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Simple Method For Cross-bite Setup For Complete Dentures: A

Case Report

Article · December 2014

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Montenegro.FLB, Marchini. L J Pak Prosthodont Assoc 2014; 02(02): 91-95

Simple Method For Cross-bite Setup For Complete Dentures: A Case Report.

Fernando Luiz Brunetti Montenegro1 Leonardo Marchini 2

1
Lecturer, Department of Geriatric Dentistry in Brazil and Latin America.
2
Assistant Professor, Department of Preventive and Community Dentistry, College of
Dentistry and Dental Clinics, University of Iowa, USA.

Correspondence: Dr. Leonardo Marchini, Assistant Professor, Department of Preventive and Community
Dentistry, College of Dentistry and Dental Clinics, University of Iowa, 337-1 Dental Science N, Iowa City, IA 52242
(USA). Email: leonardo-marchini@uiowa.edu

ABSTRACT:
The purpose of this paper is to present a simplified and inexpensive method for cross bite artificial tooth setup
for complete dentures, as well as to debate some points that support this technique.
Key Words: Complete dentures, Artificial teeth, Tooth setup.
How to cite this article: Montenegro FLB, Marchini L. Simple method for cross-bite setup for complete dentures:
a case report. J Pak Prosthodont Assoc 2014; 02 (02): 91-95.
Acknowledgments: The authors thank Ms. Anna Okulist for her English language proofreading this manuscript.

Introduction to progressive asymmetric compensation of the

Cross bite tooth set-up for complete dentures is a
technique known since the late nineteenth century
(1880), especially in cases of severe bone resorption
of the ridges. It was used to obtain greater chewing
efficiency and to keep denture base displacement /
1
dislodgement to a minimum. At that time, there
were no specific teeth for this purpose, and several
authors proposed many clinical solutions, including
using a five premolar setup in inverted sides (right
uppers in the position of left uppers and vice versa).
In 1918, Gysi patented specific teeth for cross bite
setup with specific anatomical details and different
inclinations compared to normal posterior artificial
2
teeth. It became a new standard to solve cases of
maxilo-mandibular size discrepancies and also for
cases presenting with severe residual ridge
3-5
resorption.
6
In a recent study among healthy Germans, only a
small proportion develop temporomandibular
dysfunction (TMD), even with the presence of many
harmful occlusal factors. Cross bite of natural teeth
was not characterized to induce TMD signs and
symptoms, which is consistent with the idea of
functionality suggested by Gysi in the past century.
Furthermore, untreated cross bite in children can lead
91
condyle-fossa relationship, resulting in a shift in jaw
position. Due to this adaptation process, cross bite is
usually a well-tolerated malocclusion in adulthood,
7, 8
providing adequate masticatory function.
More recently, a renewed interest in specific artificial
teeth for cross bite tooth setup for complete
9
dentures was observed among some manufacturers.
However, these teeth are usually expensive, and
complete denture patients usually present with
disadvantaged economic backgrounds. To help solve
the issue of cross bite tooth setup for complete
denture patients that cannot afford expensive
artificial teeth, this paper aims to present a simple
and inexpensive technique to obtain adequate cross
bite tooth setup in a patient with jaw size
discrepancy.
Case Report
This case report is about a 67-year-old female patient
reporting a non-contributory health story. She
presented with severe residual ridge resorption and a
large difference in size between the mandible and
maxilla, contributing to inadequate function of old
dentures. The jaw size discrepancy clearly precludes
Montenegro.FLB, Marchini. L
an efficient occlusal scheme if artificial teeth are
setup in the conventional bite relationship.
Considering the patient’s disadvantaged economic
background, our option was to setup the usual,
commercially-available artificial teeth in a cross-
Figure 1 –Maxillary denture tooth setup, occlusal
view. Second molar was not included due to the
reduced size of the maxilla.
Figure 2 – Mandibular Denture tooth setup, occlusal
view. Comparing figures 1 & 2, the size discrepancy
between the maxilla & mandible is easily visualized.
92
J Pak Prosthodont Assoc 2014; 02(02): 91-95
inverted manner: The maxillary right posterior teeth
were mounted in the lower left posterior region and
vice versa for the lower right posterior teeth. The
same was done for the maxillary left posterior teeth,
which were mounted in the lower right posterior
region, and lower left posterior teeth (Figures 1-6).
Figure 3– Occlusion & esthetics in centric relation
(CR).
Figure 4 –Right side view of tooth setup in CR
Position.
Montenegro.FLB, Marchini. L J Pak Prosthodont Assoc 2014; 02(02): 91-95

