A comparison of lingualized occlusion and monoplane occlusion in complete dentures

Harold E. Clough, D.D.S., M.S.,* Jack M. Knodle, D.D.S.,* Stephen H. Leeper, D.D.S., M.A.,** Myron L. Pudwill, D.D.S., M.S.,*** and David T. Taylor, D.D.S., M.S.**** University of Nebraska Medical Center, College of Dentistry, Lincoln, Neb.

M any types of occlusal forms and posterior tooth arrangements have been used in complete dentures for almost 200 years. Some of these occlusal schemes have been clinically evaluated and the results tabulated.‘-‘2

The search continues for a posterior tooth form that will satisfy patients’ expectations regarding (1) esthetic requirements, (2) comfort, and (3) masticatory effi- ciency.

OCCLUSAL FORMS

The three major groups of occlusal forms available are (1) anatomic: 33- or 30-degree cusps; (2) semiana- tomic: 20-degree cusps; and (3) nonanatomic or cusp- less: O-degree cusps.

Becker et a1.13 described the use of a “lingualized occlusion,” a combination of anatomic teeth for the maxillary denture and modified nonanatomic teeth for the mandibular denture, in “an attempt to maintain the esthetic and food-penetrating advantages of the ana- tomic teeth while maintaining the mechanical freedom of the nonanatomic form.”

In this present study two noninterfering occlusal schemes were compared: (1) the lingualized occlusion, using a combination of anatomic (30-degree) teeth for the maxillary denture and modified nonanatomic teeth for the mandibular denture, and (2) nonanatomic or cuspless (O-degree) teeth for both the maxillary and mandibular dentures.

The comparison was made by constructing two sets of dentures for the same patient, allowing the patient to wear both, and then asking the patient to report a preference and give reasons for the choice.

*Professor, Section of Removable Prosthodontics. **Associate Professor and Chairman, Department of Adult Restor-

ative Dentistry. ***Associate Professor, Section of Removable Prosthodontics. ****Instructor, Section of Removable Prosthodontics.

METHOD

Thirty edentulous patients, 16 men and 14 women, were selected at random. Their ages ranged from 44 to 91 years.

The patients were examined and the condition of the tissue noted prior to treatment. The number of com- plete dentures previously worn and the type of posteri- or teeth in the dentures currently worn were deter- mined. Both the general attitude of the patient and the attitude toward care of the current dentures were observed.

Two sets of complete maxillary and mandibular dentures were made for each patient. One set of dentures used nonanatomic teeth (Trubyte Rational, Dentsply International, Inc., York, Pa.), and the other was made with maxillary anatomic (Trubyte Pilking- ton-Turner 30’) and mandibular nonanatomic (Tru- byte Rational) teeth in the lingualized occlusion scheme.

The technique was the same for all patients. 1. Primary casts of the maxillary and mandibular

arches were obtained for the purpose of constructing individual impression trays.

2. A single impression was developed for each arch with polysulfide impression material after establishing the borders with modeling compound.

3. The maxillary and mandibular master casts were duplicated.

4. Both sets of casts were mounted with the same face-bow transfer record and centric relation record, with the same denture bases, on two different artic- ulators.

5. A second set of denture bases and occlusion rims (not used to transfer records) was placed on one of the articulators and contoured to approximate the originals.

6. Maxillary and mandibular anterior teeth of the same mold and shade were arranged as identically as possible on both articulators.

176 AUGUST 1983 VOLUME 50 NUMBER 2

LINGUALIZED AND MONOPLANE OCCLUSION

Table I

Pa- Previous Previous Denture tient sets of tooth inserted

No. of adjustments Denture

No. Age Sex dentures type first O-degree Lingualized preferred Reason for preference

O-degree Lingualized

20-degree O-degree

O-degree Lingualized

20-degree O-degree 20-degree O-degree

O-degree O-degree O-degree O-degree O-degree O-degree

Lingualized O-degree

1 1

2 1

1 3

2 2 3 3 3 3 2 2 3 3 6 5

Lingualized Chews better; more stable

Looks better; chews better

Looks better; fits better

Both satisfactory Both satisfactory Both satisfactory Wife likes appearance Both satisfactory Lingualized chews

better, but O-degree more stable

Patient had difficulty with choice; could not remember

Chews better More comfortable Chews better; cuts

food up better Chews easier; wife

likes appearance More comfortable Chews better,

especially meat; better speech; more comfortable

Easier to chew More solid; fits better;

chews better; not as much freedom of movement

Looks better; good fit; not much difference

Chews better, especially steak; could immediately tell difference from O-degree

More comfortable; no cheek biting

Chews better Appearance better;

