OCCLUSION IN PARTIAL DENTURES

By

Prof. Dr. Osama Baraka

The application of the principles of occlusion to partial dentures may be

complicated by two factors, namely, a displaced intercuspal position of the
existing natural teeth and the differing movements of natural and denture
teeth during occlusal function.
Difficulties:
In order to provide good occlusal function by partial dentures the
following difficulties may be encountered and attempts should be made to
overcome them before the final impressions are made:
1. The existing intercuspal position may be causing a disturbance and
potential disorder. These include cusp interferences on closure to intercuspal
position and during articular movements.
2. Altered occlusal curve by exfoliation of unopposed teeth. A decision
may have to be made to reduce the height of such teeth by occlusal
adjustment or by crowning at a reduced level.
3. High caries incidence and periodontally disturbed abutment teeth.
These may have to be crowned and splinted to sound adjacent teeth. This
treatment may also apply to teeth whose occlusal surfaces have been worn
and are required for improved function.
4. Differing responses of mucosa and teeth in the registration of jaw
relationships.

5. Methods of making the jaw registration and the materials used.

6. Laboratory errors.
 Analysis and treatment plan:
Analysis prior to partial dentures should be comprehensive and a
planning session with the technician is essential. X-rays and hand-held casts
should be available for decisions on corrections to the occlusal curve, the
acceptance (or not) of the habitual intercuspal position and articulation, the
removal or treatment of any doubtful teeth (especially those selected as
abutments), the type of teeth to be used which will provide the best function
with the opposing natural teeth, and the methods to be used in transferring
the jaw relationships.
If occlusal adjustment is advised in order to correct a potentially harmful
intercuspal position of the mandible a retruded arc mounting of model on an
adjustable articulator will be necessary.
Vertical jaw relation
For most patients requiring removable partial denture, measurement of
the vertical dimension is not necessary. If natural teeth in opposing arches
contact in centric occlusion, this vertical separation of the jaw should be
considered the vertical dimension of occlusion for that patient and the
prosthesis should be constructed at that vertical dimension.
Increasing this vertical dimension of occlusion should be considered only
if patient displays symptoms that suggest the vertical dimension of occlusion
has been diminished, such as tired aching muscles, unexplained pain in the
head or neck or an appearance of premature aging caused by shortened
nose-chin distance. The most significant signs of overclosure are excessive
free-way space, extreme anterior vertical overlap in which the mandibular
teeth strike the soft tissue of the palate, and migration of the condyles as
seen in radiograph.
 Only a small percentage of partial denture patients (those who have lost
all posterior teeth in one or both arches) need to have the vertical dimension
of occlusion established by measurement, this is done by measuring the
vertical dimension of the rest and then subtracting 3mm (the average amount
of free-way space).
Horizontal jaw relation:
Two horizontal relationships of the mandible to the maxilla are of
importance in the occlusion for partial dentures; centric relation and centric
occlusion. In more than 90% of all person, centric relation and centric
occlusion do not coincide. Patients with partial denture will always function in
these two positions and in the intervening space, so deflective occlusal
contacts in either position must be avoided.
Treat at centric jaw relation or centric occlusion:
The decision whether to construct a prosthesis at centric jaw relation or
centric occlusion must be made. The following clinical situations indicate
construction of the prosthesis at centric jaw relation:
1- Coincidence of centric jaw relation and centric occlusion.
2- Situations in which all posterior tooth contacts are to be restored with
cast restorations.
3- Absence of posterior tooth contacts.
4- Clinical symptoms of occlusal trauma.
5- Only a few remaining posterior contacts.
In the absence of these indications, the removable partial denture should
be constructed at centric occlusion. Special care must be taken in the
construction and fitting of the prosthesis to make certain that no new
interferences are built into the occlusion at centric jaw relation or between
centric jaw relation and centric occlusion.
 Methods of establishing occlusion:
I- Functionally generated path technique:
An acrylic resin denture base is attached to the framework. On the
acrylic resin base is constructed a hard-wax occlusion rim. The occlusion rim
is constructed so that when first inserted it is slightly high in occlusal contacts
and will keep the remaining natural teeth apart about 1 mm. The occlusion
rim should be made wider than the buccolingual width of the tooth opposing
the rim.
The patient takes the framework with the denture base and occlusion
attached home and wears it continuously for 24 hours except when eating
and when drinking hot or chilled drinks.
The patients are instructed to close the jaws together firmly and to grind
the wax in all possible jaw positions. The resulting pathway will be a record
of all possible jaw movements and tooth contacts even involuntary or bruxing
contacts while sleeping are also recorded. The completed wax pattern will
resemble a slightly larger version buccolingually of the teeth opposing the
edentulous space (Fig. 11-1).
The wax pattern is boxed and poured in improved stone. Before
separating the template from the wax record, the whole assembly is mounted
on an articulator.

