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Concepts of Occlusion Concepts of Occlusion
Vicki C Petropoulos DMD, MSVicki C Petropoulos DMD, MS
Associate Professor of Preventive and Restorative Associate Professor of Preventive and Restorative SciencesSciences
University of PennsylvaniaUniversity of Pennsylvania
School of Dental MedicineSchool of Dental Medicine
AcknowlegementsAcknowlegements
��Many of these images are courtesy of theMany of these images are courtesy of the
American College of American College of ProsthodontistsProsthodontists, UCLA , UCLA
Complete Dentures Educational Complete Dentures Educational
Curriculum CD, 2004.Curriculum CD, 2004.
Learning GoalsLearning Goals
�� To understand differences between To understand differences between natural dentition and complete denture natural dentition and complete denture occlusionocclusion
�� To understand the goals of complete To understand the goals of complete denture occlusion and why balance is denture occlusion and why balance is neededneeded
�� To understand the four types of denture To understand the four types of denture occlusionocclusion
�� To understand HanauTo understand Hanau’’s s QuintQuint
Learning GoalsLearning Goals
�� To understand the different types of To understand the different types of
posterior tooth forms, adv. and posterior tooth forms, adv. and disadvdisadv..
Natural dentitionNatural dentition presents presents in a variety of individual in a variety of individual tooth size, shape, form and tooth size, shape, form and alignment, but ideally exhibit alignment, but ideally exhibit certain characteristic certain characteristic occlusion features.occlusion features.
Natural Occlusion
(organic)
•• Bilateral Posterior Centric Bilateral Posterior Centric ContactContact
•• Anterior GuidanceAnterior Guidance
•• Mutually Protective Mutually Protective Scheme of OcclusionScheme of Occlusion
Natural Occlusion
(organic)
Complete denture Complete denture ““dentitiondentition”” also presents in also presents in a variety of forms, but also a variety of forms, but also exhibit certain common exhibit certain common characteristicscharacteristics
Complete Denture
Occlusion
•• Bilateral centric contactsBilateral centric contacts•• Bilateral eccentric contacts Bilateral eccentric contacts
(balance) to provide stability of (balance) to provide stability of the denture bases during functionthe denture bases during function
Complete Denture
Occlusion
•• Because of compromises Because of compromises
inherent in restoring the inherent in restoring the
edentulous arch, complete edentulous arch, complete
denture tooth forms and denture tooth forms and
arrangements (i.e. occlusion), arrangements (i.e. occlusion),
should be designed to provide should be designed to provide
function and esthetics while function and esthetics while
minimizing denture base minimizing denture base
tipping (lateral) forces tipping (lateral) forces
Complete Denture Occlusion
Fundamental differences of natural and Fundamental differences of natural and complete denture occlusioncomplete denture occlusion
1.1. Sensory feedback mechanismSensory feedback mechanism
2.2. Derivation of :Derivation of :
•• retentionretention
•• stabilitystability
•• supportsupport
3.3. Reaction of supporting structures to Reaction of supporting structures to masticatorymasticatoryforcesforces
1. Sensory Feedback1. Sensory Feedback
Precision of feedback is significantly compromised Precision of feedback is significantly compromised
following loss of teeth and associated structures following loss of teeth and associated structures
(periodontal ligament)(periodontal ligament)
For natural dentition, retention, stability, and support are derFor natural dentition, retention, stability, and support are derived ived
through the through the periodontiumperiodontium which provides; which provides;
�� Sensory feedback mechanismSensory feedback mechanism
�� Difference in reaction of supporting structures to Difference in reaction of supporting structures to masticatorymasticatory forcesforces
�� Differences in load transfer mechanism and physiologyDifferences in load transfer mechanism and physiology
2. Derivation of retention, stability and 2. Derivation of retention, stability and
support for support for natural occlusionnatural occlusion
2. Derivation of retention, stability and support for 2. Derivation of retention, stability and support for complete complete denture occlusiondenture occlusion
Complete dentures receive their retention, stability, and
support from the soft tissues overlying residual bone
(ridges, buccal shelf, palate, etc.).
