Concepts of Occlusion

Vicki C Petropoulos DMD, MS Associate Professor of Preventive and Restorative Sciences University of Pennsylvania School of Dental Medicine

Acknowlegements
Many of these images are courtesy of the American College of Prosthodontists, UCLA Complete Dentures Educational Curriculum CD, 2004.

Learning Goals
To understand differences between natural dentition and complete denture occlusion To understand the goals of complete denture occlusion and why balance is needed To understand the four types of denture occlusion To understand Hanau’s Quint

Learning Goals To understand the different types of posterior tooth forms. adv. and disadv. .

but ideally exhibit certain characteristic occlusion features. form and alignment. .Natural Occlusion (organic) Natural dentition presents in a variety of individual tooth size. shape.

Natural Occlusion (organic) • • • Bilateral Posterior Centric Contact Anterior Guidance Mutually Protective Scheme of Occlusion .

Complete Denture Occlusion Complete denture “dentition” also presents in a variety of forms. but also exhibit certain common characteristics .

Complete Denture Occlusion • • Bilateral centric contacts Bilateral eccentric contacts (balance) to provide stability of the denture bases during function .

occlusion).e. should be designed to provide function and esthetics while minimizing denture base tipping (lateral) forces . complete denture tooth forms and arrangements (i.Complete Denture Occlusion • Because of compromises inherent in restoring the edentulous arch.

2. Sensory feedback mechanism Derivation of : • retention • stability • support Reaction of supporting structures to masticatory forces .Fundamental differences of natural and complete denture occlusion 1. 3.

Sensory Feedback Precision of feedback is significantly compromised following loss of teeth and associated structures (periodontal ligament) .1.

2. Derivation of retention, stability and support for natural occlusion

For natural dentition, retention, stability, and support are derived through the periodontium which provides;
Sensory feedback mechanism Difference in reaction of supporting structures to masticatory forces Differences in load transfer mechanism and physiology

2. Derivation of retention, stability and support for complete denture occlusion

Complete dentures receive their retention, stability, and support from the soft tissues overlying residual bone (ridges, buccal shelf, palate, etc.).

Denture Bearing Surface

Retention
Resistance to dislodgment forces in a vertical direction away from the bearing surface

Denture Bearing Surface • Stability Resistance to laterally oriented dislodgment forces .

Denture Bearing Surface • Support Factors of the Bearing Surface which resist forces in a vertical direction towards the bearing surface .

Reaction of supporting structures Natural occlusion Physiologic levels of tension results in alveolar bone apposition (such as that transmitted by loading the periodontal ligament through natural dentition) Complete denture occlusion Non-physiologic compression as may occur under denture bases results in further residual ridge resorption (RRR) .3.

Summary Natural Dentition • • • • Denture “Dentition” • • • • • • • • • • Retained in PDL Units move independently Malocclusion effects not immediate Non-vertical forces affect only teeth involved and usually well tolerated Incising doesn’t affect posteriors Bilateral balance is rare Tactile sensitivity Mobile bases on mucosa Teeth move as an unit Malocclusion affects entire base immediately Non-vertical forces affect all teeth and are traumatic Incising affects all teeth attached to base Bilateral balance is often desired for base stability Decreased tactile sense .

stability and support. stability and support between natural and complete denture teeth The differences in the design of natural and complete denture occlusion are the consequence of differences in the derivation of retention.Summary • Goal of complete denture occlusion is preservation of structure and restoration of function and esthetics Consequences of tooth loss create anatomic changes which result in differences in derivation of retention. Complete denture form and tooth placement is biomechanical in nature • • • .

The Edentulous State Residual ridge reduction Compromised reflex adaptability Possible increase in parafunctional movements Increased risk of maladaptive denturewearing experience .

shaping and positioning of the arch. and the mechanics for obtaining proper tooth inclination. inclinations and rotations for esthetics. .Occlusion Denture occlusion is not just about the occlusal plane. The setting of teeth includes orientation of the plane.

Occlusion The dentist has the power to establish all factors of occlusion in a complete denture except the condylar path. .

Tissue resiliency and denture movement during function account for the higher frequency of non-chewing contacts .Chewing with Dentures During mastication the teeth make contact on the chewing side and the non-chewing side.

Types of Denture Occlusion Balanced The preferred occlusal scheme Monoplane (Neutrocentric) Monoplane with balance Lingualized occlusion .

Is “Balance” necessary? Protrusive position Protrusive position Balanced occlusion vs Non-balanced occlusion .

Is “Balance” Necessary? “Bolus in” “Balance out” .

To Balance or Not to Balance But do we need balanced occlusion? .

Brien Lang
“There is little scientific support to select an occlusal concept, however a report by Brewer (1963) found in a 24 hour test period that teeth contact during chewing (10 mins) were much less than tooth contacts during non chewing (2-4 hours). This suggests a need for balanced articulation especially during parafunction”

Balanced denture teeth provide denture stabilization during parafunctional jaw movements by ensuring even pressure in all parts of the arch.

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We spend 2-4 hours/day in parafunction and only 10 minutes/day in function

Objective of Balanced Occlusion To create stability of the denture bases during eccentric movement Instability of the bases leads to: Irritation of the hard and soft tissues Excessive denture movement Unequal distribution of forces Potential for more rapid loss of osseous support .

When do we Achieve Balanced Occlusion? At the final try in. we will verify the Jaw Relationship Record At that point we will do a protrusive record to set the condylar inclination Balance will be achieved in the lab .

Types of Denture Teeth Artificial teeth can be Anatomic (30 degrees or greater) Semi-anatomic (30 to 0 degrees) Nonanatomic (0 degrees) .

Advantages Anatomic More esthetic Supposed higher chewing efficiency Ease in achieving balanced occlusion Nonanatomic Easier to set Kinder to edentulous ridges .

Disadvantages Anatomic More time consuming to set May cause more/faster bone resorption Nonanatomic Unaesthetic Supposed to decrease chewing efficiency .

With anatomic teeth it is generated by the tooth arrangement With monoplane teeth it is generated by a balancing ramp .Balance Balance can be achieved with anatomic OR monoplane teeth.

.Verify contacts in working excursions Lack of working side contacts may be the result of: • Poor buccal centric • Insufficient curve of Wilson • Working interferences in the 2nd molar region • Balancing interferences on the opposite side *Check these in the order cited.

Verify contacts during balancing excursion Lack of balancing side contacts may be the result of: • Poor lingual centric • Working interferences on the opposite side. particularly in the 2nd molar region .

Working Balancing Protrusive .

. positive outlook and good neuro-musculature control.All things being considered. the most successful denture wearers are usually those who have a good patient/provider relationship and a good.

Always Remember… Dentures are not a replacement for teeth… Dentures are a replacement for no teeth. .

Occlusion The static relationship between the incising or masticating surfaces of the maxillary and mandibular teeth or tooth analogs .

Five Determinants of Mandibular Movements Right TMJ Left TMJ Teeth Tissues/nerve impulses (proprioception) CNS .

Planes of Reference .

Mandibular Movement Rotation Around the terminal hinge axis Translation Condyle glides along the posterior incline of the tubercle .

Mandibular Opening .

Types of Movement Border Functional Speaking (phonetics) Chewing (mastication) Swallowing (deglutition) Parafunctional Bruxing clenching .

Denture Forces The amount of force generated with a denture vs. natural occlusion is approximately only 16 %!!!!! .

Posterior Determinants of Occlusion Shape of articular eminence Medial walls of glenoid fossa Shape of condyles .

Anterior Determinants of Occlusion Vertical overlap of anterior teeth Horizontal overlap of anterior teeth Lingual concavities of maxillary anterior teeth .

Anterior Determinants of Occlusion .

.Role of Anterior Teeth In a normal occlusal relationship the maxillary and mandibular canines contact during lateral movements.

Dynamic Occlusal Contacts Any movement of the mandible from the centric occlusion position that results in tooth contact is termed eccentric. There are three basic eccentric movements Protrusive Laterotrusive Retrusive .

