inclination. However,
by tilting the tooth in relation to the
mean occlusal plane, one may create
an effective inclination of greater or
less than 30 degrees.

Interaction of the five


factor
Of the four that he can control two of
them (the incisal guidance and the
plane of occlusion) can be altered
only a slight amount because of
esthetic and physiologic factors. The
important working factors for the
dentist to manipulate are the
compensating curve and the
inclinations or cusp on the occlusal
surfaces of the teeth.

Selection of Posterior
Tooth Forms
Factors affecting the selection of posterior
teeth forms:
1. The capacity of the ridge to receive and
resist forces of mastication.
2. Inter ridge distance.
3. Ridge relationship
4. Esthetics
5. Patients age and neuromuscular
coordination
6. Previous denture wearing experience.

Posterior artificial teeth are classified


according to their oclusal form into
anatomic, semi-anatomic and non
anatomic.
1. Anatomic Teeth the standard anatomic
tooth has inclines of approximately 33.
The cuspal inclination is measured by the
angle formed by the mesiobuccal cuspal
incline to the horizontal plane when the
long axis of the tooth is vertical.

2. Non Anatomic Teeth (0) Non


anatomicteeth have a flat occlusal
surace (without cusps) this type of
teeth does not function efficiently
unless the occlusal surface is
provided with cutting ridges and spill
ways this types of teeth were
designed to eliminate the problems
evolved with using anatomic teeth.

Semi Anatomic Teeth Examples of


the semi anatomic teeth are twenty
degree teeth.

Problems with Anatomic


Tooth Forms
In edentulous mouths, these same

cusps can cause trauma, discomfort,


and instability to the bases because
of the horizontal components they
generate. The basic problem initiallly
is the coordination of their cusps to
harmonize with one another and the
mandibular movements.

The problem of unmodified, cusped teeth


for complete dentures can be summed
up as follows:
1. It is mandatory to use an adjustment
aritculator.
2. Eccentric records must be made for
articulator adjustments.
3. Mesiodistal interlocking will not permit
settling of the base without horizontal
forces developing. So reduction of cusp
height and performing long centre
concept becomes mandatory.

4. Harmonious balanced occlusion is


lost when settling occurs.
5. The base need prompt and frequent
refitting to keep the occlusal stable
and balanced.
6. The presence of cusps generates
more horizontal force during
function.

Problems with Non


anatomic Tooth Forms
1. Non anatomic (flat) teeth occlude in
only two dimensions (length and width),
but the mandible has an accurate three
dimensional movement due to its
condylar behavior.
2. This form loses shearing efficiency.
3. Bilateral and protrusive balance are not
possible with a purely flat occlusaion.
Non anatomic teeth set on inclines for
balance require as much concern as
anatomic teeth for jaw movements.

the flat teeth do not function


efficiently unless the occlusion
surface provides cutting ridges and
generous spillways.

Balanced Occlusion with


Non Anatomic or Flat
Balanced occlusion with cupless teeth
Teeth

can be achieved by several ways:


1.Zero-degree teeth with inclination of
the lower second molar
2.Zero-degree teeth with balancing
ramps placed posterior to the most
distal molar.

3. Zero-degree teeth set to steep


compensatory.

Occlusal Designs for


Balanced Occlusal
Lingualized Occlusion
This method of lingualizing the
occlusaion was suggested as a method
to achieve bilateral balanced occlusion.
The lingulaized occlusaion utilizies only
the upper lingual cusps on each side to
act as cutters operating in the central
fossa of the lower teeth this gives mortar
and pestle type contact that lingualizes
the resultant force without moving the
teeth in relation to the ridges.

Lingualized occlusion is indicated


when the patient places high priority
on esthetics but a non anatomic
occlusal scheme is indicated by oral
conditions suchs as sever alveolar
resorption, class II jaw relation or
displaceable supporting tissues.

Advantages of
lingualized occlusion
a. Most of the advantages attributed

to both anatomic and non anatomic


forms are retained
b. Cusp form is more natural in
appearance
c. Good penetration of the bolus is
possible
d. Bilateral balanced occlusion is
readily obtained

Linear Occlusion concept


In this type of occlusion the teeth are
arranged so that the masticatory
surfaces of the mandibular posterior
teeth have straight long, very narrow
occlusal form resembling that of a
line articulating with apposing
monoplane teeth.

Monoplane Teeth with Compensating


Curve
The arrangement of monoplane
teeth in a compensating curve of
occlusion is similar to that for
anatomic teeth.

Non-Balanced Occlusion
When the foundation tissues is
compromised, i.e. severely resorbed
ridge, knife-edge, thin wiry ridge or
one that is covered with thick
movable flabby tissues, favorable
control of occlusal forces can be
utilized by the use of non-anatomic
teeth arranged following the
monoplane occlusion concept.

Monoplane Occlusion
Concept
The monoplane occlusion concept utilizing nonanatomic teeth with flat occlusal surfaces set
to a flat occlusal plane. The posterior limit of
the extent of lower posterior teeth is the
point at which the mandibular ridge begins to
curve upward, with elimination of contact
between the upper and lower second molars,
which are considered as space fillers. The
patients should avoid incising with their
anterior teeth, as the purpose of the anterior
teeth is to produce a desired appearance. If
they recognized this limitations, no balancing
contact will be necessary for protrusive
occlusion.