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Complete Removable Prosthodontics

9-5-2009
Complete Denture Occlusion
Complete Denture Articulation
1. Definitions
a. Occlusion is the relationship of the teeth in one position, static relationship when
they are in that one position
b. Articulation are when these teeth move across each other, like when you protrude,
retrude, and do excursive movements
i. Talks about the entire spectrum of functional movement
2. Natural Teeth vs. Artificial Occlusions
a. Natural dentitions periodontal tissues are innervated
b. Natural teeth receive individual pressures of occlusion and can move independently
i. Artificial teeth move as a unit on a base
c. Non-vertical forces on natural teeth affect only the teeth involved.
i. Artificial teeth the effect involved all teeth on the base
d. Incising with natural teeth doesnt affect the posterior teeth.
e. Proprioception found in natural teeth allows patient to avoid prematurities and
interferences.
i. In artificial teeth, lack of proprioception means prematurities would cause the
bases to shift on the foundation tissue
f. The differences make the CD occlusion a unique problem. The occlusion must
function in the compromised situation of the edentulous mouth. It must be
designed to redress the unequal stability of the upper and lower denture bases.
Lower dentures are almost always less stable, so the occlusal design and position of
lower teeth are usually given priority in approaching a solution to the problem of CD
occlusion.
i. We dont want cusp over cusp or incline contacting incline or long axis over
long axis in the dentures
ii. Or between a maxillary denture and mandibular natural teeth
3. Axioms for Denture Occlusion (Sears VH, J. Prosthet Dent, 1952)
a. The smaller the area of occlusal surface acting on food, the smaller will be the
crushing force (on food) transmitted to the supporting structures
b. Vertical force applied to an inclined occlusal surface causes non-vertical force on the
denture base
c. Vertical force applied outside (lateral to) the ridge crest creates tipping forces on
the denture base
d. Vertical forces applied to inclined supporting tissue will cause non-vertical forces on
the denture base
4. Dentures are subject to the principles of physics the inclined plane and the lever. The
forces operate whether we recognize them or note. Controlling these forces generated by
the occlusion will enhance function, stability, comfort, and longevity of the dentures.
5. There are numerous concepts, techniques, and philosophies of complete denture occlusion
6. Metal Inserts
a. Metal on occlusal surface of the posterior teeth with a plus sign on it that is raised
up; these are called Sosan Blades
b. Hardy Cutters are a three tooth block with acrylic resin teeth that have a metallic
blade sticking up out of the resin
c. These are extremely efficient at chewing, they will chew up cheek and tongue and
anything else that gets in the way
i. Among the things dentures have to do is chew up food, these are top of the
line at chewing

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7. One philosophy: Posterior denture teeth should have cusps which function in harmony with
mandibular movements
a. Ideal occlusion in the natural teeth doesnt involve the posterior teeth contacting in
excursive movements
b. This is completely different than natural teeth
c. Mutually Protected Occlusion = Canine guidance = when the pt slides to the right
the only teeth that are touching are the canines, everything else is separated.
When you protrude the anterior teeth cause the posterior teeth to disclude. It is the
opposite situation here.
d. Setting posterior teeth like this is placing them in Balanced Occlusion
e. This is a very hard scheme to do
8. A philosophy: Posterior denture teeth should not have cusps because cusps create lateral
forces which are hard to control
a. So the form of the tooth is non-anatomic and the arrangement of the teeth is nonbalanced
b. There is no contact of anterior teeth and no vertical
overlap
c. The posterior teeth do not slope up as they go to the
posterior
9. Common Occlusal Schemes
a. Form of the posterior teeth and their arrangement
b. Types:
i. Anatomic, balanced occlusion (BO)
ii. Non-anatomic, (balanced or non-balanced)
iii. Lingualized (balance or non-balanced)
10.
Anatomic, Balanced Occlusion
a. Introduction
i. Definition: Stable, simultaneous contact of
opposing maxillary and mandibular posterior
teeth in CR position and continuous, smooth
bilateral gliding contacts from this position to
any eccentric position within the normal range of
mandibular function (usually not beyond edgeto-edge position of anterior teeth)
ii. If you have BO and slide your teeth to the left all
of the teeth on the WS stay in contact, and all of
the teeth on the NWS except one stay in contact
iii. In protrusion all of the anterior teeth contact and
there are posterior teeth contacting
iv. Balanced Occlusion refers to what happens when the pt moves into eccentric
movement, there are contacts on both sides
b. Specifics
i. Teeth glide evenly over each other from the central incisor through the
second molar on the working side of the arch
ii. Contacts on the non-working side should exist and must not interfere with the
smooth gliding movement of the working side
iii. No single tooth can interfere and cause the others to life or separate from
their opponent
iv. Posterior contacts must exist simultaneously with contacts on the anterior
teeth in protrusive movements
v. May use anatomical or zero-degree teeth
vi. Requires precise jaw relation records so it is technically challenging
vii. Results may be short lived
c. Advantages

d.

e.