.Protrusive The mandible moves forward from the centric occlusion position The predominant protrusive contact occurs between the maxillary and mandibular anterior teeth.

Protrusive .

. Working contacts occur between the inner inclines of max buccal and outer inclines of mand buccal.Laterotrusive (Working) Most function occurs on the working side (lateral movement) the side to which the mandible is shifted. Working contacts and cross-tooth contacts occur on the working side.

Mediotrusive (Non-working) Formerly balancing contacts. Potential sites of contact on the inner inclines of maxillary lingual and mandibular buccal cusps. but now the teeth disclude. . Mediotrusive contacts are interferences.

Laterotrusive .

Retrusive .

mobile teeth and gingival clefting The preferred occlusal scheme for dentures .History Bilateral Balanced Occlusion Based on theories related to dentures Became apparent these principles did not apply to fixed prosthodontics Resulted in premature wear.

Unilateral Balanced Occlusion Group Function Earlier rehabs were modified by eliminating balancing contacts Led to the functionally generated path or “wax chew-in” technique Importance of incisal guidance discovered and incorporated into the occlusal scheme Results in tipping forces on a denture .

Group Function Based on the philosophy that the more teeth to share the load the better Incisal guidance established first Spreads working side contact over 3 or more teeth in each arch These teeth should be adjacent to each other Involves buccal cusps only .

Group Function .

Centric Relation The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterior superior position against the shapes of the articular eminence. This position is independent of tooth contact .

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Centric Relation The most important factor to remember is that it is REPEATABLE!!! .

CR=CO with even and simultaneous contact of all posterior teeth .Optimum Functional Occlusion CR---for purposes of this lecture it is the most superoanterior position.

REVIEW .

Differences between Natural and Complete Denture Occlusion Natural Dentition Retained in PDL Units move independently Malocclusion effects not immediate Non-vertical forces affect only teeth involved and usually well tolerated Incising doesn’t affect posteriors Bilateral balance is rare Tactile sensitivity Denture “Dentition” Mobile bases on mucosa Teeth move as an unit Malocclusion affects entire base immediately Non-vertical forces affect all teeth and is traumatic Incising affects all teeth attached to base Bilateral balance is often desired for base stability Decreased tactile sense .

Goals of Complete Denture Occlusion Minimize trauma to the supporting structures Preserve remaining structures Enhance stability of the dentures Facilitate esthetics and speech Restore mastication efficiency to a reasonable level .

Types of Complete Denture Occlusion Bilateral balance Neutrocentric We prefer bilateral balance because this type of occlusal arrangement limits tipping of the dentures during parafunctional movements. .

Bilateral Balanced Denture Occlusion The stable simultaneous contact of opposing upper and lower teeth in centric relation position with a smooth bilateral gliding contact to any eccentric position within the normal range of mandibular function. . developed to lessen or limit tipping or rotation of the denture bases in relation to the supporting structures.

. it can be achieved with nonanatomic teeth using balancing ramps or by manipulating the compensating curve. However.Bilateral Balanced Denture Occlusion Traditionally bilateral balance was achieved with anatomic posterior denture teeth.

Bilateral Balanced Denture Occlusion with Anatomic Posterior Denture Teeth Protrusive Balancing Working Bilateral Posterior Centric Contact Centralized Forces “Balanced” Occlusion to minimize tipping Centric .

Monoplane with Balancing Ramps Working Balancing Bilateral balanced occlusion can also be obtained with nonanatomic posterior teeth if balancing ramps are employed. Protrusive . In all lateral excursions you should observe at least three points of contact bilaterally if bilateral balance is to be achieved.

Lingualized Opposing Monoplane with Balancing Ramps Working Balancing A similar concept is used when lingualized maxillary teeth oppose nonanatomic teeth in the mandible. . In all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral balance.

not a chewer or a grinder. When using this concept of occlusion the patient is instructed not to incise the bolus.” . With this tooth arrangement DeVan noted that “the patient will become a chopper. There is no curve of Wilson or Curve of Spee (compensating curve) incorporated into the set up.Monoplane Occlusion (Neutrocentric Concept) This concept of occlusion assumes that the anterior-posterior plane of occlusion should be parallel to the denture foundation area and not dictated by condylar inclination. There is no vertical overlap of the anterior teeth. The plane of occlusion is completely flat and level.

