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Occlusal harmony is necessary if the dentures are to be comfortable, to function efficiently, and to preserve the supporting structures. It is difficult to see occlusal discrepancies intra orally with complete denture. Remounting of the dentures on the articulators and selective sliding procedures should be carried out at the time of placement.
Occlusal harmony is necessary if the dentures are to be comfortable, to function efficiently, and to preserve the supporting structures. It is difficult to see occlusal discrepancies intra orally with complete denture. Remounting of the dentures on the articulators and selective sliding procedures should be carried out at the time of placement.
Occlusal harmony is necessary if the dentures are to be comfortable, to function efficiently, and to preserve the supporting structures. It is difficult to see occlusal discrepancies intra orally with complete denture. Remounting of the dentures on the articulators and selective sliding procedures should be carried out at the time of placement.
if the dentures are to be comfortable, to function
efficiently, and to preserve the supporting structures.
It is difficult to see occlusal discrepancies intra orally with complete denture.
The resiliency of the supporting soft tissues and displaceability of the tissues in varying degrees tend to disguise premature occlusal contacts.
The tissues permit the dentures to shift; as a result, after the first interceptive occlusal contact the remaining teeth appear to make satisfactory contacts. The eye cannot be relied upon to observe occlusal discrepancies, and the patient cannot be depended upon to diagnosed occlusal faults.
It is the responsibility of the dentist to find and correct these occlusal discrepancies and permit the patient to depart free of occlusal disharmony.
Occlusal faults can be determined by obtaining and interocclusal record from the patient and remounting the dentures on an articulator.
These faults can be corrected by careful selective grinding procedures.
Remounting of the dentures on the articulators and selective sliding procedures should be carried out at the time of placement of the dentures.
Selective grinding / Occlusal Reshaping is defined as the,
intentional alteration of the occlusal surfaces of the teeth to change their form.
GPT-8 Teeth are altered by selective grinding to make simultaneous cusp tip to cusp tip contact on both sides of the arch when the jaws are in left or a right lateral position, balanced occlusion in a static eccentric position exists. When the mandible is in a straight protruded relation with the maxilla and the posterior teeth are altered to make cusp contacts at the same time to anterior teeth make incisal edges contact , balanced occlusion protrusion exists. as small as 15 micron
Problems caused
Compression of articular disc
Occlusion is defined as any (static) contact between the incising or masticating surfaces of upper & lower teeth Supported by roots that are anchored to the bone
Moves independently in their socket
Malocclusion may remain uneventful for years
Occlusal forces affect only concerned teeth
Non vertical forces tolerated better
Mastication usually done in the second molar region
Bilateral balance is not found
Proprioceptive mechanism enables the patient to avoid prematurities and gives better control
Supported by denture base placed on slippery mucosa
Moves as a unit on their base
Malocclusion evokes immediate instability & pain Forces acting affect the whole base
Non vertical forces not tolerated
The second premolar area is preferred for mastication
Bilateral balance is necessary for denture stability Poor feed-back mechanism, so neuromuscular control is compromised
Natural occlusion Artificial occlusion Concepts of occlusion
1.Balanced occlusion
2.Monoplane/non-balanced occlusion
3.Lingualised occlusion Defined as bilateral simultaneous, anterior and posterior occlusal contact of teeth in centric and eccentric positions.
SIGNIFICANCE
Swallowing Stability Maintains integrity of foundation tissues Minimal stresses on TMJ I ncreased efficiency
Hanaus quint
Condylar guidance I ncisal guidance Plane of occlusion Compensating curve Cuspal inclination SELECTIVE GRINDING:
Modification of occlusal & incisal surfaces of teeth at selected areas to correct occlusal errors & gain a balanced occlusion.
Artificial teeth move about to a minor degree during festooning and while the wax denture base is being converted in to resin.
This tooth movement is due primarily to dimensional changes in the wax denture base,in the investing materials ,and in the resin denture base during curing.
Occlusal discrepancies caused by these dimensional changes ordinarily are removed before the dentures are polished.
Occlusal harmony in complete denture is necessary so that the denture will be: 1- comfortable and functions efficiently. 2- preserve the supporting structures 1) Inaccurate maxillo-mandibular relation record by the dentist. 2) Errors in the transfer of maxillo-mandibular relation. 3) ill-fitting record bases. 4) Incorrect arrangement of the posterior teeth. 5) Failure to close the flask completely during processing. 6) Warpage of the dentures by over-heating them during polishing. 7) Changes in the denture base material (dimensional changes of the acrylic dough).
