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Journal of Oral Rehabilitation, 1980, Volume 7, pages 31-33

A simplified technique for determining the


occlusal plane in full denture construction

M A R T Y N H. S P R A T L E Y Department of Dental Prosthetics, School of


Dental Science, University of Melbourne
Summary

Because of difficulties encountered by students in determining the occlusal plane at the


registration stage of full denture treatment, a simple technique which can be easily
taught has been devised. Review of literature revealed a wide variety of landmarks
and techniques advocated by various authorities and these are discussed. A technique
using direct vision is described and a review of a series of patients showed it to be
valid for the majority of cases.
Introduction

It has been observed that when treating their first full denture patient, students
encounter a great deal of difficulty in judging the level and angulation of the occlusal
plane. It has also been noted that staff, who can be assumed to be experienced, also
encounter problems. The purpose of this paper is to describe the alternative technique
which may be more easily used. The occlusal plane is defined as an imaginary flat
plane extending through the tips of the upper central incisors and the tips of mesiopalatal cusps of the upper first molars (Fenn, Liddelow & Gimson, 1961). Note that
this is a flat plane which is found only rarely among natural teeth. The occlusal plane
set initially in the clinic is only a guide and may have to be modified later because the
teeth are set in the denture with compensating curves and depart from the flat plane
for functional reasons.
In this paper it is the vertical level of this plane and the angulation that is being
discussed. Some authors (Lang & Kelsey, 1972) talk about the buccal lingual position
of this plane which is geometrically an impossibility as the occlusal plane, by definition,
has infinite dimensions in those directions. The idea of the occlusal plane being
parallel to the alar tragal or Camper's line (Stedman, 1972) is very old, having been
mentioned in early textbooks (Fripp, date unknown but pre-1920; Wilson, 1920).
It also appears in many textbooks in current use (Boucher, Hickey & Zarb, 1975).
Many other landmarks and techniques have been reported over the years. Gillis
(1933) described a technique involving the corner of the mouth and the ear lobe, not
very dissimilar to the technique proposed later in this paper. DeVan (1935) suggested
placing it midway between the ridges, a technique which is much easier to follow in the
Correspondence: M. H. Spratley, Department of Dental Prosthetics, University of Melbourne,
School of Dental Science, 711 Elizabeth Street, Melbourne 3000, Australia.

0305-182X/8O/O100-0031 $02.00

1980 Blackwell Scientific Publications


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M. H. Sprat ley

laboratory than in the clinic. Pound (1951) describes a method in which the patient's
head is held erect and the plane is set parallel to the floor, hardly an easy task for the
inexperienced student. Sears (1952) advocated having the plane closer to the less
favourable ridge to improve stability. Standard (1957) used Stensen's Duct as a
landmark. Others have disputed the reliability of this but in any case it is hardly an
obvious landmark in a living patient with the mouth closed and rather unsuitable for
teaching as one or two points cannot constitute a plane. Wright, Swartz & Godwin
(1961) maintained that the plane should follow the position of the natural teeth which
is satisfactory for immediate dentures but useless for replacement dentures when the
natural teeth are long gone. Boucher (1964) uses the retromolar pads and a position
parallel to the bases. Again, ideal in the laboratory but difficult in the clinic. Wright
(1966) mentioned tongue position, retromolar pads and the relationship to the
corners of the mouth which are ail good landmarks for the experienced operator but
difficult for students.
It must be remembered that occlusal planes in natural dentitions and dentures are
not necessarily the same, although it would seem reasonable that the dentures should
not depart too radically from that which they are replacing. Also, aesthetic considerations largely determine the height of the plane anteriorly depending on how much
tooth is to be shown. It would seem, therefore, that the general consensus of opinion
is to set the level and angulation of the occlusal plane at or just below the level of the
relaxed lip anteriorly and parallel to the interpupillary line transversely and alar tragal
line antero-posteriorly.
The most common technique is to hold the occlusal plane guide (Fox, 1924) in
position against the upper rim and to hold a straight edge, most commonly a ruler or a
record card, up against the face at the interpupillary line and the alar tragal line.
Even this does not seem to be an easy task for nervous students working on patients
that, sensing the student's lack of confidence, become agitated themselves. Consequently, students seem to be unable to judge this parallelism accurately.
Alternative method
The upper occlusal rim of quite conventional form is tried in the mouth and
marked at the desired tooth level anteriorly (usually such as to show 0-3 mm of tooth
with the lips at rest). The labial fullness may also be adjusted at this stage. Using an
occlusal plane guide the plane is adjusted usually by melting off wax with a hotplate
or selectively by adding wax until a position is reached where, looking along the flat
of the plane guide, it appears to be at or just below the ear lobes.
After occlusal planes have been determined using this technique, a series of photographs full-face and profile, were taken of patients at the registration stage. The alar
tragal line and interpupillary lines were marked on the prints, the occlusal plane being
obvious from the Fox guide. It was noticed that in the majority of cases a high degree
of parallelism existed (Fig. 1). Problems were encountered with patients with large
maxillary tuberosities. In these cases it was sometimes impossible to raise the level of
the plane high enough posteriorly to approach the ear lobes. However, it was also
noted that the plane in these cases was not parallel to the alar tragal line, dropping
away posteriorly.
A further series of photographs were taken of dentate persons and they were
similarly marked. Several things were apparent: first, in no case could the plane be set
against the teeth in such a way that it contacted the first molars and the central