11.
a.
b.
c.

d.

e.

f.

i. More esthetics, natural appearance because they look like natural teeth
ii. Penetrate bolus better because it isnt a flat surface
iii. Greater denture stability in eccentric movements because the teeth remain
in contact
iv. Often times referred to cross-tooth and cross-arch balance
Disadvantages
i. Precise, accurate records required
1. Have to pick your patient, they have to be able to do the excursive
movements in the direction you tell them to
ii. More time-consuming to develop
iii. Function against inclines -> greater lateral forces placed on alveolar ridges
iv. Articulator precision not duplicated in mouth
v. Difficult in Class II, Class III, and crossbites so Class I only
vi. Results are short-lived because there is resorption under the denture
Indications
i. Young, healthy alveolar ridges
1. Not for people with extreme resorption of their ridges
ii. Good neuromuscular control to allow precise records
1. Not for people with Parkinsons or bad muscular control
iii. Skeletal Class I patient
iv. Balanced occlusion in old dentures
v. Vertical overlap of anterior teeth
Rudolph Hanau, 1925 ON NBDE ----- For Balanced Occlusion
Paper titled Articulation: Defined, analyzed, and formulated
Hanaus factors governing articulation
Hanaus Quint
i. Incisal guidance
ii. Condylar guidance this one cannot be changed on the patient
iii. Cusp height
iv. Plane of occlusion
v. Compensating curve
1. If these 5 things are correct you will have balanced occlusion
Incisal Guidance
i. Horizontal Overlap
ii. Vertical Overlap some patients will demand this, it is permissible with this
scheme
iii. The influence of the contacting surfaces of the maxillary and mandibular
anterior teeth on mandibular movement
iv. Definition: the influence of the contacting surfaces of the maxillary and
mandibular anterior teeth on mandibular movement
Condylar Guidance
i. The influence of the contours/slope of the glenoid fossae on mandibular
movement
1. Definition: mandibular guidance generated by the condyles
transversing the contours of the glenoid fossa
2. When a pt protrudes this slope causes the posterior teeth to separate
3. The teeth cannot be on a flat plane and get balanced occlusion the
posterior teeth will separate in protrusion
ii. Christensens Phenomenon
1. Separation of posterior teeth during mandibular protrusion caused by
the slope of the articular eminence
Cusp height/angle
i. 0, 10, 15, 20, 33, 45 all in degrees
1. In our kit we have 0 degree and 15 degree teeth

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g. Plane of occlusion
i. The average plane established by the incisal and occlusal surfaces of the
teeth
ii. You can raise it a little bit but not much, there are some guidelines
1. You cant be above the retromolar pad or above the tongue
h. Compensating curve
i. Definition: the A-P and M-L curvature of occluding surfaces and incisal edges
of artificial teeth used to develop balanced occlusion
1. In the lab we will be setting non-balanced occlusion so our teeth will be
on a flat plane
2. A-P curved called the Curve of Spee
3. M-L curve called the Curve of Wilson
a. In dentures they combine those two and call it the
Compensating curve
4. Curvature allows mandibular 2nd molar to be lower than the mandibular
1st molar this causes the maxillary 2nd molar to be up higher than the
maxillary 1st molar (allowing for contact)
i. Thielemanns Formula (NTK ON EXAM)
i. Balanced Occlusion = (IGxCG)/(CHxCCxPO)
ii. IGxCG = CHxCCxPO
1. If you move the anterior teeth to get more vertical overlap you have
increased the incisal guidance
2. What do you do to put it back in balanced occlusion?
3. You could decrease the condylar guidance but we cant do that
4. So you will have to increase CH, CC, or PO
5. On NBDE they changed the IG and asked what you needed to do to
put it back into Balanced Occlusion
12.
Non-Anatomic, Balanced Occlusion
a. Definition: teeth are arranged on a single plane, condylar and incisal inclinations are
set at 0. No attempt is made to eliminate deflective occlusal contacts in protrusive
or lateral movements.
b. Posterior teeth are non-anatomic (0 degree cusps) and are arranged with a curve or
a ramp in the occlusal plane to give some protrusive and lateral balance
c. Uses the Pleasure curve which incorporates a reverse curve on the premolars and
first molars and a compensating curve on the second molars (also called a
balancing ramp)
i. Distal part of 2nd molar maintains contact with maxillary tooth, all other teeth
separate
1. Not as hard to set
13.
Non-Anatomic, Non-Balanced Occlusion
Neutrocentric
a. Specifics
i. Non-anatomic teeth arranged on a flat
plane which evenly divides the space
between the upper and lower ridges. No
occlusion over incline/slope of mandibular
ridge. Occlusal plane height should be 2/3
up the RM pad.
1. Non-anatomic because teeth have
no cusps
a. This is what we will be setting this week and is easier to set
ii. Plane of occlusion parallels the mean denture base foundation
iii. Posterior teeth positioned over the crest of the mandibular ridge to centralize
the forces