chews better Chews better,

especially meat Feels better; fewer

sore spots Less trouble, but both

work well Better fit Better fit; could eat

and sleep better Food does not stick to

teeth as much

More comfortable; chews in protrusive

THE JOURNAL OF PROSTHETIC DENTISTRY 177

1

2

3

51

67

49

4 64 5 77 6 55 7 82 8 86 9 68

M 1

F 2

F 1

F 1 F 1 F 1 M 2 F 3 M 3

10 91 M Not wearing

Not wearing Lingualized 1 2 O-degree

11 12 13

59 M 2 75 F 2 58 M 1

61 M 2

77 F 1 47 F 1

O-degree O-degree O-degree Lingualized

ZO-degree Lingualized

14

15 16

O-degree Lingualized

O-degree Lingualized do-degree Lingualized

17 54 M 1 O-degree O-degree 18 56 M 2 20-degree O-degree

19

20

74 F 2

F 1

do-degree O-degree

46 30-degree O-degree

Lingualized

Lingualized

No preference No preference No preference Lingualized No preference No preference

Lingualized Lingualized Lingualized

Lingualized

Lingualized Lingualized

4 3 5 4 2 4

5 3

3 4 2 2

3 2

3 Lingualized 1 Lingualized

3

3

Lingualized

Lingualized

4

3

4 3

7 6 4 3

4 5

3 2

3 3

2 2 6 5

3 2

3 3

Lingualized

Lingualized Lingualized

Lingualized

Lingualized

O-degree

O-degree O-degree

Lingualized

O-degree

21 44 F Single denture

F 2 M Never

worn M 1

20-degree O-degree

20-degree O-degree Never worn O-degree

22 64 23 67

24 53 O-degree Lingualized

25 65 M 1 O-degree O-degree

26 67 M 1 Unknown Lingualized

27 79 M 1 Unknown Lingualized 28 71 M 2 O-degree O-degree

29 63 F 1 O-degree O-degree

30 78 M 5 O-degree Lingualized

CLOUCH ET AL

7. The posterior occlusal scheme for the dentures on one articulator was monoplane and the other was lingualized.

8. Both sets of dentures were tried in the mouth in wax and adjustments were made in the anterior arrangements to make them as identical as possible.

9. If a corrective centric relation record was neces- sary at the time of the wax trial insertion, both sets of casts were remounted with the same interocclusal wax record obtained with one set of bases.

10. Both sets of dentures were processed with the same acrylic resin by the same procedures.

One of the two sets of dentures was inserted first in random fashion. Thirteen of the patients received the lingualized occlusion first; 17 patients received the monoplane dentures first.

The patients wore the first occlusal scheme for 3 weeks. The patients were asked to observe the chewing efficiency, comfort, and appearance of the dentures. Adjustments were accomplished as necessary.

After the 3-week period was completed, the dentures were exchanged.and the same procedures followed.

RESULTS

On completion of the procedure, the following data were collected (Table I):

1. The number of adjustments required for each set of dentures

2. The chewing ability of each posterior scheme as observed by the patient

3. The dentures preferred by the patient and the reason for that preference

The 30 patients required a few more adjustments (95) while wearing the monoplane dentures than they did with the lingualized teeth (90). The average number of adjustments for the monoplane occlusion dentures was 3.17 and for the lingualized occlusion dentures, 3. With the t-test used to compare the means, no significant difference was found in the two occlusal patterns as measured by the number of adjustments required.

Sixteen patients previously had been wearing den- tures with monoplane occlusion, or an occlusal scheme that was so worn as to be unidentifiable. Only four of these (25%) preferred the monoplane occlusion. One had never had dentures, a second was not wearing dentures, and a third already had lingualized occlusion. Of the remaining 11 who had previously used anatomic teeth (20- or 30-degree), all who had a preference (8) chose the lingual&d occlusion.

Eighteen patients had never worn dentures or had only one set. Of these, 12 (66.67%) preferred lingual- ized occlusion, three liked the monoplane, and three

had no preference. The others (12) had worn two, or more, sets of dentures previously. The same per- cent of this group (66.67%) selected the lingualized occlusion.

There were 15 subjects 65 years of age and over, and the same number under 65. Of those 65 and over, 46.67% preferred lingualized occlusion, 33.33% pre- ferred monoplane occlusion, and 20% had no prefer- ence. In the younger age group, under 65 years of age, all who expressed a preference said that they liked the lingualized occlusion (86.67%).

Of the 16 men, 10 chose the lingualized occlusion (62.50%), five (31.25%) the monoplane occlusion, and one (6.25%) had no preference. The 14 women either had no preference (28.57%) or chose the lingualized occlusion (71.43%).