Determination of occlusal plane

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Fig. 1. Eull face (a) and profile (b) views looking along the occlusal plane guide. The interpupillary
line and alar tragal line have been marked on the photographs.

incisors (most contacted premolars rather than molars) and the planes could seldom
be described as parallel to the alar tragal line although they were often parallel to the
interpupillary line. However, those persons were generally much younger than the
full denture patients and as already stated, the occlusal plane of a full denture need
not follow exactly the plane of the natural arch.
Conclusions

Because of the ease in which the occlusal plane may be set by this method, it being
judged by direct vision using easily recognizable reference points and there being no
need to estimate parallelism, it is considered an excellent method particularly for
student teaching.
References
C O . (1964) (Editor) Swenson's Complete Dentures, 5th edn, p. 219. Mosby, St Louis.
CO., HICKEY, J.C. & ZARB, G.A. (1975) Prosthetic treatment for edentulous patients,
7th edn. Mosby, St Louis.
DEVAN, M . M . (1935) An analysis of stress counter action on the part of alveolar bone with a view
to its preservation. Dental Cosmos, 11, 109.
FENN, H.R.B., LiDDELOw, K.P. & GIMSON, A . P . (1961) Clinical Dental Prosthetics, 2nd edn, p. 188.
Staples Press.
Fox, F.A. (1924) The principles involved in full upper and lower denture construction. Dental Cosmos,
151.
FRIPP, S.T. (circa 1920) Impression Taking and Denture Making, p. 20. DeTrey & Co. Ltd, London.
GiLLis, R.R. (1933) A denture technique applicable by the average dentist. American Dental Association Journal, 20, 309.
LANG, B.R. & KELSEY, C.C. (1972) International Prosthodontic Workshop, p. 154. The University of
Michigan Press.
POUND, E. (1951) Aesthetic dentures and their phonetic values. Journal of Prosthetic Dentistry, 1,
98.
SEARS, V . H . (1952) Occlusion, the common meeting ground in dentistry. Journal of Prosthetic Dentistry, 2, 15.
STANDARD, S . G . (1957) Fstablishing the plane of occlusion in complete denture construction.
American Dental Association Journal, 54, 845.
STEDMAN'S MEDICAL DICTIONARY (1972) 22nd edn, p. 712. The Williams & Wilkins Company.
WILSON, G . H . (1920) A Manual of Dental Prosthetics, 4th edn, p. 162. Lea & Febiger, New York.
WRIGHT, C.R. (1966) Evaluation of the factors necessary to develop stability in mandibular dentures.
Journal of Prosthetic Dentistry, 16, 414.
WRIGHT, C.R., SWARTZ, W.H. & GODWIN, W.C. (1961) Mandibidar Denture Stabilitya New Concept. Ann Arbor, Michigan, Overbeek.
BOUCHER,
BOUCHER,

Manuscript accepted 28 February 1978


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