Schuyler, Friedrich and Vaeghan in 1935 observed the disturbances in occlusal relationship and opening of the bite of full dentures made of acrylic resin, even when the flask was completely closed during processing. Osborne and Taylor in 1941 have noted the disturbance and attributed it to over packing and the accompanying displacement of teeth in the mold.
It was felt, however, that these changes were caused in part by the volumetric change of acrylic resin during polymerization. Extra oral corrections
Recognizing pre mature contact (Dark ring with a light centre)
Grind until multiple, uniform distributed & even contacts. Intra oral corrections
Using articulating papers.
Central bearing devices. correlator coble device Abrasive paste. Extra-oral selective grinding is more preferable than intra-oral selective grinding for the following reasons:
1) Presence of compressible tissue under the denture, that may move with the denture especially in flabby ridge and very resorbed ridges, while in extra-oral selective grinding the dentures are on hard bases (casts).
2) The bad psychological impact on the patient as he will see his teeth ground in front of him in intra- oral selective grinding.
3) Lateral excursion (right and left) and protrusive movements are difficult. Avoid grinding functional cusps. (BULL Rule)
Grind opposing fossae or marginal ridge.
Centric holding cusp reduced when it interferes with another centric holding cusp
Can be reduced if it causes interferences in centric & eccentric position.
Elimination of protrusive interferences along a path of 3-5mm
Working side interferences are eliminated until canines meet edge to edge or upto distance of 3-4mm.
The objectives as stated by Schuyler in 1935 are,
1)Maximum distribution of stress in centric maxillo-mandibular relation.
2)Retention of the maxillo-mandibular opening.
3)Harmony of guiding inclines, which distributes eccentric occlusal stresses.
4) Reduction of the incline of guiding tooth surfaces, that occlusal stresses may be more favorably applied to the supporting tissues.
5) Retention of sharpness of cutting cusps.
6) Increase in food exits.
7) Decrease in contact surfaces. 1. Laboratory remounting
2. Clinical remounting
3. Direct intraoral correction Disadvantages Cannot correct errors made while recording jaw relations Cannot correct errors made while mounting the casts on the articulator Does not compensate changes caused by settling of the denture bases
Advantages Correct errors made during recording of jaw relations, or while mounting cast on articulator Less chair side time Corrections away from the patients view No saliva which makes detection by articulating paper difficult No shifting of dentures or incorrect closure by pt The prematurities are ground until multiple, uniformly distributed and even contacts are obtained bilaterally Clinical remounting is currently the most commonly preferred method of occlusal correction Ask patient to bite on cotton rolls for 10 min. Guide mandible into CR several times. Bite registration material is placed on the post. teeth of the mandibular denture
Guide mandible into CR
Obtain interocclusal record of CR. Mount upper denture using remounting jig
Mount lower denture OCCLUSAL INDICATORS Qualitative Indicators Articulating paper Articulating silk Articulating film Metallic shim-stock film High spot indicator Occlusion sprays Wax template Quantitative indicators T Scan occlusal analysis system It is a paper impregnated with blue dye
It is placed bilaterally and teeth are tapped together
High points will show a dark staining or a dough nut shape blue circles
High points are trimmed with carborumdum stone, till all contacts show an equal distribution of force.
Articulating paper Micronised colour pigments Wax oil emulsion Articulating Silk 8 microns thick Universally applicable Articulating Film Form a thin biocompatible film To check the occlusion& approximal contacts when checking the trial fit of crowns. Occlusion sprays A softened wax is place between both dentures, areas of heavy contact will show thinning of wax or even a hole.
Time Magnitude Distribution of occlusal contacts T Scan Complete dentures Fixed or removable dentures Complete arch reconstruction involving implants Complete arch reconstruction involving FPD Natural tooth occlusal equilibration Disclusion time reduction Occlusal splints Mandibular repositioning devices T Scan T Scan T Scan T Scan left right 1) Lock the articulator condyles to allow for hinge movement only.
2) Use a blue articulating paper to mark teeth with high contacts in centric relation.
3) Loosen the condyles allow for eccentric movemnts.