Fig. (11-1) Functionally generated pathway. Left; for mandibular denture. Right; for
maxillary denture.
 The incisal guide pin of the articulator is opened 1 mm. The partial
denture teeth are fitted to the framework to contact the record. (Fig 11-2).
Selective grinding of the denture teeth is carried-out to develop the occlusal
anatomy of the denture tooth to conform to the functionally generated stone
path and the vertical dimension will return to normal.
Advantage:
The functionally generated path technique eliminates the need for
face-bow records and for adjusting an articulator in centric and eccentric
positions.
Disadvantages:
1- If opposing partial dentures are required, the occlusion in one of the
arches must be completed before a generated path can be developed.
2- During the generation of the path, movement of the distal extension
base is possible.
3- Verifications of the recording in the mouth is difficult.
Arranging teeth to an occluding template
The teeth are usually arranged for intercuspation with the opposing
teeth in a normal cuspal relationship. With a functionally generated
occlusion, however, it is not absolutely necessary that normal opposing tooth
relationships be reestablished. The occlusal surface of the artificial teeth
must be modified to occlude with the template. The teeth must be occluded
too high and then modified to fit the template at the established vertical
dimension of occlusion.
Teeth arranged to an occluding template should be placed in the center
of the functional range. When natural teeth have registered the functional
occlusion, the teeth should be arranged buccolingually in the center of the
template, regardless of its relation to the residual ridge. On the other hand,
if some artificial occlusion in the opposing arch has been recorded, the teeth
should be arranged in a favorable relation to their foundation, even if this
means arranging them slightly buccally or lingually from the center of the
template.

II- Articulator technique:

Face bow transfer:
When most or all the posterior teeth are to be replaced in one or both
arches, the use of the face bow is essential in eliminating unnecessary
problems in developing the occlusion. The use of the face bow makes the
mounting of the maxillary cast on the articulator more convenient and more
accurate.
Intercuspal position jaw registration:
1- Direct apposition of casts.
This method is used when there are sufficient opposing teeth remaining
in contact to make the existing jaw relationship obvious and when only a few
teeth are to be replaced on short denture base. In this method opposing casts
may be occluded by hand. The occluded casts should be held in apposition
with 2 wire nails attached with sticky wax to the bases of the casts until they
are securely mounted on the articulator. A face bow mounting is generally not
indicated.

2- Interocclusal records with posterior teeth remaining.

A second method, which is a modification of the first, is used when
sufficient teeth remain to support the partial denture (Kennedy class III) but
the relation of the opposing teeth does not permit the occluding of casts by
hand. In such cases, jaw relations must be established as for fixed
restorations using some kind of interocclusal record. The least accurate of
these is the interocclusal wax record. A wax record should be further
corrected with an impression paste, which is used as the final recording
medium.

An interocclusal record also may be made with an adjustable frame. The

adjustable frame is devised for use with materials that offer no resistance to
closure, such as zinc-oxide and eugenol impression pastes (Fig. 11-2).

Fig. (11-2): Left; wax interocclusal record corrected by paste. Right; the adjustable
frame interocclusal record.

3- Trial bases:
Fast-cure acrylic bases (joined preferably by a lingual bar connector)
with compound occlusal rims are advised especially where there are distal
extension bases. The rim is reduced by 3-4mm from contact in intercuspal
position and the registration made using the material best suited to the
dentist, while the existing opposing natural teeth maintain light contact (Fig.
11-3).
Record bases must be as identical as possible to those of the finished
prosthesis. If a distal extension base is to be supported by the functional form
of the residual ridge, it is necessary that the recording of jaw relations be
deferred until the master cast has been corrected to that functional form.
Fig. (11-3): Left; a space is created between the upper teeth and lower wax rim. Right;
an interocclusal record by zink oxide paste.

4- jaw relation records made entirely on occlusion rims:

When there is no occlusal contact between the remaining natural teeth
(e.g. when a distal extension partial denture opposing a complete denture
or when both arches has only anterior teeth present) the jaw relation
records are made entirely on occlusion rims. The principles applied for such
partial dentures are the same as to a complete denture (Fig. 11-4).