This may be disadvantageous in the patients exhibiting parafunctional grinding habits .Monoplane Occlusion (Neutrocentric Concept) Centric Balancing At balancing and protrusive positions there is separation of the denture teeth in the posterior regions leading to tipping of the dentures.

Hanau’s Quint Five Factors Affecting Occlusal Balance Condylar Inclination Incisal Guidance Occlusal Plane Inclination Compensating Curve Cuspal Inclination .

Hanau’s Quint Inter-relationship of these five factors may be described by Theilman’s Formula In order to maintain a balanced occlusion: C= Condylar Inclination x Incisal Guidance OccPlane x Cuspal Inclination x CompCurve .

Hanau’s Quint Factors controlled by the dentist Of these five factors. the patient presents you with Condylar Inclination Occlusal Plane cannot be altered substantially since functional requirements dictate its position and orientation The remaining three factors can be controlled by the dentist C= Condylar Inclination x Incisal Guidance OccPlane x Cuspal Inclination x CompCurve .

the patient presents you with Condylar Inclination Occlusal Plane cannot be altered substantially since functional requirements dictate its position and orientation The remaining three factors can be controlled by the dentist C= Condylar Inclination x Incisal Guidance OccPlane x Cuspal Inclinationx CompCurve Inclination .Hanau’s Quint Factors controlled by the dentist Of these five factors.

Hanau’s Quint Within the confines of esthetics and phonetics. minimize Incisal Guidance in Complete Dentures to minimize inclined tipping forces Adjust remaining factors to maintain balance C= Condylar Inclination x Incisal Guidance OccPlane x Cuspal Inclination x CompCurve .

Posterior Tooth Forms Lingualized Monoplane – neutrocentric Monoplane with balancing ramps Lingualized opposing monoplane Semi-anatomic Anatomic (30 degree) .

Posterior Tooth Forms .

Anatomic Tooth Forms .

Semi-anatomic Tooth Forms .

Nonanatomic Tooth Forms .

General Concepts of Denture Occlusion Common Features Functional anatomy is the main determinant of denture tooth position Simultaneous. bilateral posterior contact in centric relation (centric occlusion) Centralization of centric occlusal forces over the mandibular residual ridges • Buccal-Lingually • Anterior-Posteriorly .

Balance and the Monoplane Occlusion Minimize vertical overlap within the dictates of esthetics and phonetics .

Balance and Monoplane Occlusion Minimize vertical overlap within the dictates of esthetics and phonetics .

Bilateral Balance Anatomic posterior teeth vs Lingualized .

Bilateral balance with anatomic denture teeth Balancing side .

there should be less lateral displacement of the denture and less lateral forces during function when using lingualized posterior denture teeth.Lingualized Occlusion Centric Occlusion Conventional Lingualized Theoretically. .

. resulting in potentially less lateral forces and displacement during function.Lingualized Occlusion The lingual cusp tips should be in contact with the central fossae of the opposing mandibular teeth. The cuspal inclines of the mandibular teeth are relatively flat.

Lingualized Occlusion Working Side Centric Occlusion Balancing Side .

Lingualized Occlusion .

Lingualized Occlusion Indications for use High esthetic demands Severe mandibular ridge atrophy Displaceable supporting tissues Malocclusion Previous successful denture with Lingualized Occlusion Advantages Good esthetics Freedom of non-anatomic teeth Potential for bilateral balance Centralizes vertical forces Minimizes tipping forces Facilitates bolus penetration (mortar and pestle effect) .

Complete Denture Occlusion Investigators have not shown one type of denture occlusion to be : superior in function safer to oral structures more acceptable to patients .

IN SUMMARY: Complete Denture Occlusion Neuromuscular control may be the single most significant factor in the successful manipulation of complete dentures under function Tongue function and denture wearing experience .

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