4) Use a red articulating paper to mark teeth with high contacts at eccentric movements.
5) High points are evaluated and centric prematurities are removed t .
A dark ring with a light center usually denotes a premature contact.
You should distinguish between marks made by normal occlusal contacts and those of premature contacts.
Articulating paper should not be reused many times and should be changed often.
Make grinding until even (same intensity), stable, and multiple marks spread over wide area in both sides OCCLUSAL ERRORS & THEIR SELECTIVE GRINDING
a) A)Centric position errors: 1) Pair of opposing teeth hold other teeth out of contact: - deepen the fossae corresponding to cusps till other teeth came in contact.
2) UPPER & LOWER TEETH ARE NEARLY END TO END: - grind the inner inclines of upper buccal & lower lingual cusps. - grind lingual of upper lingual cusps. - grind buccal of lower buccal cusps.
3) Upper teeth are far buccal to lower ones: - grind the inner inclines of upper lingual cusps & lower buccal cusps.
B) WORKING SIDE ERRORS: 1) Both upper buccal & lower lingual cusps are long: - grind the high cusp tips of non functional
2) Buccal cusps make contact but lingual dont: - grind the buccal cusp tips & alter their inclines (in)non functional cusps).
3) Lingual Cusps Make Contact But Buccal Dont: - grind lingual cusps & alter their inclines (of non functional cusp only).
4) Upper Buccal & / Or Lingual Cusps Are Mesial To Intercuspation Position: - reduce upper mesial inclines & lower distal inclines 5) UPPER BUCCAL & / OR LINGUAL CUSPS ARE DISTAL TO INTERCUSPATION POSITION: - reduce upper distal inclines & lower mesial inclines
6) teeth on working side are out of contact: -selective grinding to balancing side
C) BALANCING SIDE ERRORS: 1) Balancing side show heavy contact, and working side show no contact: - grind the inner incline of lower buccal cusp.
2) No contact on balancing side: - grind the buccal upper cusps on lower lingual cusps of cusps on working side.
D) PROTRUSIVE POSITION ERRORS:
1) Anterior teeth show heavy contacts with no posterior contact: - reduce palatal surface of upper anteriors & labial surface of lower anteriors.
2) Posteriors show heavy contact with no anterior contact: - grind distal inclines of upper cusps & mesial inclines of lower cusps.
Note: -You have to wipe markings every time to ensure good localization of abnormal contacts.
- after finishing selective grinding, teeth are milled (polished) with pumice.
Disadvantages Requires a lot of patient cooperation. Patient should have good neuromuscular control. Saliva. Inaccurate closure by patient. Misleading due to resiliency of tissues and shifting of denture bases.
Adjustment of occlusion can be done by-
Selective reshaping of ridges of cusps. Changes can be made at angles of marginal ridge. Reduction of cusp height can be done. Reduction of sulcus by reducing angles of triangular and oblique ridges.
While reduction do not create flat areas, always maintain rounded contours polished surface of cusps and ridges. All eccentric interferences should be removed first then only centric relation interferences should be removed. Occlusal contouring diamond instrument #8833, maximum speed 120,000 R.P.M. Football shaped diamond instrument 8868- 023, maximum speed 80,000 R.P.M. Dura white stones, nmbers 1C2, 1C4, FL1, KN3. Enamel adjustment kit. Selective grinding in complete denture Prosthodontics is an important laboratory procedure which is carried out by remounting of the dentures after processing is completed.
This remounting may either be laboratory remount or patient remount. In spite of carrying out each step in denture construction very carefully, it is seen that in the end when the dentures are remounted there is an occlusal pre maturities or interferences and selective grinding may be needed. 1. Boucher's Prosthodontics Treatment for Edentulous Patients. Twelfth Edition.Chapter 20.
2. Dalhousie continual education
3. Complete Denture Prosthodontics, 1 st Edition, 2006 by John Joy Manappallil, Chapter 19
CONCEPTS OF ARRANGEMENT OF ARTIFICAL TEETH, SELECTIVE GRINDING AND BALANCED OCCLUSION IN COMPLETE DENTURE PROSTHODONTICS, NUJHS Vol. 2, No.1, March 2012 ISSN 2249-7110 .
Occlusal adjustment by selective grinding and use of an anterior De programmer,Tetsuo Saito* (Quintessence Int 1990;21:887-892.)