Denture Bearing Surface
•• RetentionRetention
�� Resistance to dislodgment forces in a vertical Resistance to dislodgment forces in a vertical
direction away from the bearing surfacedirection away from the bearing surface
Denture Bearing SurfaceDenture Bearing Surface
•• StabilityStability
�� Resistance to laterally oriented dislodgment forcesResistance to laterally oriented dislodgment forces
Denture Bearing SurfaceDenture Bearing Surface
•• SupportSupport�� Factors of the Bearing Surface which resist forces Factors of the Bearing Surface which resist forces
in a vertical direction towards the bearing surfacein a vertical direction towards the bearing surface
Natural occlusion
Physiologic levels of tension results in
alveolar bone apposition (such as that
transmitted by loading the periodontal
ligament through natural dentition)
Complete denture occlusion
Non-physiologic compression as may
occur under denture bases results in
further residual ridge resorption (RRR)
3. Reaction of supporting structures
•• Mobile bases on mucosaMobile bases on mucosa
•• Teeth move as an unitTeeth move as an unit
•• Malocclusion affects entire base Malocclusion affects entire base immediatelyimmediately
•• NonNon--vertical forces affect all vertical forces affect all teeth and are traumaticteeth and are traumatic
•• Incising affects all teeth attached Incising affects all teeth attached to baseto base
•• Bilateral balance is often desired Bilateral balance is often desired for base stabilityfor base stability
•• Decreased tactile senseDecreased tactile sense
•• Retained in PDLRetained in PDL
•• Units move independentlyUnits move independently
•• Malocclusion effects not Malocclusion effects not immediateimmediate
•• NonNon--vertical forces affect only vertical forces affect only teeth involved and usually teeth involved and usually well toleratedwell tolerated
•• Incising doesnIncising doesn’’t affect t affect posteriorsposteriors
•• Bilateral balance is rareBilateral balance is rare
•• Tactile sensitivityTactile sensitivity
Natural DentitionNatural Dentition Denture Denture ““DentitionDentition””
Summary
SummarySummary•• Goal of complete denture occlusion is preservation of Goal of complete denture occlusion is preservation of
structure and restoration of function and estheticsstructure and restoration of function and esthetics
•• Consequences of tooth loss create anatomic changes Consequences of tooth loss create anatomic changes which result in differences in derivation of retention, which result in differences in derivation of retention, stability and support between natural and complete denture stability and support between natural and complete denture teethteeth
•• The differences in the design of natural and complete The differences in the design of natural and complete denture occlusion are the consequence of differences in denture occlusion are the consequence of differences in the derivation of retention, stability and support.the derivation of retention, stability and support.
•• Complete denture form and tooth placement is Complete denture form and tooth placement is biomechanical in naturebiomechanical in nature
The Edentulous StateThe Edentulous State
�� Residual ridge reductionResidual ridge reduction
�� Compromised reflex adaptabilityCompromised reflex adaptability
�� Possible increase in parafunctional Possible increase in parafunctional
movementsmovements
�� Increased risk of maladaptive dentureIncreased risk of maladaptive denture--
wearing experiencewearing experience
OcclusionOcclusion
�� Denture occlusion is not just about the Denture occlusion is not just about the
occlusal plane.occlusal plane.
�� The setting of teeth includes orientation of The setting of teeth includes orientation of
the plane, shaping and positioning of the the plane, shaping and positioning of the
arch, inclinations and rotations for arch, inclinations and rotations for
esthetics, and the mechanics for obtaining esthetics, and the mechanics for obtaining
proper tooth inclination.proper tooth inclination.
OcclusionOcclusion
�� The dentist has the power to establish all The dentist has the power to establish all
factors of occlusion in a complete denture factors of occlusion in a complete denture
except the condylar path.except the condylar path.
Chewing with DenturesChewing with Dentures
�� During mastication the teeth make contact During mastication the teeth make contact
on the chewing side and the nonon the chewing side and the non--chewing chewing
side.side.
�� Tissue resiliency and denture movement Tissue resiliency and denture movement
during function account for the higher during function account for the higher
frequency of nonfrequency of non--chewing contactschewing contacts
Types of Denture OcclusionTypes of Denture Occlusion
�� BalancedBalanced
�� The preferred occlusal schemeThe preferred occlusal scheme
��Monoplane (Monoplane (NeutrocentricNeutrocentric))
��Monoplane with balanceMonoplane with balance
�� Lingualized occlusionLingualized occlusion
Is Is ““BalanceBalance”” necessary?necessary?
