OCCLUSION IN COMPLETE

DENTURE

By
Sahana.R
PG – II YR
 CONTENTS

• Introduction
• Difference between Natural and Artificial dentition
• Requirements of Complete denture occlusion
• Axioms for artificial occlusion
• Types of Complete denture occlusion
• Tooth forms of posterior teeth
• Errors of occlusion in Complete denture
• Conclusion
• References
 INTRODUCTION

• Occlusion is the static relationship between the incising or masticating surfaces of

the maxillary or mandibular teeth or tooth analogues.(GPT- 9)

• Occlusion in complete denture must be developed to function efficiently and with

the least amount of trauma to the supporting tissues.

• Complete denture must meet three major needs

a). Comfort
b). Function
c). Esthetics
DIFFERENCE BETWEEN NATURAL AND ARTIFICIAL DENTITION
NATURAL DENTITION
• Presence of proprioceptive feedback
mechanism
• Teeth receive individual pressures of
occlusion and move
independently.
• Malocclusion of natural teeth may be
uneventful for years
• Nonvertical forces on natural teeth
during function affect only the teeth
involved and are usually well tolerated
ARTIFICIAL DENTITION
• Proprioceptive feedback mechanism is
lost
• The artificial teeth move as a unit on
their base
• Malocclusion on artificial teeth evokes
an immediate response and involves
all of the teeth and the base
• In artificial teeth the effect involves all
of the teeth on the base and is
traumatic.
 NATURAL DENTITION ARTIFICIAL DENTITION

• Incising with the natural teeth does not • Incising with artificial teeth affects all of
affect the posterior teeth the teeth on the base
• In natural teeth , the second molar is • Heavy pressures of mastication in the
the favored area for masticating hard second molar region with artificial
foods dentition will tilt the base and shift it, if it
is on an inclined foundation
• In natural teeth, bilateral balance is • In artificial teeth bilateral balance
rarely found is generally considered necessary for base
stability.
• In natural teeth, proprioception gives • With artificial teeth, no such feedback
the neuromuscular system control during signal system is present
function.
 REQUIREMENTS OF COMPLETE DENTURE
OCCLUSION
• Stability of occlusion at centric relation position and in an area forward and lateral
to it.

• Balanced occlusal contacts bilaterally.

• Unlocking the cusps mesiodistally to allow for gradual but inevitable settling of the
bases due to tissue deformation and bone resorption.

• Control of horizontal force by buccolingual cusp height reduction according to

residual ridge resistance form and interarch distance.

• Functional lever balance by favorable tooth-to-ridge crest position

• Cutting, penetrating, and shearing efficiency of occlusal surfaces.

• Anterior incisal clearance during all posterior masticatory function and bruxing
activity.

• Minimum occlusal contact areas for reduced pressure in comminuting food (lingual
contact occlusion).

• Sharp ridges or cusps and generous sluice ways to shear and shred food with the
minimum of force necessary.
 OCCLUSION

INCISING WORKING BALANCING

 REQUIREMENTS FOR INCISING UNITS

• These units should be sharp in order to cut efficiently.

• They should not contact during mastication.

• They should have as flat an incisal guidance as possible considering esthetics and
phonetics.

• They should have horizontal overlap to allow for base settling without interference.

• They should contact only during protrusive incising function.

 REQUIREMENTS FOR WORKING OCCLUSAL
UNITS

• They should be efficient in cutting and grinding.

• They should have decreased buccal-lingual width to minimize the work force directed to the
denture foundation.

• They should function as a group with simultaneous harmonious contacts at the end of the
chewing cycle and during eccentric excursions.

• They should be over the ridge crest in the masticating area for lever balance.

• They should have a surface to receive and transmit the force of occlusion essentially vertically.

• They should center the work load near the anteroposterior center of the denture.

• They should present a plane of occlusion as parallel as possible to the mean foundation plane.
 REQUIREMENTS FOR BALANCING
OCCLUSAL UNITS

• They should contact on the second molars when the incising units contact in
function.

• They should contact at the end of the chewing cycle when the working units
contact.

• They should have smooth gliding contacts for lateral and protrusive excursions
 AXIOMS FOR ARTIFICIAL OCCLUSION

• The smaller the area of occlusal surface acting on food, the smaller will be the
crushing force on food transmitted to the supporting structures.

