Occlusion on Osseointergrated Implant Prosthesis Implant supported fixed dental prosthesis have become a desirable treatment option of tooth

replacement in partially edentulous patients. Their goal is to replace form, function and esthetics (Yuan J.C.C, Sukotjo C, 2013). Occlusion is a major determinant of the success rate and longevity of these prosthesis. It influences both the biological as well as functional aspects of the prosthesis (Goodacre CJ et al, 2003). Four occlusal schemes can be adopted for implant supported dental prosthesis. These Include: 1. 2. 3. 4. Balanced Occlusion Mutually protected occlusion Group function Implant protected occlusion

Balanced occlusion Balanced occlusion is occlusion where there is simultaneous bilateral contact of opposing occlusal contacts of some or all the teeth in all mandibular positions. Balanced occlusion is developed by the dental technician when setting artificial teeth on the articulator. There are five determinants of balanced occlusion (The Hanaus quint): 1. Orientation of occlusal plane This is determined by the clinician when trimming the upper occlusal rim during jaw registration. Average value articulators have preset distances between the condylar components and the incisal tips. 2. Condylar guidance angle Condylar guidance is the Mandibular guidance generated by the condyle and the articular disc traversing the glenoid fossa (GPT) This is usually set at about 30 degrees for average value articulators. A steep condylar path requires steep compensating curve for occlusal balance. 3. Incisal guidance angle. This is the angle formed in the horizontal plane by drawing a line in the sagittal plane between the incisal edges of the maxillary and mandibular incisors when the teeth are in centric occlusion. (GPT)

Incisal guidance angle is set at 10 15 degrees. 4. Cuspal angle. The cuspal angles of artificial teeth are determined by the manufacturer. There are: a) Anatomical teeth e.g. 20, 30 and 40 degree cuspal angle. b) Zero degree/ Cuspless teeth Used where the residual alveolar ridge is flat or where there are problems with jaw registration. 5. Compensating curves. a) The curve of spee This is the antero- posterior curve, measured with reference from the incisal tip along the buccal cusps of maxillary teeth. b) The curve of Wilson The Lateral curve. It runs from the tip of the buccal cusps through the palatal cusps on one side and through the palatal cusps to the buccal cusps on the opposite side. These curves compensate for mandibular movements both in excursion and lateral excursion.

Mutually Protected Occlusion Also called canine protected occlusion, it is an occlusal scheme whereby the posterior teeth prevent excessive contact of anterior teeth in maximum intercuspation, and the anterior teeth disengage the posterior teeth in all excursive mandibular movements (GPT). This reduces frictional wear of teeth.

Group Function occlusion

This refers to multiple contact relations between the maxillary and mandibular teeth in lateral movements on the working side whereby simulataneous contact of several teeth acts as a group to distribute occlusal forces (GPT). Absence of contacts on non working side prevents those teeth from being subjected to the destructive, obliquely directed forces found on the non working side

Implant Protected Occlusion It refers to an occlusal scheme that is specifically designed to restore an osseointergrated implant, and which allows for a suitable environment that ensures the longevity of both the implant and the prosthesis (Misch CE, 1993). It aims at reducing the occlusal forces on implant prosthesis. Overloading on these prosthesis may cause Peri- Implantitis which may lead to failure of both the implant and the prosthesis. Modifications to normal occlusal schemes include: I. Provision of Load sharing occlusal contacts II. Modification of the occlusal table and anatomy A narrow occlusal table is preferred since it reduces the chance of offset loading and and increases axial loading thus reducing bending moments on an implant. III. Correction of load direction IV. Increase in implant surface areas and V. Elimination or reduction of occlusal contacts in implants with unfavorable biomechanics (Yuan J.C.C, Sukotjo C, 2013). These modifications must follow the basic principles of implant occlusion which include: Anterior guidance whenever possible. This should be as shallow as possible to avoid greater forces on the anterior implants which may result from steep incisal guidance angles.

Bilateral stability in centric (habitual) occlusion Wide freedom in centric (habitual) occlusion Evenly distributed occlusal contacts and forces No interferences between the retruded position and the centric (habitual) position Smooth and even lateral excursive movements without working/non working interferences (Kim Y et al, 2005).

References 1. Goodacre C.J., Bernal G, Rungcharassaeng K, Kan Y.J. (2003). Clinical complications with implants and implant prosthesis. J prosthet Dent 2003; 90:121-32. 2. GPT (Glossary of Prosthodontic Terms). J Prosthet Dent. 2005 Jul; 94(1):10-92. Available from: (www.academyofprosthodontists.org/_Library/ap_articles_download/GPT.pdf) 3. Kim Y, Oh T.J., Misch C.E, Wang H.L. (2005). Occlusal considerations in implant therapy: clinical guidelines with biomechanical rationale. Clin Oral Implants Res, 16:26-35,2005. 4. Misch CE (1993). Occlusal considerations in implant supported prosthesis. In Contemporary Implant Dentistry 3rd ed. St Louis : Mosby; 1993. 5. Yuan J.C.C, Sukotjo C (2013). Occlusion for implant supported fixed dental prosthesis in partially edentulous patients: a literature review and current concepts. J periodontal implant Sci 2013; 43: 51-57. http://dx.doi.org/10.5051/jpis.2013.43.2.51
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