Fig. (11-4): Complete maxillary denture opposing mandibular RPD. The jaw relation is
made entirely on occlusion rim.
5- jaw relation record made by using the framework :
Autopolymerizing acrylic resin should be used to construct a record
base on the framework. Wax occlusion rim is added to the record base. The
jaw relation record is made with a pressure - free media so the record base
will not be subjected to an occlusal pressure (Fig. 11-5).
 Fig. (11-5): recording base and wax rim on the framework.

Protrusive registration:
The registration of protrusive and lateral positions now follows if an
articulation scheme is planned. This will be determined by the incisal
guidance and articulation scheme of the existing natural incisor and canine
teeth. If these teeth are being replaced articulator adjustment to the positional
records is made as for complete dentures.

Desirable contact relationships for removable partial dentures

1- Simultaneous bilateral contacts of opposing posterior teeth must occur

in centric occlusion.
2- Occlusion for tooth borne dentures may be arranged similar to the
occlusion seen in a harmonious natural dentition.
3- Balanced occlusion in eccentric positions should be formulated when
the partial denture is opposed by a maxillary complete denture.
4- Working side contacts should be obtained for the mandibular distal
extension base.
5- Simultaneous balancing and working contacts should be formulated
for the maxillary bilateral distal extension partial denture wherever possible.
Such an arrangement will compensate in part for the unfavorable position the
maxillary artificial teeth must occupy in relation to the residual ridge.
6- When occlusion is developed for a Class II removable partial denture
(maxillary or mandibular), only working side contacts are necessary, because
the cross-arch framework stability gained from tooth engagement provides
resistance to movement. Balancing side contacts do not enhance stability
beyond that provided by the contralateral teeth.
7- In the class IV removable partial denture situation, contact of opposing
anterior teeth in centric occlusion is desirable to prevent a continuous
eruption of the opposing natural incisors. Contact the opposing anterior teeth
in eccentric positions should not be developed.
8- Contact of opposing posterior teeth in a straight forward protrusive
relationship is not desirable in any situation except when an opposing
complete denture is placed.

9- Artificial posterior teeth should not be arranged farther distally than

the beginning of a sharp upward incline of the lower residual ridge or over the
retromolar pad.
10- The principle of tripod contact between well shaped supporting cusp
with adequate overjet and overlap by the guiding cusps applies.
11- The number of teeth should be minimal compatible with adequate
function and the prevention of any drift of opposing teeth. Also, Teeth with a
narrower buccal-lingual width than the original teeth are selected
Correcting occlusal discrepancies:
A- Intraoral method:
An articulating paper or occlusal indicator wax is used as a means of
identifying occlusal contacts. The technique for detecting occlusal
discrepancies interiorly is used when the removable partial dentures being
corrected are stable in the mouth (e.g. class III).
The method of detecting and correcting occlusal discrepancies
intraorally is as follows:
1- With partial dentures out of mouth two opposing natural teeth that
contact when patient closes in centric occlusion are selected. Their contact
is verified by using a celluloid strip (Fig. 11-6).
2- With one partial denture in mouth and patient closing in centric
occlusion, relationship of selected index teeth is noted. If index teeth are
not contacting, articulating paper is used to locate interference. Premature
contacts in intercuspal position will penetrate the paper and leave a clear
punched out mark on the teeth (Fig. 11-6). Interferences must be relieved
using the same rules of complete denture. The fossa mark should be
removed leaving the supporting cusp untouched. After interferences are
corrected index teeth must be in contact.
3- After interference in centric occlusion are corrected, interference in
centric relation, and in protrusive and lateral excursions must be corrected.

Fig. (11-6): Left, celluloid strip used to check interferences. Right, articulating paper
marks on occlusal surfaces of teeth showing interference or high point as bull’s eye
mark and normal contact as a solid mark. Sliding contacts leave a blurred mark.
 4- For patient receiving two removable partial dentures, after one partial
denture is cleared, the same procedure is followed with opposing partial
denture. After each denture has been corrected individually, final step is to
correct for interference with both dentures seated in mouth.
5- The patient should not be aware of any occlusal changes after partial
denture adjustment.

B- Occlusal correction by remounting:

Occlusal adjustment of distal extension removable partial dentures is
accomplished more conveniently and accurately by using an articulator than
by any intraoral method.
An irreversible hydrocolloid impression in a stock tray is made while the
partial denture is seated. The denture undercut is blocked by wax and the
impression is poured into dental stone (Fig. 11-7). The maxillary cast is
mounted on the articulator with face-bow transfer. Then centric jaw relation
records must be made to mount the mandibular cast. Articulating paper is
used to locate interfering cusps and to help determine evenness of occlusal
contacts.

Fig. (11-7): Remounting casts with the prosthesis are mounted on the articulator.