• Vertical force applied to an inclined occlusal surface causes nonvertical force on

the denture base.

• Vertical force applied to a denture base supported by yielding tissue causes the
base to teeter when the force is not centered on the base.

• Vertical force applied outside (lateral) to the ridge crest creates tipping forces on
the base.

• Vertical forces applied to inclined supporting tissues will cause nonvertical forces
on the denture base.
TYPES OF COMPLETE DENTURE ARTICULATION

• Balanced articulation

• Linear or monoplane articulation

• Lingualized articulation
TOOTH FORMS OF POSTERIOR TEETH

• Anatomic teeth (30o - 450)

• Semi-anatomic teeth (<20o)

• Cuspless teeth (zero degree)

 BALANCED ARTICULATION

• The bilateral, simultaneous occlusal contact of the anterior and posterior teeth in
excursive movements (GPT – 9)

Objectives of balanced articulation

1). To improve the stability of denture.

2). Necessary during many excursive movements like swallowing saliva,closing to

reseat dentures and bruxism,performed by patients in between meals.

3). To reduce resorption of the residual ridge and soreness.

4). To improve oral comfort & well being of the patient.

 GENERAL CONSIDERATIONS FOR BALANCED
OCCLUSION

• The wider and larger the ridge & the teeth closer to the ridge, the greater the lever
balance.

• Wider the ridge and narrower the teeth buccolingually, greater the balance.

• The more lingual the teeth are placed in relation to the ridge crest, the greater the
balance.

• The more centered the force of occlusion anteriopsosteriorly, the greater the
stability of the base
 TYPES OF BALANCED OCCLUSION
Unilateral balanced occlusion:

• Type of occlusion when occusal surfaces of teeth on one side occlude

simultaneously, as a group, with a smooth uninterrupted glide.

Bilateral occlusal balance

• Type of occlusion seen when simultaneous contact occurs on both the sides in
centric and eccentric positions.

• For minimal occlusal balance,there should be atleast 3 point contact on occlusal

plane (2 posterior & 1 anterior).
 Protrusive occlusal balance

Usually seen during the protrusion of the mandible.

Present when mandible moves forward and the occlusal contacts are
smooth and simultaneous in the posterior both on right and left side
and on anterior teeth.

Lateral occlusal balance

Minimal 3 point contact during lateral movement of the mandible.Absent in normal

dentition.Prevents leverage action in dentures.
 MECHANICS OF BALANCED OCCLUSION

• In natural teeth when the mandible is protuded so that

the incisal edges of the upper & the lower teeth
contact, there is a gap between the upper & lower
posterior teeth, this is termed as “Christensen’s
phenomenon”.

• But this occlusion could cause tipping of the

denture in the posterior region. Thus
simultaneous anterior & posterior contacts are
required when mandible is protruded.
CONCEPTS PROPOSED TO ATTAIN BALANCED
OCCLUSION

1). Gysi’s concept- For the use of 330 anatomic teeth under various
movements of articulator.

2). Sear’s concept- Balanced occlusion for non-anatomical teeth with

anterioposterior & lateral curvature.

3). Pleasure’s concept- Introduced the pleasure curve or the posterior reverse
lateral curve

4).Frush’s concept- Arranging teeth in 1-dimensional contact

5).Hanua’s Quint- Rudolph proposed nine factors that govern articulation of artificial
teeth

1. Condylar guidance

2. Incisal guidance

3. Compensating curves

4. Relative cusp height

5. Plane of orientation

When patients with steep incisal guidance brings his mandible forward, the
movement is controlled by the lingual surface of upper anteriors thus leading
to the lifting of the posterior part of denture . To prevent this other three
components have to be modified
Nine factors governing the articulation are called as Laws of articulation

• Horizontal condylar guidance

• Compensating curve
• Protrusive incisal guidance
• Plane of orientation
• Buccolingual inclination of the tooth axis
• Sagittal condylar pathway
• Sagittal incisal guidance
• Tooth alignment
• Relative cusp height
6). Boucher’s concept

• Orientation of the occlusal plane, incisal guidance & the condylar guidance.
• Anguation of the cusp.
• Increase in the height of the cusp without changing the form of the teeth.

7). Lott’s concept

 THIELEMANN FORMULA (1932)

• Provides algebric relationship of the 5 Balanced articulation factors.

