Lingualized Occlusion For Removable

Prosthodontics

Presented by:

Dr. Mujtaba Ashraf

MDS II

Becker CM, Swoope CC, Guckes AD

J Prosthet Dent 1977;38:601-8

Journal Club Presentation

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Introduction

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The literature is filled with discussions of the

various types of occlusal forms and posterior tooth

arrangements.

The search for the ideal denture occlusion has

been going on for almost two centuries in an effort

to find the tooth form which provides maximum

denture stability and masticatory efficiency

without compromising the health of the underlying

bone.

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Prof. Alfred Gysi was first to design

and patent “Cross-Bite Posterior

Teeth” in 1927 . Each maxillary

tooth featured a single, linear cusp

that fit into shallow mandibular

depression. So the Concept of

lingualized occlusion was

introduced by A. Gysi in 1927.

Maxillary posterior teeth featured single,

linear cusps that fit into shallow mandibular

depressions.

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Today, the available occlusal forms can be

classified into three major groups :

• anatomic- 30 degree cusps,

• semianatomic- 20 degree cusps,

• nonanatomic or cuspless- 0 degree cusps

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Advantages of various cusp forms suggested in the literature

Cusp Form Advantages

Anatomic

occlusion

• Penetrates food more easily

• Resists the rotation of denture bases through cusp

interdigitation

• Provides better esthetics

• Acts as a guide for proper jaw closure

Non-anatomic

occlusion

• Does not lock the mandible in one position

• Permits the use of less time consuming

techniques

• Minimizes horizontal stress because of the

absence of inclined planes

• Adapts easily to Classes II and III jaw relations

• More easily adjusted after changes in vertical and

horizontal relations

• Easier to arrange in crossbite19 July

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Cusp Form Disadvantages

Anatomic

occlusion

• More occlusal disharmony during settling and

difficult to correct by adjustment

• Precise jaw closure and base stability required for

interdigitation

• Increased horizontal forces

• Difficult to adapt to abnormal jaw relationships

Non-anatomic

occlusion

• Poor esthetics

• Decreased masticatory efficiency

• More difficult to obtain balanced occlusion

• Psychological

Disadvantages of various cusp forms suggested in the literature

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LlNGUALlZED OCCLUSION

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Lingualized occlusion is an attempt to maintain the

esthetic and food-penetration advantages of the

anatomic form while maintaining the mechanical

freedom of the non-anatomic form.

The lingualized concept utilizes anatomic teeth for the

maxillary denture and modified non-anatomic or

semi-anatomic teeth for the mandibular denture

Lingualized occlusion should not be confused with

placement of the mandibular teeth lingual to the ridge

crest, as suggested by several authors.19 July

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Lingualized Occlusion has been defined as “a form

of denture occlusion that articulates the maxillary

lingual cusps with the mandibular occlusal surfaces

in centric, working, and nonworking mandibular

positions. GPT-9

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EVOLUTION

Gysi was first to report the biomechanical advantages of

lingualized tooth forms (1927).

The basic concepts of lingualized occlusion were first

suggested by Payne (1941).

Pound discussed a similar occlusal concept and used the term

“lingualized occlusion” (1973).

Ortman, Murrell, Becker, and Kelly provided additional

support for this occlusal concept (1977).

Parr GR, Loft GH. The occlusal spectrum and complete dentures. Compend Contin Educ Dent 1982; 3:241-50

Parr GR, Ivanhoe JR. Lingualized occlusion:an occlusion for all reasons. Dent Clin North Am 1996;40:103-12

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Gysi designed and patented

“Cross-Bite Posterior Teeth” in

1927.

Each maxillary tooth featured a

single, linear cusp that fit into a

shallow mandibular depression.

These teeth were reasonably

esthetic, easy to arrange, and

encouraged vertical force

transmission via their mortar-

and-pestle anatomy.

Gysi’s Cross-bite Posterior Teeth

Gysi A. Special teeth for cross-bite cases.Dent Digest 1927;33:167-71

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By 1935, Dr. FA French had patented

his “Modified Posterior Teeth”.

The maxillary teeth featured shallow

fossae, while the mandibular teeth

displayed narrow, planar occlusal

surfaces.

French FA. The problem of building satisfactory dentures. J Prosthet Dent 1954;4:769-81

Dr. French’s Modified Posterior Teeth19 July

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PAYNE’S CONCEPT

This changed in 1941, when

Dr. SH Payne introduced a

more cogent form of

lingualized occlusion.

According to Payne’ article,

a mortar-and-pestle

arrangement was created via

judicious recontouring of

30-degree teeth.

Payne SH. A posterior set-up to meet individual requirements. Dent Digest 1941;47:20-2

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The maxillary lingual

cusps maintained

contact with the

mandibular teeth in

eccentric movements.

In contrast, the

maxillary buccal cusps

did no contact to the

opposing teeth during

mandibular movements.

Payne SH. A posterior set-up to meet individual requirements. Dent Digest1941;47:20-2

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POUND’S CONCEPT

Pound also championed

lingualized occlusion in his articles

and presentations.

Pound used maxillary teeth having

cusp angles greater than 30

degrees in conjunction with

mandibular teeth having cusp

angles of 20 degrees or less.

He carefully reshaped mandibular

fossae to produce cross-arch

balance.