Twenty of the 30 patients (66.67%) expressed a preference for the lingualized occlusion. Only five patients (16.67%) preferred the monoplane occlusion, while the same number had no preference. This preference for the lingualized occlusion was significant at the 0.005 level according to chi-square analysis.

The patients were asked to give reasons for their denture preferences. Those selecting the lingualized occlusion mentioned that those dentures “chewed bet- ter” (13 times); that they “fit better”; were “more stable” or “more comfortable” (nine times); that they “looked better” (seven times); and that “the speech was better” and “no cheek biting” occurred (one time each).

Those preferring the monoplane occlusion, on the other hand, mentioned “more comfortable” or “fit better” four times and “could eat better” once.

Most preferred the lingualized occlusion no matter what type of occlusion they had had previously or how many different sets of teeth they had used over the years.

It could be assumed that improved esthetics helped influence both the younger age group and the women to choose the lingualized occlusion exclusively when they expressed a preference.

The reason given for the preference of lingualized occlusion from those among this group of 30 patients who did so would seem to support the contention that lingualized occlusion improves the masticatory abilities and the appearance of the dentures, as compared to a cuspless scheme, while providing the same noninterfer- ing freedom and bilaterally balanced occlusion.

SUMMARY Two sets of dentures, one with lingualized occlusion

and the other with monoplane occlusion, were made for each of 30 edentulous patients. Sixty-seven percent of

178 AUGUST 1983 VOLUME 50 NUMBER 2

LINGUALIZED AND MONOPLANE OCCLUSION

those people preferred the lingualized occlusal scheme because of improved masticatory ability, comfort, and esthetics.

REFERENCES

I

2.

3.

4.

5.

6.

I.

ILlanly, R. S., and Vinton, P.: A survey of the chewing ability of denture wearers. J Dent Res 30~314, 1951. Trappozzano, ‘v’. R , and Lazzari, J. B.: An experimental study of (he testing of occlusal patterns on the same denture bases. ,J PKOS.IYII:‘L. DEBUT 2:440, 1952. Payne, 5. H.: A comparative study of posterior occlusion. ,J PKOSTHET DEFII- 2:661, 1952. Trappozzano, V. R.: Testing of occlusal patterns on the same denture base. J PROYIME~ DENT 9:53, 1959. Bascom, P. W.: Masticatory elficiency of complete dentures. J PROSTHI;?‘ DEYIT 12~453, 1962. Friedman, S.: .2 comparative analysis of conflicting factors in the selection of occlusal patterns for edentulous patients. J PROSTHIX DE\:.r 14:30, 1964. Kapur, K. K., end Soman, S.: The effect of denture factors on mast&tory performance. J PROSTHET DENT 1.5~662, 1965.

8 Brrlvel-, A. A., Reihel, P. R., and Nossif, N. J.: Comparison of zero-degree teeth and anatomic teeth on complete dentures. J PKOSI+E:~ DENT 17:28, 1967.

0. (:xlsson, G. E., Otterland, A., and Wennstrom, A.: Patient factors in appreciation of complete dentures. J PROSTHET DENT 17:322. 1967.

IO. Kelly, E. K.: Factors aHecting the masticatory performance of complete denture wearers. J PROSMET DENT 33:122, 1975.

I I. Frederickson, E. J.: Comparison of posterior teeth. J Am Dent Asaoc 92:133, 1976.

12. Kelsey, C.. Caplowitz, J.. and Schoonmaker, RI.: EHects of occlusal forms on pressure and bending during mastication with complete dentures. J Dent Res 55:312, 1976.

13. Becker, C. M., Swoope, C. C., and Guckers, A. D.: Lingual- ized occlusion for removable prosthodontics. J PR~STHET DENT 38:601, 1977.

Bound volumes available to subscribers

Bound volumes of the JOURNALOF PROSTHETIC DENTISTRY are available to subscribers (only) for the 1983 issues from the publisher at a cost of $39.00 ($49.00 international) for Vol. 49 (January-June) and Vol. 50 (July-December). Shipping charges are included. Each bound volume contains a subject and author index, and all advertising is removed. Copies are shipped within 30 days after publication of the last issue in the volume. The binding is durable buckram with the journal name, volume number, and year stamped in gold on the spine. Pqyment must accompany all orders. Contact Mr. Deans Lynch at The C. V. Mosby Co., 11830 Westline Industrial Drive, St. Louis, MO 63146, USA.

Subscriptions must be in force to qualify. Bound volumes are not available in place of a regular JOURNAL subscription.

THE JOURNAL OF PROSTHETIC DENTISTRY 179