• Balanced articulation = Condylar guidance x Incisal guidance

Cusp angle x Compensating curve x Occlusal plane

• When Numerator = Denomenator Balanced occlusion occurs

• Numerator > Denomenator anterior guidance occur

• Numerator < Denomenator posterior deflective contacts occur and lack of

anterior tooth contact in eccentric position.
 CONDYLAR GUIDANCE

• Mandibular guidance generated by the condyle and articular disc traversing

the contour of the articular eminence (GPT -9)

• Recorded from the patient using protrusive registration.

• The interocclusal records are transferred to the articulator and then

accomodated to glide freely into position.

Mechanics: Increase in the condylar guidance will increase the jaw separation
during protrusion. This factor cannot be modified. So in patients
with steep condylar guidance incisal guidance is decreased to
prevent the posterior jaw separation.
 Components of condylar guidance

a).Horizontal condylar guidance - Guides the forward movement for protrusive

balance.
b).Lateral condylar guidance- Guides the sideward or lateral movement of
the mandible.

Posterior slope of the articulator eminence

represented by the condylar tract of articulator
 INCISAL GUIDANCE
• The influence of the contacting surfaces of the mandibular and maxillary anterior teeth
on mandibular movements ( GPT -9 )

• Determined by the dentist & customized during anterior try-in desired overjet and
overbite are determined.

• If overjet is increased, the inclination of incisal guidance is decreased .

• Incisal guidance has more influence on posterior teeth than condylar guidance.

• If the incisal guidance is steep, steep cusps or occlusal plane or steep compensatory
curve is needed to balance occlusion.

• Incisal guide angle should be acute with suitable vertical overlap and horizontal overlap
to achieve balanced occlusion
Component of incisal guidance:

1). Horizontal component

2). Vertical component
• Shallow condylar guidance
produces lesser tooth
separation during
protrusion

• Shallow incisal guidance lesser

posterior teeth separation
• Hence incisal guide angle should be as flat (close to zero
degree) as esthetics and phonetics will permit.

• It should never be greater then the condylar guidance.

 PLANE OF OCCLUSION OR OCCLUSAL PLANE

• 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
surfaces (GPT -9)

• Established anteriorly by height of lower canine and posteriorly by height of

retromolar pad.

• Parallel to camper’s line & tilting of the plane >10 o is not advisable
• If occlusal plane is greater than 0 degree the actual influence
of the condylar guidance is less.
 COMPENSATING CURVE
• The anteroposterior curving (in the median plane) and the mediolateral curving
(in the frontal plane) within the alignment of the occluding surfaces and incisal
edges of artificial teeth that is used to develop balanced occlusion.

• Determined by inclination of posterior teeth and their vertical relationship to

occlusal plane.

• 2 types of curves

1). Anterioposterior compensating curve

2). Lateral compensating curves

 CURVE OF SPEE

• The anatomic curve established by the occlusal alignment of the teeth, as

projected onto the median plane, beginning with the cusp tip of the mandibular
canine and following the buccal cusp tips of the premolar and molar teeth,
continuing through the anterior border of the mandibular ramus, ending with the
anterior most portion of the mandibular condyle. ( GPT – 9 )

• Significance - When the patient moves his mandible forward, the posterior teeth
set on this curve will continue to remain in contact thus avoiding disocclusion.
• Posterior teeth separation when the curve
of spee not incorporated

• Incorporating the curve spee will provide

posterior tooth contact during protrusion
 LATERAL COMPENSATING CURVES

CURVEOF WILSON

• This is a curve that is convex downwards.The lower teeth are inclined lingually
to give prominence to buccal cusp and bringing them to heavy occlusal contact
with the upper buccal cusp during lateral movements on working side.

• It is used to arrange the molars.

• It is named after George Wilson

 REVERSE CURVE OR ANTI MONSOON CURVE

• A curve of occlusion that is convex upwards .

• It is followed when the maxillary 1st premolars are arranged to prevent their
interference to lateral movements.
 CUSPAL ANGULATION

• It is an important factor that modify the effect of plane of occlusion & the
compensating curves.

• Mesiodistal cusps are reduced to prevent the locking of cusps.

• In shallow bite cases the cuspal angle should be reduced to balance the incisal
guidance.