Pound E. Utilizing speech to simplify a personalize denture service. J Prosthet Den1970;24:586-600

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Pound ensured that maxillary

buccal cusps did not contact

mandibular teeth during

eccentric mandibular

movements.

He accomplished this by

reducing the facial surfaces of

the mandibular posterior teeth

rather than elevating the buccal

cusps of the maxillary teeth.

Though the method for eliminating maxillary buccal contact was

dissimilar, the mechanical results were nearly identical to those described

by Payne.

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OBJECTIVE

In a lingualized occlusion scheme, the objective is the

elimination of buccal cusp contacts in order to

alleviate lateral stresses or lateral dislodging forces.

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The lingual cusps of the upper posteriors make contact in

centric relation in the central fossae of the lower

posteriors.

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The buccal cusps are out of

contact; however the lingual cusps

are in contact in centric, working

and balancing movements.

For this reason, all the stresses

created during working and

balancing motions are of a

downward nature, thus creating

stability.

Working Side

Balancing Side19 July

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INDICATIONS FOR LINGUALIZED OCCLUSION

• Lingualized occlusion can be used in most denture

combinations.

• It is particularly helpful when the patient places high

priority on esthetics but non-anatomic occlusal

scheme is indicated because oral conditions such as

severe alveolar resorption, a Class II jaw relationship,

or displaceable supporting tissue.

• If the non anatomic occlusal scheme is used, esthetics

in the premolar region are compromised. With

Lingualized occlusion, the esthetic result is greatly

improved while still maintaining the advantages of a

non-anatomic system.19 July

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A monoplane occlusal scheme limits esthetic results in the

premolar region.19 July

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A lingualized occlusion provides improved esthetics in

the premolar region.19 July

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Lingualized occlusion also can be used

effectively when a complete denture opposes a

removable partial denture.

Patients having parafunctional habits, so that

reduced amount of horizontal forces are

transmitted to supporting tissues.

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Implant-supported overdentures to eliminate lateral

forces that can rock abutments loose over time.

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PRINCIPLES

1. Anatomic posterior (30 or 33 degree) teeth are used for

the maxillary denture.

Tooth forms with prominent lingual cusps are helpful.

2. Non-anatomic or semi-anatomic teeth are used for the

mandibular denture.

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Either a shallow or flat cusp form is used.

A narrow occlusal table is preferred when severe

resorption of the residual ridges has occurred.

3. Maxillary lingual cusps should contact mandibular

teeth in centric occlusion.

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Modification of the mandibular posterior teeth is

accomplished by selective grinding which is

always necessary regardless of specific tooth or

material.

Selective grinding smooth the central fossae of the

mandibular teeth, lowers marginal ridges, and

forms slight buccal and lingual inclines

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The mandibular buccal cusps

should not contact the upper

teeth in centric occlusion, as

is customary with usual

anatomic tooth placement.

It is helpful to slightly rotate

the maxillary posterior teeth

buccally to allow for slight

clearance of the buccal cusps

in the working position and

to reduce the need for

extensive grinding 19 July

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4. Balancing and working contacts should occur only on the

maxillary lingual cusps.

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Working Side Balancing Side

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Reduction of antero-posterior interferences on the

mandibular teeth may be necessary in order to

provide a range of balanced occlusion in the

protrusive position.

Selective grinding for should be done

only on the mandibular teeth so that

lateral balancing contacts and the

vertical dimension of occlusion are not

changed.

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A wide variety of cusped and non-cusped tooth

forms may be used to create arrangements that may

be considered to be lingualized occlusion.

Generally, maxillary teeth with cusp angles of ≥30

degrees are opposed by mandibular teeth displaying

cusp angles of ≤20 degrees.

Some of the most popular combinations include 30-

to 33-degree cusp designs for maxillary teeth and 0-

degree cusp designs for mandibular teeth.

BalancingWorking

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Advantages of Lingualized Occlusion

Most of the advantages attributed to both the anatomic

and non-anatomic forms are retained.

Cusp form is more natural in appearance compared to

non-anatomic tooth form.

Good penetration of the food bolus is possible.

Bilateral mechanical balanced occlusion is readily

obtained for a region around centric relation.

Vertical forces are centralized on the mandibular teeth.

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Summary

Lingualized occlusion provides a useful combination

of several occlusal concepts.

Many advantages of anatomic and non-anatomic

occlusions are retained. Adjustment to compensate for

minor changes in vertical and centric relation is

readily accomplished.

Satisfactory occlusion is easily obtained, and balanced

occlusion can be accomplished.

The lingualized occlusal concept is not a panacea, and

all other procedures still must be carefully executed.19 July

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References

1. Sears, V. H. : Chewing Members, J. PROSTHET. DENT. 1: 761-

763, 1951. (Historical reprint of an original paper presented in 1922.)

2. Hall, R. E.: The Inverted Cusp Tooth, J. Am. Dent. Assoc. 18:

2366-2368, 1931.

3. Hardy, I. R.: The Development in the Occlusal Patterns of

Artificial Teeth, J. PROSTHET. DENT. 1: 14-28, 1951.

4. Sears, V. H.: Thirty Years of Non Anatomic Teeth, J. PROSTHET.

DENT. 3: 596-617, 1953.

5. Rapp, R.: The Occlusion and Occlusal Patterns of Artificial

Posterior Teeth, J. PROSTHET. DENT. 4: 461-480, 1954.

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