Balanced Balanced
occlusion occlusion
NonNon--balanced balanced
occlusionocclusionvsvs
Protrusive positionProtrusive position Protrusive positionProtrusive position
Is Is ““BalanceBalance”” Necessary?Necessary?
““Bolus inBolus in””
““Balance outBalance out””
To Balance or Not to BalanceTo Balance or Not to Balance
�� But do we need balanced occlusion?But do we need balanced occlusion?
Brien LangBrien Lang
�� ““There is little scientific support to select There is little scientific support to select
an an occlusalocclusal concept, however a report by concept, however a report by
Brewer (1963) found in a 24 hour test Brewer (1963) found in a 24 hour test
period that teeth contact during chewing period that teeth contact during chewing
(10 (10 minsmins) were much less than tooth ) were much less than tooth
contacts during non chewing (2contacts during non chewing (2--4 hours). 4 hours).
This suggests a need for balanced This suggests a need for balanced
articulation especially during articulation especially during parafunctionparafunction””
�� Balanced denture teeth provide denture Balanced denture teeth provide denture
stabilization during stabilization during parafunctionalparafunctional jaw jaw
movements by ensuring even pressure in movements by ensuring even pressure in
all parts of the arch.all parts of the arch.
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
��We spend 2We spend 2--4 hours/day in parafunction 4 hours/day in parafunction
and only 10 minutes/day in functionand only 10 minutes/day in function
Objective of Balanced Objective of Balanced
OcclusionOcclusion�� To create stability of the denture bases To create stability of the denture bases during eccentric movementduring eccentric movement
�� Instability of the bases leads to:Instability of the bases leads to:
�� Irritation of the hard and soft tissuesIrritation of the hard and soft tissues
�� Excessive denture movementExcessive denture movement
�� Unequal distribution of forcesUnequal distribution of forces
�� Potential for more rapid loss of osseous Potential for more rapid loss of osseous supportsupport
When do we Achieve Balanced When do we Achieve Balanced
Occlusion?Occlusion?
�� At the final try in, we will verify the Jaw At the final try in, we will verify the Jaw
Relationship RecordRelationship Record
�� At that point we will do a protrusive record At that point we will do a protrusive record
to set the condylar inclinationto set the condylar inclination
�� Balance will be achieved in the labBalance will be achieved in the lab
Types of Denture TeethTypes of Denture Teeth
�� Artificial teeth can beArtificial teeth can be
�� Anatomic (30 degrees or greater)Anatomic (30 degrees or greater)
�� SemiSemi--anatomic (30 to 0 degrees)anatomic (30 to 0 degrees)
�� Nonanatomic (0 degrees)Nonanatomic (0 degrees)
AdvantagesAdvantages
�� AnatomicAnatomic
�� More estheticMore esthetic
�� Supposed higher Supposed higher
chewing efficiencychewing efficiency
�� Ease in achieving Ease in achieving
balanced occlusionbalanced occlusion
�� NonanatomicNonanatomic
�� Easier to setEasier to set
�� Kinder to edentulous Kinder to edentulous
ridgesridges
DisadvantagesDisadvantages
�� AnatomicAnatomic
�� More time consuming More time consuming
to setto set
�� May cause more/faster May cause more/faster
bone resorptionbone resorption
�� NonanatomicNonanatomic
�� UnaestheticUnaesthetic
�� Supposed to decrease Supposed to decrease
chewing efficiencychewing efficiency
BalanceBalance
�� Balance can be achieved with anatomic Balance can be achieved with anatomic
OR monoplane teeth.OR monoplane teeth.
��With anatomic teeth it is generated by the With anatomic teeth it is generated by the
tooth arrangementtooth arrangement
��With monoplane teeth it is generated by a With monoplane teeth it is generated by a
balancing rampbalancing ramp
Verify contacts in working excursionsVerify contacts in working excursions
Lack of working side contacts may be the result of:Lack of working side contacts may be the result of:•• Poor buccal centricPoor buccal centric
•• Insufficient curve of WilsonInsufficient curve of Wilson
•• Working interferences in the 2Working interferences in the 2ndnd molar regionmolar region
•• Balancing interferences on the opposite sideBalancing interferences on the opposite side
**Check these in the Check these in the order citedorder cited..
Verify contacts during balancing excursionVerify contacts during balancing excursion
Lack of balancing side contacts may be the result of:Lack of balancing side contacts may be the result of:•• Poor lingual centricPoor lingual centric
•• Working interferences on the opposite side, particularly in the Working interferences on the opposite side, particularly in the
22ndnd molar regionmolar region
BalancingBalancing ProtrusiveProtrusive
WorkingWorking
�� All things being considered, the most All things being considered, the most
successful denture wearers are usually successful denture wearers are usually
those who have a good patient/provider those who have a good patient/provider
relationship and a good, positive outlook relationship and a good, positive outlook
and good and good neuroneuro--musculature control.musculature control.
Always RememberAlways Remember……
Dentures are not a replacement for teethDentures are not a replacement for teeth……
Dentures are a replacement for no teeth.Dentures are a replacement for no teeth.
OcclusionOcclusion
�� The static relationship between the The static relationship between the
incising or masticating surfaces of the incising or masticating surfaces of the
maxillary and mandibular teeth or tooth maxillary and mandibular teeth or tooth
analogsanalogs
Five Determinants of Five Determinants of
Mandibular MovementsMandibular Movements
�� Right TMJRight TMJ
�� Left TMJLeft TMJ
�� TeethTeeth
�� Tissues/nerve impulses (proprioception)Tissues/nerve impulses (proprioception)
�� CNSCNS
Planes of ReferencePlanes of Reference
Mandibular MovementMandibular Movement
�� RotationRotation
�� Around the terminal hinge axisAround the terminal hinge axis
�� TranslationTranslation
�� Condyle glides along the posterior incline of Condyle glides along the posterior incline of
the tuberclethe tubercle
Mandibular OpeningMandibular Opening
Types of MovementTypes of Movement
�� BorderBorder
�� FunctionalFunctional
�� Speaking (phonetics)Speaking (phonetics)
�� Chewing (mastication)Chewing (mastication)
�� Swallowing (deglutition)Swallowing (deglutition)
�� ParafunctionalParafunctional
�� BruxingBruxing
�� clenchingclenching
Denture ForcesDenture Forces
�� The amount of force generated with a The amount of force generated with a
denture vs. natural occlusion is denture vs. natural occlusion is
approximately only 16 %!!!!!approximately only 16 %!!!!!
Posterior Determinants of Posterior Determinants of
OcclusionOcclusion
�� Shape of articular eminenceShape of articular eminence
��Medial walls of glenoid fossaMedial walls of glenoid fossa
�� Shape of condylesShape of condyles
Anterior Determinants of OcclusionAnterior Determinants of Occlusion
�� Vertical overlap of anterior teethVertical overlap of anterior teeth
�� Horizontal overlap of anterior teethHorizontal overlap of anterior teeth
�� Lingual concavities of maxillary anterior Lingual concavities of maxillary anterior
teethteeth
Anterior Determinants of OcclusionAnterior Determinants of Occlusion
Role of Anterior TeethRole of Anterior Teeth
�� In a normal occlusal relationship the In a normal occlusal relationship the
maxillary and mandibular canines contact maxillary and mandibular canines contact
during lateral movements.during lateral movements.
Dynamic Occlusal ContactsDynamic Occlusal Contacts
�� Any movement of the mandible from the Any movement of the mandible from the centric occlusion position that results in centric occlusion position that results in tooth contact is termed tooth contact is termed eccentriceccentric..
�� There are three basic eccentric There are three basic eccentric movementsmovements
�� ProtrusiveProtrusive
�� LaterotrusiveLaterotrusive
�� RetrusiveRetrusive
ProtrusiveProtrusive
�� The mandible moves forward from the The mandible moves forward from the
centric occlusion positioncentric occlusion position
�� The predominant protrusive contact occurs The predominant protrusive contact occurs
between the maxillary and mandibular between the maxillary and mandibular
anterior teeth.anterior teeth.
ProtrusiveProtrusive
Laterotrusive (Working)Laterotrusive (Working)
��Most function occurs on the working side Most function occurs on the working side (lateral movement) the side to which the (lateral movement) the side to which the mandible is shifted.mandible is shifted.
��Working contacts and crossWorking contacts and cross--tooth contacts tooth contacts occur on the working side.occur on the working side.
��Working contacts occur between the inner Working contacts occur between the inner inclines of max buccal and outer inclines inclines of max buccal and outer inclines of mand buccal.of mand buccal.
Mediotrusive (NonMediotrusive (Non--working)working)
�� Formerly balancing contacts, but now the Formerly balancing contacts, but now the
teeth disclude.teeth disclude.
�� Potential sites of contact on the inner Potential sites of contact on the inner
inclines of maxillary lingual and inclines of maxillary lingual and
mandibular buccal cusps.mandibular buccal cusps.
��Mediotrusive contacts are interferences.Mediotrusive contacts are interferences.
LaterotrusiveLaterotrusive
RetrusiveRetrusive
HistoryHistory
�� Bilateral Balanced OcclusionBilateral Balanced Occlusion
�� Based on theories related to denturesBased on theories related to dentures
�� Became apparent these principles did not Became apparent these principles did not
apply to fixed prosthodonticsapply to fixed prosthodontics
�� Resulted in premature wear, mobile teeth and Resulted in premature wear, mobile teeth and
gingival gingival cleftingclefting
�� The preferred occlusal scheme for denturesThe preferred occlusal scheme for dentures
Unilateral Balanced OcclusionUnilateral Balanced Occlusion
�� Group FunctionGroup Function
�� Earlier rehabs were modified by eliminating Earlier rehabs were modified by eliminating
balancing contactsbalancing contacts
�� Led to the functionally generated path or Led to the functionally generated path or ““wax wax
chewchew--inin”” techniquetechnique
�� Importance of incisal guidance discovered Importance of incisal guidance discovered
and incorporated into the occlusal schemeand incorporated into the occlusal scheme
�� Results in tipping forces on a dentureResults in tipping forces on a denture
Group FunctionGroup Function
�� Based on the philosophy that the more Based on the philosophy that the more
teeth to share the load the betterteeth to share the load the better
�� Incisal guidance established firstIncisal guidance established first
�� Spreads working side contact over 3 or more Spreads working side contact over 3 or more
teeth in each archteeth in each arch
�� These teeth should be adjacent to each otherThese teeth should be adjacent to each other
�� Involves buccal cusps onlyInvolves buccal cusps only
Group FunctionGroup Function
Centric RelationCentric Relation
�� The maxillomandibular relationship in The maxillomandibular relationship in which the condyles articulate with the which the condyles articulate with the thinnest avascular portion of their thinnest avascular portion of their respective disks with the complex in the respective disks with the complex in the anterior superior position against the anterior superior position against the shapes of the articular eminence. shapes of the articular eminence.
�� This position is independent of tooth This position is independent of tooth contactcontact
Centric RelationCentric Relation
�� The most important factor to remember is The most important factor to remember is
that it is REPEATABLE!!!that it is REPEATABLE!!!
Optimum Functional OcclusionOptimum Functional Occlusion
�� CRCR------for purposes of this lecture it is the for purposes of this lecture it is the
most superoanterior position.most superoanterior position.
