19. occlusal schemes lingualizied oposing monoplane with balancing ramps

19. Occlusal Schemes - 19. Occlusal Schemes - Lingualized Lingualized Opposing Monoplane with Balancing RampsOpposing Monoplane with Balancing Ramps

John Beumer III, DDS, MSJohn Beumer III, DDS, MSandand

Michael Hamada DDSMichael Hamada DDSDivision of Advanced Prosthodontics, Division of Advanced Prosthodontics, Biomaterials and Hospital DentistryBiomaterials and Hospital Dentistry

UCLA School of DentistryUCLA School of Dentistry

This program of instruction is protected by copyright ©. No portion of This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.any information storage or retrieval system, without prior permission.

Lingualized Opposing Monoplane with Lingualized Opposing Monoplane with Balancing RampsBalancing Ramps


Begin by positioning the appropriate protrusive insert. Check Begin by positioning the appropriate protrusive insert. Check to ensure that the incisal guide pin is set at zero and in contact to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table.with the incisal guide table.

Protrusive insertsProtrusive inserts

Zero Zero settingsetting

Protrusive Protrusive insertinsert

As previously mentioned (13c, 1a), the wax rim is ideally contoured on As previously mentioned (13c, 1a), the wax rim is ideally contoured on the patient and used to mount the upper cast with a facebow transfer the patient and used to mount the upper cast with a facebow transfer record. When the lower cast is mounted on the articulator with a centric record. When the lower cast is mounted on the articulator with a centric relation record, the plane of occlusion is readily seen.relation record, the plane of occlusion is readily seen.

The three landmarks used to identify the plane of occlusion are:The midpoint of the retromolar pads bilaterally as previously marked on the mandibular cast.The incisal edge of the maxillary central incisors

Setting the Maxillary Anterior TeethSetting the Maxillary Anterior Teeth

Midpoint of Midpoint of retromolar retromolar

padpad

Midpoint of Midpoint of retromolar retromolar

padpad

Mark the casts indicating midline, crest of the ridge, and the retromolar pad. These landmarks will be used to check your denture setup.

MaxillaMidlineAnterior land

MandibleRidgeRetromolar pad

Cast LandmarksCast Landmarks

To set the remaining maxillary anterior teeth a clear glass or plastic slab is positioned on the mandibular record base to represent the plane of occlusion.


Mark indicating midpoint of the retromolar pad


Soften some baseplate wax and attach some to the ridge lap portion of the other maxillary central incisor and attach it to the record base as shown. Set the lateral incisors and cuspids as shown previously (Section 13c, 1a Lingualized occlusion).


Note the angulations of the anterior teeth in relation to the occlusal plane when viewed in profile.

Occlusal Occlusal planeplane


““Toed-in” PositionToed-in” Position

Note how the cervical and incisal edges of the cuspid are aligned vertically (yellow line). The facial surface of the cuspid however, is canted inward and appears “toed in” (red line) due to the prominence of the cervical area of the tooth (yellow arrow). The centrals and laterals are inclined slightly towards the distal.

• Vertical overlap (0-1mm)*• Horizontal overlap (1-2 mm)• No contact is centric occlusion

*When using monoplane teeth with balancing ramps the the vertical overlap is kept to a minimum.

Setting Mandibular Anterior TeethSetting Mandibular Anterior Teeth

Patients with skeletal Class I relationships

Magnitude of horizontal overlap?

In Class II patients the mandible tends to travel farther anteriorly in function than the typical Class I patient and consequently more horizontal overlap is necessary to allow for this functional movement.

In contrast Class III patients often demonstrate little or no anterior movement of the mandible during function. Consequently, little or no horizontal overlap is developed in the set up.

Setting Mandibular Anterior TeethSetting Mandibular Anterior Teeth

Patients with skeletal Class II or Class III relationships

Setting the Mandibular Anterior TeethSetting the Mandibular Anterior Teeth

Positions of the anterior teeth. The lateral incisors should be placed similar in angulation and position to the central incisors. Note that the cuspids are towed out at the cervical.

Setting the Mandibular Anterior TeethSetting the Mandibular Anterior Teeth

The horizontal overlap should be consistent throughout the anterior region. In this setup it is about 1.5 mm.


Background - Setting the posterior teeth The number and combination of the denture teeth utilized varies depending on the arch length of the patient.

The mandibular occlusal table should end prior to the ascending ramus.

The distal surface of most posterior maxillary denture tooth should extend one half 1-2mm distal to the most posterior mandibular denture teeth.


Position the posterior mandibular teeth over the crest of the ridge. Check to ensure they are set to a flat plane and on the plane of occlusion.Make corrections as necessary


Position the maxillary posterior teeth. The tips of the maxillary lingual cusps should contact the central groove of the mandibular posterior teeth as shown.


Note that the distal surface of the most posterior maxillary tooth extends 1-2mm distal to the distal surface of the most posterior mandibular tooth.


By properly centering the lingual cusps of the maxillary teeth over the central grooves of the mandibular teeth the horizontal overlap should be ideal and should be sufficient to prevent biting of the cheek and corner of the mouth.

Horizontal overlap


Note that the Note that the maxillary premolars in maxillary premolars in the of the Ivoclar the of the Ivoclar Ortholingual denture Ortholingual denture teeth are of sufficient teeth are of sufficient length to harmonize length to harmonize with the cuspid. with the cuspid.


Verify that all the maxillary teeth, with the exception of the lateral incisors and perhaps the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.


Reestablish centric Reestablish centric contactscontacts as necessary by as necessary by manipulating the manipulating the mandibular posterior mandibular posterior teeth. Make sure that the teeth. Make sure that the incisal guide pin incisal guide pin maintains contact with maintains contact with the incisal guide table the incisal guide table when you have when you have completed this step.completed this step.


The balancing ramps are added as shown.The balancing ramps are added as shown.

Note that the maxillary 2Note that the maxillary 2ndnd molar extends slightly posterior to molar extends slightly posterior to the mandibular 2the mandibular 2ndnd molar in order that it may engage the molar in order that it may engage the balancing ramps during lateral excursions.balancing ramps during lateral excursions.


In all lateral excursions you should observe at least three In all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral balance. points of contact bilaterally to maintain bilateral balance.

Bilateral balance with balancing ramps

WorkingWorking BalancingBalancing

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19. occlusal schemes lingualizied oposing monoplane with balancing ramps