Figure 5 –Left side view of tooth setup, CR Position.

Figure 8 –Tooth setup try-in, right side movement
showing posterior contacts on both working and non-
working sides during lateral movement to the right.

Figure 6: Lingual view showing maximum

intercuspation. This figure also shows the preserved
room for the tongue, which otherwise would be
constrained by conventional tooth setup.
Figure 9 –Tooth set-up try-in, left side movement.
This figure shows posterior contacts on both working
and non-working sides during left lateral movement.

Figure 7–Tooth setup try-in, centric relation showing

maximum intercuspation in CR position.

93
Montenegro.FLB, Marchini. L
Figure 10 –Denture delivery, centric relation. This
figure shows maximum intercuspation in CR.
Figure 11–Denture delivery, right side movement
showing posterior contacts on both working & non-
working sides during right lateral movement.
Anterior teeth were setup by the conventional
technique. All steps before artificial tooth setup
(impressions, jaw relation record, artificial tooth
selection) remained the same; the only change was in
posterior tooth setup.
The occlusal scheme chosen for this case was a
10
bilaterally balanced occlusion, as seen in Figures 7-
9 After minor adjustments, the dentures were then
o
sent for flasking, acrylization (72 C/12 hours),
finishing, and polishing.
After laboratory steps, the dentures were delivered
to the patient (Figures 10-12), and the same occlusal
94
J Pak Prosthodont Assoc 2014; 02(02): 91-95
Figure 12–Denture delivery, left side movement. This
figure shows posterior contacts on both working and
non-working side during lateral movement to the left.
Figure 13 – Posed smile. No esthetic changes were
noticed due to cross bite tooth setup, and the final
esthetics were considered adequate.
scheme previously observed during the try-in step
was observed again. The final esthetics can be
observed in Figure 13. The cross bite tooth setup did
not interfere with final esthetic outcomes, which
were considered adequate by both patient and
dentist. One year recall scheduling was indicated for
denture assessment, as usual.
Discussion
In a study of articulator records of 150 complete
denture wearers (96 men and 54 women) to assess
the existence of cross bite, the incidence of bilateral
cross bite was 7.3% (8.3% for men and 5.3% for
Montenegro.FLB, Marchini. L
women). In 12% of the total sample, right cross bite
was observed (8.3% in men and 18.5% in women),
while left cross bite was present in 26.6% of the
11
sample (26.2% in men and 28.0% in women).
12
Furthermore, Curtis et al. considered posterior
tooth setup in cross bite valid when the residual
ridges are severely resorbed to prevent inadequate
function of dentures. The decrease in masticatory
efficiency is associated with inadequate elderly
13,14
nutrition. Although this decrease is not common
in healthy aging, it is much more frequent in denture
15
wearers, mainly among those with poor denture
10
function.
Large size discrepancies between edentulous maxilla
and mandible, although relatively common, have
received scarce attention in recent decades. Some
attempts to fix the problem include surgical
16
approaches and the above mentioned specific
9
artificial teeth. Even though results for both
approaches seem to be adequate, they are expensive,
and most complete dentures patients cannot pay for
them. The alternative tooth setup presented here
may be a feasible, cost-effective alternative for these
cases. However, more systematic studies are needed
to verify its effectiveness and overall patient
satisfaction when compared to other treatment
modalities.
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