The occlusal plane indicator: A new device for determining the inclination of the occlusal plane

Urbano A. Santana-Penin, MD, PhD,a and Maria J. Mora, MD, PhDb Faculty of Medicine and Odontology, University of Santiago de Compostela, Santiago de Compostela, Spain
Accurate determination of the inclination of the occlusal plane is important in a number of situations, and includes confirming the correct development of the dentition in children, providing a basis for nonanatomic tooth design in the preparation of fixed prostheses, and assisting in decisions as to whether to perform intrusions or extrusions. This article describes a simple device for determination of the inclination of the occlusal plane. (J Prosthet Dent 1998;80:374-5.)

he inclination of the occlusal plane (IOP) is one of the key factors governing occlusal balance.1 Determination of IOP is an important step before construction of equilibrated complete dentures, because bilaterally balanced occlusion is the situation of choice. Anteroposterior IOP is typically determined with a device called the Fox plane,2 which is positioned parallel to Campers plane.3,4 Other devices, such as the Leary parallelometer,5 permit determination not only of anteroposterior IOP, but also of inclination with respect to the bipupilar line (left-right IOP). Determination of IOP is also important in dentate subjects for diagnostic purposes and as a basis for design of rehabilitation therapies. In dentate subjects, anteroposterior IOP can be evaluated indirectly by articulator mounting of diagnostic casts. Observation of arcs of closure allows assessment of IOP with respect to one of the facial planes (normally the Frankfort plane). Anteroposterior IOP can also be evaluated by lateral teleradiography,6,7 though this technique does not allow accurate determination of right and left IOPs. Left-right IOP can be evaluated by comparing the left-to-right canine plane with the bipupilar plane. However, there is currently no way of determining anteroposterior IOP directly in the clinical context, because the plane of occlusion is, of course, not directly visible from the side. This article describes a simple device, the occlusal plane indicator (International patent application PCT/ES95/00080) for evaluation of anteroposterior IOP.

Fig. 1. Occlusal plane indicator.

PROCEDURE
The device, made of stainless steel or some other rigid material, is U-shaped (Fig. 1). One arm of the U (the inner arm) is shorter and bears 2 sliding rests designed to be positioned against the occlusal surface
aProfessor, bProfessor,

Department of Occlusion and Prosthodontics. Department of Occlusion and Prosthodontics.

of the right (or left) second molar and the right (or left) canine of the maxillary arch. The other arm of the U (the outer arm) is longer and lies outside the mouth, which the occlusal line on that side. Thus, this arm permits evaluation of anteroposterior IOP with respect to Campers plane (superior border of tragus of ear to inferior border of ala of nose) or the Frankfort plane (superior border of meatus of ear to inferior border of orbital margin) (Fig. 2). These lines can be traced onto the subjects face. This procedure allows anteroposterior IOP to be evaluated on both sides of the face. If required, specific segments of the occlusal plane can be evaluated, by positioning the rests of the inner arm against other teeth in the maxillary arch.
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ly, taking IOP into account during the planning of a prosthetic program may reduce the risk of unnecessary tooth removal. Occlusal dysfunction is typically evaluated in view of the presence of discluded canines, which can be readily detected without accurate knowledge of anteroposterior IOP. However, we believe that anteroposterior IOPs constitute a more reliable basis for evaluation of occlusal dysfunction. Furthermore, rehabilitation programs should ideally aim for gradual attainment of physiologic IOP.
REFERENCES
1. Hanau RL. Articulation defined, analyzed and formulated. J Am Dent Assoc 1926;57:1694-709. 2. Fox FA. The principles involved in full upper and lower denture construction. Dent Cosmos 1924;66:151. 3. The Academy of Prosthodontics. The glossary of prosthodontics terms. 6th ed. J Prosthet Dent 1994;71:41-121. 4. Kazanoglu A, Unger JW. Determining the occlusal plane with the Campers plane indicator. J Prosthet Dent 1992;67:499-501. 5. Leary DJ. Dental instrument. United States Patent Office. Patented Feb 3, 1925. Serial No. 638,326. 6. Ow RK, Djeng SK, Ho CK. The relationships of upper facial proportions and the plane of occlusion to anatomic reference planes. J Prosthet Dent 1989;61:727-33. 7. Ow RK, Djeng SK, Ho CK. Orientation of the plane of occlusion. J Prosthet Dent 1990;64:31-6. 8. Bailey JO, Nowlin TP. Evaluation of the third point of reference for mounting maxillary casts on the Hanau articulator. J Prosthet Dent 1984;51:199201. 9. Abrams L, Potashnick SR. Role of occlusion in periodontal disease. In: Genco RJ, Goldman HM, Cohen DW, editors. Contemporary periodontics. St Louis: Mosby; 1990. p. 194-202. 10. Mongini F. The Stomatognathic system. Chicago: Quintessence; 1984. p. 107-41. 11. Academy of Prosthodontics. Principles, concepts and practices in prosthodontics1994. J Prosthet Dent 1995;73:73-94.

Fig. 2. Diagram showing mode of use of occlusal plane indicator.

DISCUSSION
The procedure described in this article is noninvasive, quick, and easy to perform, and gives results immediately. The device is simple and inexpensive, even though accurate measurement requires it to be fitted with a goniometer, increasing the cost somewhat. The only significant disadvantage is that a permanent graphic image is not obtained. The inclination of the occlusal plane (IOP) is not commonly determined by dental practitioners, except as a basis for rehabilitation in edentulous subjects.2-5,8 However, the IOP often reflects occlusal dysfunction, and occlusal dysfunction is often associated with periodontal9 and temporomandibular10 disorders, so that determination of IOP may be of value for diagnosis or rehabilitation planning.11 In our opinion, right- and left-side anteroposterior IOP should be evaluated before any major treatment/rehabilitation program, whether prosthetic or orthodontic, is undertaken. For example, tooth intrusion or extrusion should aim not only to align occlusal surfaces but also to correct for alterations in IOP, and thus improve esthetics. Similar-

Reprint requests to: DR. U. SANTANA-PENIN DEPARTMENT OF OCCLUSION AND PROSTHODONTICS FACULTY OF MEDICINE AND ODONTOLOGY UNIVERSITY OF SANTIAGO DE COMPOSTELA ENTRERRIOS, S/N 15705 SANTIAGO DE COMPOSTELA SPAIN
Copyright 1998 by The Editorial Council of The Journal of Prosthetic Dentistry. 0022-3913/98/$5.00 + 0. 10/1/91325

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