• In Deep bite cases with steep incisal guidance , the jaw separation is more
during protrusion .Teeth with high cuspal inclines are required for these cases
• Cuspal angle has effect on occlusal plane and the
compensating curves.

• The closer a tooth is located to one or other guidance,the

more influence the guidance has on its angle of inclination.
 MONOPLANE OCCLUSION

• An occlusal arrangement wherein the posterior teeth have masticatory surfaces that
lack any cuspal height (GPT – 9).

• According to this multiple uniform contacts in centric relation was sufficient to avoid
harmful lateral forces, non anatomic teeth were preferred .
 PRINCIPLES
• Cuspless teeth (0°) on a flat plane with 1.5-2.0 mm overjet

• No cusp to fossa relationship

• No anterior contacts in centric position

• No overbite (It would cause tilting)

• Overjet of 2 mm is used to create an illusion of overbite

• Excursions - may or may not contact on balancing sides

• Anterior teeth make contact in excursions

 INDICATIONS
• Difficulty in obtaining repeatable centric records (muscle
incoordination)

• Skeletal malocclusion (Class II, III)

• Severe residual ridge resorption - Reduces horizontal forces

DISADVANTAGES
• Poor appearance (Non anatomic teeth)

• Reported less chewing efficiency

• Unstable dentures in patients with steep condylar guidance

 NEUTROCENTRIC CONCEPT

• Advocated by Devan in 1953

• Objectives : 1) Neutralization of inclines 2) Centralization of occlusal forces

acting on denture foundation

• A denture is stable when forces of occlusion do not alter substancially the

positional relationship of artificial teeth to the underlying bone.

• Not to just discard cusps without neutralizing other factors of articulation

 FACTORS INVOLVED

• Position – Positioning posterior teeth in as central a position in

reference to the foundation as tongue function will allow

• Proportion – A 40% reduction in tooth width

• Pitch – Inclination/Tilt was flat following occlusal plane parallel

to the underlying ridges and midway between them.

• Form – Devoid of projecting cusps

• Number – Reduction of posterior teeth from 8 to 6 teeth

 LINGUALISED OCCLUSION

• First proposed by Alfred Gysi in 1927.

• 1941 Payne desired a modification of anatomic teeth.

• Involves the use of a large upper palatal cusp against a wide lower central fossa.

• Buccal cusps of upper & lower teeth do not contact each other.
 PRINCIPLES

• Anatomic posterior teeth in maxillary denture

• Non anatomic or semi anatomic in mandibular denture

• Selective grinding of mandibular posterior teeth creates slight concavity on the

occlusal surfaces

• Maxillary lingual cusp contacting mandibular teeth in working, balancing as well as

protrusive movements
Use of mandibular posterior teeth that have
shallow central fossae for lingualised
occlusion

The buccal tubercles of posterior

maxillary teeth are aligned at a level
approximately 1mm above occlusal
plane
 INDICATIONS

• High priority on esthetics but the nonanatomic occlusal scheme is indicated

• Sever resorption

• Class 2 jaw relationship

• Displaceable supporting tissue

• Complete denture opposed by a removable partial denture

• When moe favourable stress distribution desired in parafunctional habits

 ADVANTAGES

• Both anatomic and non anatomic forms are retained

• Cusp form is more natural in appearance compared to non anatomic tooth

form

• Good penetration of food bolus is possible

• Bilateral mechanical balanced occlusion is readily obtained for a region

around centric relation.

• Vertical forces are centarlized on mandibular teeth

 DISADVANTAGES

• More challenging than Monoplane

• No scientific data to show improved stability

• Cannot be applied to difficult situation – Muscular incoordination,Severe

ridge resorption,Mal - related jaws.
 ERRORS OF OCCLUSION IN COMPLETE
DENTURES
• Errors in occlusion might not be apparent unless specific procedures are used to
test them.

• Because of tissue displaceability, it is considered that the dentures will settle into
the tissues and small errors in occlusion will correct themselves.

• If this is true, it is done at the expense of the health of soft tissues and eventually
at the expense of bone because bone is a more plastic tissue than mucosa.

• Bone, in time, will change to relieve soft tissues of excess pressure.

• Thus failure to correct occlusion before the patient wears the dentures can cause
destruction of the residual alveolar ridges.
 Errors in occlusion can result from a number of factors :

• A change in the state of the temporomandibular joints (TMJs)

• Inaccurate maxillomandibular relation records

• