Occlusion simplified

“the thin book of occlusion”

Avinash S. Bidra BDS,MS,FACP

Director, UConn Post-Graduate Prosthodontics

1st rendition- March 2020

 Dedication

To the student of prosthodontics

To my son Arjun, the apple of my eye

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 Preface

With improved knowledge and understanding of mandibular

movements, dental articulation, technology, clinical
outcomes and biomaterials, there is an enormous need to
simplify concepts of dental occlusion and provide
simplified guidelines for the student of post-graduate
prosthodontics. There is minimal, if any high quality
scientific evidence available in the whole field of
dental occlusion. As long as there is no harm to the
patient, and the clinical outcomes are favorable and
successful, simplified occlusal concepts have an
obvious benefit compared to complex occlusal concepts.

Simplification does not imply ignoring or denigrating

existing science or the large body of scientific work
produced by luminaries of the past. Simplification
simply allows easier dissemination of knowledge to
allow the modern student of prosthodontics to dedicate
time and energy on learning other contemporary topics
of supracrestal and subcrestal prosthodontics.
Simplification also saves time and allows treatment of
a larger number of patients, because after all, we are
here only because of our patients.

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 Occlusion for Removable Prosthodontics
(Complete denture/Overdenture in at least 1 arch)

• Facebow is not necessary for denture fabrication,

but casts should be mounted to an ideal maxillary
occlusal plane on a semi-adjustable or average
value articulator.
• Set articulator with 20 degrees for horizontal
condylar inclination and 15 degrees for lateral
condylar inclination (Bennett angle).
• Use canine guidance with mutually protected
articulation.
• Use semi-anatomic or lingualized denture teeth
molds (<20 degrees) for maxilla- do not use
monoplane denture teeth.
• Use semi-anatomic (<20 degrees) or lingualized
denture teeth molds for mandible. Monoplane denture
teeth in immediate denture situations is
acceptable.
• Vertical overlap of anterior teeth should be around
2-2.5mm
• Horizontal overlap is dictated by phonetics (s,ch,j
sounds), skeletal/arch relationships(Class I, II or
III) such that mandibular anterior teeth are
positioned close to the ridge.

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 Occlusion for Fixed Prosthodontics
(Single unit or multiple units on natural teeth or
implants, but not restoring an entire arch)

• Facebow is not necessary, but casts should be

mounted (and cross-mounted when applicable) to an
ideal maxillary occlusal plane, developed and
tested on interim restorations, on a semi-
adjustable articulator.
• Set articulator with 20 degrees for horizontal
condylar inclination and 15 degrees for lateral
condylar inclination (Bennett angle).
• Unless all posterior teeth are being restored, do
not attempt to change the existing occlusal scheme.
• Shorten the lingual cusps of any mandibular
posterior teeth being restored, to eliminate all
interferences.
• Leave existing natural teeth interferences as is,
but restorations should not have any interferences.
• Allow shim stock(8µ) clearance between anterior
restorations and opposing dentition.
• When posterior maxilla is atrophied, restore the
implants in definitive cross bite, rather than cusp
to cusp occlusion.

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 Occlusion for Complete Arch Fixed Prosthodontics
(One or both arches restored over natural teeth and/or
implants for partially edentulous spaces)

• Facebow is optional, but casts should be mounted

(and cross-mounted) to an ideal maxillary occlusal
plane, developed and tested on interim
restorations, on a semi-adjustable articulator.
• Set articulator with 20 degrees for horizontal
condylar inclination and 15 degrees for lateral
condylar inclination (Bennett angle).
• Use canine guidance with mutually protected
articulation as first choice.
• When sole canine guidance is not possible, then
either obtain guidance from both canine and first
premolar, or both premolars only (partial group
function).
• Shorten the lingual cusps of mandibular posterior
teeth to eliminate all interferences.
• Vertical overlap of anterior teeth should be
dictated by esthetics, phonetics, existing teeth
positions and planned vertical dimension of
occlusion.
• Horizontal overlap is dictated by esthetics,
phonetics, existing teeth positions and planned
vertical dimension of occlusion.
• Anterior coupling/contact and guidance from palatal
surface of maxillary anterior teeth is preferable
when possible. In severe class II situations, do
not over-thicken the anterior restorations to
achieve coupling, but anterior coupling can be
ignored in such situations.
• When posterior maxilla is atrophied, restore the
implants in definitive cross bite, rather than cusp
to cusp occlusion.

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Occlusion for Complete Arch Fixed Implant Supported
Prosthodontics (CAFIP)
(CAFIP in at least 1 arch)

• Facebow is not necessary for prosthesis

fabrication, but casts should be mounted to an
ideal maxillary occlusal plane on a semi-adjustable
articulator.
• Set articulator with 20 degrees for horizontal
condylar inclination and 15 degrees for lateral
condylar inclination (Bennett angle).
• Use canine guidance with mutually protected
articulation.
• Use semi-anatomic denture teeth mold (<20 degrees)
for maxilla- do not use monoplane denture teeth.
• Use semi-anatomic denture teeth mold (<20 degrees)
for mandible. Monoplane denture teeth in immediate
denture situations for use as conversion/interim
prostheses is acceptable.
• Shorten/disrespect the lingual cusps of mandibular
posterior teeth to eliminate all interferences.
• Vertical overlap of anterior teeth should be
dictated by esthetics and phonetics and should be
around 2-2.5mm
• Horizontal overlap of anterior teeth should be
dictated by esthetics and phonetics (s,ch,j sounds)
and should be around 2-2.5mm. It is possible to
convert Class II and Class III patients to class I,
as long as the mandibular anterior teeth are set in
harmony with phonetics and envelope of motion.