�� CR=CO with even and simultaneous CR=CO with even and simultaneous
contact of all posterior teethcontact of all posterior teeth
REVIEWREVIEW
�� Mobile bases on mucosaMobile bases on mucosa
�� Teeth move as an unitTeeth move as an unit
�� Malocclusion affects entire base Malocclusion affects entire base
immediatelyimmediately
�� NonNon--vertical forces affect all teeth vertical forces affect all teeth
and is traumaticand is traumatic
�� Incising affects all teeth attached Incising affects all teeth attached
to baseto base
�� Bilateral balance is often desired Bilateral balance is often desired
for base stabilityfor base stability
�� Decreased tactile senseDecreased tactile sense
�� Retained in PDLRetained in PDL
�� Units move independentlyUnits move independently
�� Malocclusion effects not Malocclusion effects not
immediateimmediate
�� NonNon--vertical forces affect only vertical forces affect only
teeth involved and usually well teeth involved and usually well
toleratedtolerated
�� Incising doesnIncising doesn’’t affect t affect
posteriorsposteriors
�� Bilateral balance is rareBilateral balance is rare
�� Tactile sensitivityTactile sensitivity
Natural DentitionNatural Dentition Denture Denture ““DentitionDentition””
Differences between Natural and Differences between Natural and
Complete Denture OcclusionComplete Denture Occlusion
Goals of Complete Denture OcclusionGoals of Complete Denture Occlusion
�� Minimize trauma to the Minimize trauma to the supporting structuressupporting structures
�� Preserve remaining Preserve remaining structuresstructures
�� Enhance stability of the Enhance stability of the denturesdentures
�� Facilitate esthetics and Facilitate esthetics and speechspeech
�� Restore mastication Restore mastication efficiency to a reasonable efficiency to a reasonable levellevel
Types of Complete Denture OcclusionTypes of Complete Denture Occlusion
�� Bilateral balanceBilateral balance
�� NeutrocentricNeutrocentric
We prefer bilateral balance because this type of We prefer bilateral balance because this type of occlusalocclusal
arrangement limits tipping of the dentures during arrangement limits tipping of the dentures during
parafunctionalparafunctional movements,movements,
Bilateral Balanced Denture OcclusionBilateral Balanced Denture Occlusion
The stable simultaneous contact of The stable simultaneous contact of
opposing upper and lower teeth in opposing upper and lower teeth in
centric relation position with a smooth centric relation position with a smooth
bilateral gliding contact to any eccentric bilateral gliding contact to any eccentric
position within the normal range of position within the normal range of
mandibular function, developed to mandibular function, developed to
lessen or limit tipping or rotation of the lessen or limit tipping or rotation of the
denture bases in relation to the denture bases in relation to the
supporting structures.supporting structures.
Bilateral Balanced Denture OcclusionBilateral Balanced Denture Occlusion
�� Traditionally bilateral balance was achieved Traditionally bilateral balance was achieved
with anatomic posterior denture teeth. with anatomic posterior denture teeth.
However, it can be achieved with However, it can be achieved with
nonanatomicnonanatomic teeth using balancing ramps or teeth using balancing ramps or
by manipulating the compensating curve.by manipulating the compensating curve.
Bilateral Balanced Denture Occlusion with Bilateral Balanced Denture Occlusion with
Anatomic Posterior Denture TeethAnatomic Posterior Denture Teeth
�� Bilateral Posterior Bilateral Posterior Centric ContactCentric Contact
�� Centralized ForcesCentralized Forces
�� ““BalancedBalanced”” Occlusion Occlusion to minimize tippingto minimize tipping
ProtrusiveProtrusive BalancingBalancing WorkingWorking
CentricCentric
Monoplane with Balancing RampsMonoplane with Balancing Ramps
WorkingWorking BalancingBalancing
Bilateral balanced occlusion can also be Bilateral balanced occlusion can also be
obtained with obtained with nonanatomicnonanatomic posterior teeth posterior teeth
if balancing ramps are employed. In all if balancing ramps are employed. In all
lateral excursions you should observe at lateral excursions you should observe at
least three points of contact bilaterally if least three points of contact bilaterally if
bilateral balance is to be achieved. bilateral balance is to be achieved.
ProtrusiveProtrusive
Lingualized Opposing Monoplane with Lingualized Opposing Monoplane with
Balancing RampsBalancing Ramps
�� A similar concept is used when A similar concept is used when lingualizedlingualized maxillary maxillary teeth oppose teeth oppose nonanatomicnonanatomic teeth in the mandible. In teeth in the mandible. In all lateral excursions you should observe at least all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral three points of contact bilaterally to maintain bilateral balance. balance.
WorkingWorking BalancingBalancing
Monoplane Occlusion Monoplane Occlusion
((NeutrocentricNeutrocentric Concept)Concept)
This concept of occlusion assumes that the anteriorThis concept of occlusion assumes that the anterior--posterior plane posterior plane
of occlusion should be parallel to the denture foundation area aof occlusion should be parallel to the denture foundation area and nd
not dictated by condylar inclination.not dictated by condylar inclination.
The plane of occlusion is completely flat and level. There is nThe plane of occlusion is completely flat and level. There is no o
curve of Wilson or Curve of Spee (compensating curve) curve of Wilson or Curve of Spee (compensating curve)
incorporated into the set up.incorporated into the set up.
There is no vertical overlap of the anterior teeth.There is no vertical overlap of the anterior teeth.
When using this concept of occlusion the patient is instructed nWhen using this concept of occlusion the patient is instructed not to ot to
incise the bolus. With this tooth arrangement incise the bolus. With this tooth arrangement DeVanDeVan noted that noted that
““the patient will become a chopper, not a chewer or a grinder.the patient will become a chopper, not a chewer or a grinder.””
Monoplane OcclusionMonoplane Occlusion
((NeutrocentricNeutrocentric Concept)Concept)
CentricCentricBalancingBalancing
At balancing and protrusive positions there is separation of At balancing and protrusive positions there is separation of
the denture teeth in the posterior regions leading to tipping the denture teeth in the posterior regions leading to tipping
of the dentures. This may be disadvantageous in the of the dentures. This may be disadvantageous in the
patients exhibiting patients exhibiting parafunctionalparafunctional grinding habits grinding habits
HanauHanau’’s s QuintQuint
�� Five Factors Affecting Occlusal BalanceFive Factors Affecting Occlusal Balance
�� Condylar InclinationCondylar Inclination
�� Incisal GuidanceIncisal Guidance
�� Occlusal Plane InclinationOcclusal Plane Inclination
�� Compensating CurveCompensating Curve
�� CuspalCuspal InclinationInclination
HanauHanau’’s s QuintQuint
�� InterInter--relationship of these five factors may be relationship of these five factors may be
described bydescribed by TheilmanTheilman’’ss FormulaFormula
�� In order to maintain a balanced occlusion:In order to maintain a balanced occlusion:
C=Condylar Inclination
OccPlane
x Incisal Guidance
x Cuspal Inclination x CompCurve
HanauHanau’’s s QuintQuint
�� Of these five factors, the patient presents you with Of these five factors, the patient presents you with
Condylar InclinationCondylar Inclination
�� Occlusal Plane cannot be altered substantially since Occlusal Plane cannot be altered substantially since
functional requirements dictate its position and functional requirements dictate its position and
orientationorientation
�� The remaining three factors can be controlled by The remaining three factors can be controlled by
the dentistthe dentist
C=Condylar Inclination
OccPlane
x Incisal Guidance
x Cuspal Inclination x CompCurve
Factors controlled by the dentistFactors controlled by the dentist
HanauHanau’’s s QuintQuint
�� Of these five factors, the patient presents you with Of these five factors, the patient presents you with
Condylar InclinationCondylar Inclination
�� Occlusal Plane cannot be altered substantially since Occlusal Plane cannot be altered substantially since
functional requirements dictate its position and functional requirements dictate its position and
orientationorientation
�� The remaining three factors can be controlled by The remaining three factors can be controlled by
the dentistthe dentist
C=Condylar Inclination
OccPlane
x Incisal GuidanceIncisal Guidance
x CuspalCuspal InclinationInclinationx CompCurveCompCurve
Factors controlled by the dentistFactors controlled by the dentist
HanauHanau’’s s QuintQuint
�� Within the confines of esthetics and phonetics, Within the confines of esthetics and phonetics,
minimize Incisal Guidance in Complete Dentures to minimize Incisal Guidance in Complete Dentures to
minimize inclined tipping forcesminimize inclined tipping forces
�� Adjust remaining factors to maintain balanceAdjust remaining factors to maintain balance
C=Condylar Inclination
OccPlane
x Incisal GuidanceIncisal Guidance
x CuspalCuspal InclinationInclinationx CompCurveCompCurve
LingualizedLingualized
Monoplane Monoplane –– neutrocentricneutrocentric
Monoplane with balancing rampsMonoplane with balancing ramps
Lingualized opposing monoplaneLingualized opposing monoplane
SemiSemi--anatomicanatomic
Anatomic (30 degree)Anatomic (30 degree)
Posterior Tooth FormsPosterior Tooth Forms
Posterior Tooth FormsPosterior Tooth Forms
Anatomic Tooth FormsAnatomic Tooth Forms
SemiSemi--anatomic Tooth Formsanatomic Tooth Forms
NonanatomicNonanatomic Tooth FormsTooth Forms
General Concepts of Denture OcclusionGeneral Concepts of Denture Occlusion
�� Common FeaturesCommon Features
�� Functional anatomy is the main determinant of denture Functional anatomy is the main determinant of denture tooth positiontooth position
�� Simultaneous, bilateral posterior contact in centric relation Simultaneous, bilateral posterior contact in centric relation (centric occlusion)(centric occlusion)
�� Centralization of centric occlusal forces over the Centralization of centric occlusal forces over the mandibular residual ridgesmandibular residual ridges
•• BuccalBuccal--LinguallyLingually
•• AnteriorAnterior--PosteriorlyPosteriorly
Balance and the Monoplane OcclusionBalance and the Monoplane Occlusion
Minimize vertical overlap within the
dictates of esthetics and phonetics
Balance and Monoplane OcclusionBalance and Monoplane Occlusion
Minimize vertical overlap within the
dictates of esthetics and phonetics
Bilateral BalanceBilateral Balance
�� Anatomic posterior teeth Anatomic posterior teeth vsvs LingualizedLingualized
Bilateral balance with anatomic denture teethBilateral balance with anatomic denture teeth
Balancing sideBalancing side
Lingualized OcclusionLingualized Occlusion
LingualizedLingualizedLingualizedLingualizedLingualizedLingualizedLingualizedLingualizedConventionalConventionalConventionalConventionalConventionalConventionalConventionalConventional
Centric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric Occlusion
Theoretically, there should be Theoretically, there should be
less lateral displacement of the less lateral displacement of the
denture and less lateral forces denture and less lateral forces
during function when using during function when using
lingualizedlingualized posterior denture posterior denture
teeth.teeth.
LingualizedLingualized OcclusionOcclusion
The lingual cusp tips The lingual cusp tips
should be in contact with should be in contact with
the central fossae of the the central fossae of the
opposing mandibular opposing mandibular
teeth. The teeth. The cuspalcuspal
inclines of the mandibular inclines of the mandibular
teeth are relatively flat, teeth are relatively flat,
resulting in potentially resulting in potentially
less lateral forces and less lateral forces and
displacement during displacement during
function. function.
Lingualized OcclusionLingualized Occlusion
Balancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing Side
Working SideWorking SideWorking SideWorking SideWorking SideWorking SideWorking SideWorking Side
Centric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric Occlusion
Lingualized OcclusionLingualized Occlusion
�� Good estheticsGood esthetics
�� Freedom of nonFreedom of non--anatomic teethanatomic teeth
�� Potential for bilateral balancePotential for bilateral balance
�� Centralizes vertical forcesCentralizes vertical forces
�� Minimizes tipping forcesMinimizes tipping forces
�� Facilitates bolus penetration Facilitates bolus penetration
(mortar and pestle effect)(mortar and pestle effect)
�� High esthetic demandsHigh esthetic demands
�� Severe mandibular ridge atrophySevere mandibular ridge atrophy
�� Displaceable supporting tissues Displaceable supporting tissues
�� MalocclusionMalocclusion
�� Previous successful denture with Previous successful denture with
Lingualized OcclusionLingualized Occlusion
Indications for useIndications for use AdvantagesAdvantages
Lingualized OcclusionLingualized Occlusion
�� Investigators have Investigators have notnot shown one type of shown one type of
denture occlusion to be : denture occlusion to be :
�� superior in functionsuperior in function
�� safer to oral structuressafer to oral structures
�� more acceptable to patientsmore acceptable to patients
Complete Denture OcclusionComplete Denture Occlusion
IN SUMMARY:IN SUMMARY:
Complete Denture OcclusionComplete Denture Occlusion
�� Neuromuscular control may be the single Neuromuscular control may be the single
most significant factor in the successful most significant factor in the successful
manipulation of complete dentures under manipulation of complete dentures under
functionfunction
�� Tongue function and Tongue function and
denture wearing denture wearing
experienceexperience