DOI

826  Indian Journal of Public Health Research & Development, January 2020, Vol. 11, Number:
No. 01 10.37506/v11/i1/2020/ijphrd/193932

A Modified Technique for Establishing the

Occlusal Plane in Complete Denture Prosthesis

Pradeep S.

Additional Professor, Dept. of Prosthodontics, Manipal College of Dental Sciences

Abstract
Occlusal plane position is considered to be the primary link between function and esthetics. Canted occlusal
planes result from the canted interpupillary line if the latter issued as reference plane. Establishing this
occlusal plane correctly by orienting is of prime importance. Bubble gauge mounted to the fox plane provides
more accurate orientation of occlusal plane irrespective of reference planes. This modification can be used to
achieve optimum result in facial asymmetries and canted interpupillary lines, since interpupillary line cannot
be used as a guide in such cases.

Clinical Implications: If a clinician uses bubble gauge-fox plane approach for establishingocclusal plane, then
the aesthetic outcome will be enhanced. This method is also of value since it reduces subjective variations.

Keywords:  Occlusal cants, reference planes, complete denture esthetics, interpupillary line.

Introduction parallel to interpupillary line anteriorlystabilises the

Occlusal plane is the average plane established by
the incisal and occlusal surfaces of the teeth. Generally,
it is not a plane but represents the planar mean of the
curvature of these surfaces1. The orientation of the
occlusal plane is lost in patients rendered edentulous and
should berelocated if complete dentures are to be esthetic
and to function satisfactorily. It is the most important
plane to be determined in complete denture work, as
it is a vital and importantbasis for tooth arrangement2.
Complete dentures are constructed to function in the
mouth asan integral part of the masticatory system;
therefore, they should be designed to conform to
the patient’s physiologic jaw relations. The plane of
occlusion forms one essential physiologic concept of
jaw relation and occlusion. A well contoured occlusal
rim with occlusal plane parallel to ridge posteriorly and
denture3.
During the maxillomandibular relations after
forming the rim with the correct vertical heights, the
plane of occlusion is modified until it is parallel with
a line projected from ala of nose to the superior edge
of the tragus of ear (Camper’s line). The incisal-canine
esthetic line should be made parallel to the interpupillary
line when the patient is looking straight ahead2,4,5,6.
An occlusal plane indicator such as a Fox plane
guide is used to achieve this goal7. In practice, a metallic
scale is used along with Fox plane8,9,10. The Fox plane
is placed inside the mouth touching the occlusal rim
and is held by the operator, while the metal scale is
held at the level of Camper’s line or interpupillary line.
Conventional method have the following disadvantages:

It is difficult to hold the scale steady. The scale

position changes every time the operator checks the
parallelism. Moreover, when checking with naked
Corresponding Author: eye, the operator has to be at eye-level to check the
Dr. Pradeep S. parallelism as any change in angulation of eye leads to
Additional Professor, Dept. of Prosthodontics, Manipal incorrect results. This not only increases the chances of
College of Dental Sciences, Manipal-576104 error but also makes the procedure tedious and time-
e-mail: paddusb@gmail.com consuming. Trying to imagine the interpupillary line and
 Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01  827
comparing it with the Fox plane guide is quite difficult.
It is difficult for the practitioner to compare between the
fox plane guide and an instrument that represents the
interpupillary line with a distance of several centimetres
apart. It is difficult to fix or stabilize the pupils because
the patient doesn’t understand the importance of
stabilizing the pupils, nor does he/she know in which
correct position to stabilize the pupils. In elderly subjects
who receive the majority of the complete dentures the
muscle coordination is poor3.

A range of facial asymmetries can influence

Fig 1: Mounted bubble gauge on fox plane
the choice of occlusal plane duringprosthodontic
treatment. Thus, an occlusal plane parallel to the ala
tragus and interpupillary lines, as often supported by
prosthodontists, may result in less than ideal esthetics in
the final restoration11,12.

In the event that one eye is higher than the other

(which often occurs), the incisal-canine line would be
made slanted in relation to true horizontal when the
patient’s head is erect. The interpupillary is not the
best esthetic reference line and has advocated making
the incisal-canine line parallel to horizontal when the
patient’s head is perfectly erect regardless of the eyes or
any other facial feature13. Fig 2: Centred bubble gauge

To overcome the above disadvantages a modification Discussion

to the Fox plane in which, bubble gauge is mounted to the
Fox plane (Fig 1). The bubble gauge consists of coloured
liquid in a tube consisting of bubble and markings in
the centre. The presence of the bubble in between the
markings indicates that the surface is parallel to ground
level or the truehorizontal14. Bubble gauge is used in
automobile industry, water level monitoring etc.
Applying the same principle to complete denture
prosthodontics, it can be used inmaxillomandibular
relations procedure where the planes are of utmost
significance.
Procedure for use of bubble gauge: The patient
is made to sit erect looking straight ahead at horizon.
The labial form of occlusal rim should provide adequate
lip support and labial fullness. The vertical length of
the maxillary occlusion rim is established. The occlusal
plane is adjusted using the centralisation of bubble in
between the markings as a guide (Fig 2). The procedure
is carried out independent of the interpupillary line.
Several method for the determination of occlusal
plane have been proposed15,16,17,18. Conventional
method have their inherent demerits. This modification
is simple and inexpensive. It is very easy to use for the
beginners. Need to be at eye level is eliminated and
hence the chances of change in the angle of operator eye
level leading to incorrect plane of occlusion are nil. This
method is of advantage in cases with facial asymmetries
and canted interpupillary lines. The practitioner would
not need to imagine or try to present the interpupillary
line with any instrument. Posture of the patient can bring
about changes in the position of bubble. So the patient is
made to sit erect looking straight ahead at horizon. When
mounting the bubble gauge to the Fox plane, it should be
done on a flat base as any inclination in surface can lead
to incorrect mountings.
Conclusion
Arranging the teeth in the correct plane of occlusion
is important for the success of complete denture
prosthesis. This modification is thus reliable alternative
828  Indian Journal of Public Health Research & Development, January 2020, Vol. 11, No. 01
method for the orientation of the occlusal plane and 8. Javid NS. A technique for determination of occlusal
can be used with less subjective bias than that of the plane. J Prosthet Dent 1974;31(3):270-72.
conventional method utilizing the interpupillary line 9. Kazanoglu A, Unger JW. Determining the occlusal
plane with the Campers plane indicator. J Prosthet
Conflict of Interest: None
Dent 1992; 67:400-501.
Source of Funding: Self funded 10. SantanaUA, Mora MJ. The occlusal plane indicator:
A new device for determining the inclination of
Ethical Clearance: Ethical Clearance was not
occlusal plane. J Prosthet Dent 1998; 80:374-75.
required hence so was not obtained
11. Namano S, Behrend DA, Harcourt JK, Wilson
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