Philosophies of

Occlusion for Implants

Implant Occlusion
Single Crown
Fixed Partial Dentures
Full arch prostheses (screw retained)
Overdentures

Many Philosophies of Occlusion

No definitive scientific studies to prove:

one type of tooth form

one type of occlusal scheme

to be clearly preferred by patients

to be more efficient than another

Tooth Forms Occlusal Schemes

Anatomic Canine Guidance

Non Anatomic (Mutually Protected)
Group Function
Lingualized
(Balanced)
Monoplane

Denture Tooth Forms and
Occlusal Forms

QuickTime and a
TIFF (LZW) decompressor
are needed to see this picture.

Occlusion & Implants
Evidence Based Review
Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

No Preferred occlusal scheme

Clinicians advocate axial loading of implants,
but no evidence, at present,
demonstrating benefits

Occlusion & Implants
Evidence Based Review
Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

No evidence at present that

progressive occlusal loading of implant

is beneficial
occlusal overload is detrimental to

implants

Absence of Scientific Evidence
Not proof against!

Follow best available clinical

principles
Do not build in heavy non-axial
loading or overloading
Clinical Principles for Occlusion

Based on Clinical Experience

Not Scientific Evidence
 General Principles

Improve denture stability or axial

loading of single teeth
Centric contacts on flat surfaces,
not inclines

General Principles
Center
lowerr
Posterior
12mm
12m
Nona
Anatomi
Anatom
Overjet to

setup
setu
Avoid Cheek
Biting

General Principles

Improve denture
stability or single
tooth loading
Center occlusal contacts
over ridge
Simultaneous posterior
contacts in centric

 General Occlusal Principles

For overdentures or full arch

prostheses opposing a CD:
No anterior contacts in centric
Minimizes anterior resorption
Grazing anterior contacts in
excursions
Incising

Occlusal Schemes

Canine Guidance SingleTeeth

Group Function FPDs
Lingualized
Monoplane Dentures

Crowns or FPDs
Either canine guidance or group function
works - no preference
Use what the patient has
Use what would be easiest

 Overdentures
or
Full Arch Prostheses

ALL Occlusal Schemes Devised to

Maximize Denture Stability
Lingualized Occlusion
Maxillary cusped tooth
Mandibular cuspless or shallow cusped
tooth
Maxillary lingual cusp balances
like a mortar in a pestle

Lingualized Occlusion

Lingual cusp contacts

opposing central fossae

Mandibular cuspal inclines

are shallow (0, 10)

Less lateral displacement

Lingualized Occlusion
How Stability is Improved
Simultaneous bilateral
anterior and posterior in
all excursions

Tilting forces theoretically

neutralized

 Enter
Enter Bolus
Bolus Exit
Exit
Balance?
Balance?
Many patients chew bilaterally
Biting forces maximum close to intercuspation
(where balance most effective)
Non-functional aspects (swallow)

 Point of Loading Affects Stability
Browning, 1986

Loaded centrally, M, D, L, B
M
B caused unseating
B
C
Central loading better than L
distal loading
D

Lingualized Contacts

Working Side

Only buccal cusp

contact is inner
incline of
mandibular teeth
(balancing)
Balancing Side
IIF Rule

B LBW
IIF you have contacts on the Inner Inclines of Functional cusps

on
rtk
aicn
tgs
they are balancing contacts

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IO
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Test!

 Rules for Balancing Contacts
Balancing contacts should be lines, not
points
Balancing contacts should never be heavier
than working contacts

Balanced Occlusion (Lingualized)
Indirect evidence that balanced occlusion may:
reduce ridge resorption (Maeda & Wood , 1989)

allow for increased functional forces in

excursions (Miralles et al, 1989)

 Lingualized Cusp Angles

Always use steep cusped

maxillary tooth (33)
When condylar guidance is
steeper use more cusp angle
in mandible (10)

 Lingualized
Occlusion
Balance cannot be set without an articulator
Clinical remount on an articulator - fewer
adjustments

Condylar Inclination
Posterior teeth separate as working
condyle moves forward (and
downward)
Anterior teeth contact
Closer to condyle, more separation
More anterior separation of
Premolars if steep anterior guidance

Effect of Mandible Moving Downward
During Excursions

Maintaining Balancing Contacts
Change occlusal plane angle
Increase compensating curves
Increase cusp angles or effective cusp
angles

 Checking for
Balance
Feels Sm
Feels Smoo
ooooooooooththin
in excursions
excursions

-- Fingers
Fingers on
on max.
max. canines
canines
--
Check
Check on
on articulator
articulator

Assess
Contacts:
Centric Stops
Excursions

Improving Denture
Occlusion
Most important cusp - maxillary lingual
Mandibular buccal cusps more lateral - more
tipping

When Not to Balance
Difficulty in obtaining repeatable centric
record
incoordination,
muscle splinting

Dramatic malocclusions
Severe ridge resorption
lateral forces displace the denture

Implants tend to negate this factor

Monoplane Occlusion
Cuspless teeth set on a flat plane with 1.5- 2
mm overjet
No cusp to fossa relationship
No anterior contacts present in centric
position
No overbite

 Monoplane Occlusion
How Stability is Improved

Elimination of cusps
Lateral forces reduced, improving stability
Simplifies denture tooth arrangement

Monoplane Occlusion
With Condylar Inclination

Monoplane Occlusion
With Condylar Inclination

Ensure Teeth Set Over Ridge
Minimize tilting/tipping
Maximize stability
Minimize contacts on buccal of flat cusps

 Monoplane
Occlusion
Functional, but unesthetic
Not balanced - flat
Zero degree teeth can be
balanced if condylar
inclinations are shallow

Monoplane Occlussion -
When?
Jaw size discrepancies, malocclusions
cross-bite, Cl II, III

Minimal ridge
reduces horizontal forces

implants help
Uncoordinated jaw movements

 Summary
No definitive studies to show one type
of occlusion is best
Follow established clinical principles
Assess each case - adapt to clinical
situation
Continue to read the literature