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iv. Often eliminate one posterior tooth from the arrangement
v. No effort is made to achieve gliding contacts in eccentric movements
b. Monoplane Occlusion
i. Two key objectives (MM DeVan, 1954)
1. Neutralize the inclines
a. Put the occlusal plane parallel to the crest of the ridge
b. No inclination relative to the crest of the ridge
c. Flatten the occlusal inclines of the teeth
2. Centralize occlusal forces over ridges
a. No vertical overlap - NONE
c. Advantages
i. Simple technique, requiring less precise recores
ii. Lateral forces
iii. Area of Closure a CR to MI discrepancy is less destructive
iv. Good for skeletal Class II, III, and crossbites
d. Disadvantages
i. The least esthetic scheme ugly!
ii. Lingual positioning of posterior teeth may crowd the tongue
e. Indications
i. Excessive inter-ridge distance (interarch distance)
ii. Skeletal class II, class III jaw relationships (no cusp-fossa relationships), and
crossbites
iii. Successful previous dentures were monoplane/nonbalanced
iv. Limited oral dexterity poor neuromuscular
control
v. Severely resorbed ridges
vi. No vertical overlap of anterior teeth
14.
Lingualized, Balanced or Non-Balanced
Occlusion
a. Introduction - We will be doing one like this
i. Articulates the maxillary lingual cusps with
the mandibular occlusal surfaces in centric,
working and non-working mandibular
positions GPT, 7th edition
1. 1927 Gysi, 1929 Garmer, 1930 Payne
ii. Maxillary lingual cusps are the major functioning occlusal element
iii. Cusps oppose mandibular cuspless teeth or shallow cusp (10 degree) teeth
iv. Can be (maxillary/mandibular) = 10/0 or 30/10 or 30/0
b. Specifics
i. Maxillary posterior teeth are anatomic cusp form teeth
ii. Mandibular posterior teeth are zero degree of shallow cusp (10) teeth
iii. Teeth may be set on a flat plane (non-balanced) or set to a compensating
curve (for balanced scheme)
iv. Buccal cusps of maxillary teeth are raised up off the occlusal plane and do
not contact the mandibular teeth in centric occlusion or in eccentric
movements
v. Theoretically combines the advantages of cusp form teeth with the
advantages of zero degree teeth
c. Advantages
i. More centralized forces
ii. Creates only one contact point
1. Only palatal cusp will be in contact
iii. Minimizes frictional contacts
iv. Simplifies the working and non-working contacts

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v.
vi.
vii.
viii.
ix.

d.

15.
a.
b.
c.
d.
16.
a.

Can be used with all ridge contours

Esthetics cusps look more natural
Area of closure = easier accommodation to unpredictable changes
Better penetrating = less vertical force required
May be used in Class II, Class III, and crossbite relationships
1. has most of the advantages of other schemes while eliminating or
minimizing the disadvantages Parr and Ivanhoe, DCNA 1996
Indications
i. Class I, II, II jaw relationships, and crossbites
ii. Where esthetics are paramount
iii. Can be justified for most situations
A Philosophy of Occlusion
Simultaneous, bilateral contact of all posterior teeth when the mandible is in
centric jaw relation to the maxillae
Absence of contact of maxillary and mandibular anterior teeth when the posterior
teeth are in centric occlusion (i.e. mandible is in centric relation)
Absense of deflective occlusal contacts between opposing teeth during eccentric
jaw movements
Form, contour, and positions of anterior and posterior teeth create a natural and
pleasing appearance
Summary
All occlusal forms may be arranged with or without bilateral balance. No scientific
data are available to identify a superior tooth form or a superior arrangement.
Advantages of one occlusal scheme or concept are often cited as disadvantages by
advocates of another scheme. The least complicated approach that fulfills the
requirements of the patient may have much to recommend it as the denture
occlusion for that patient.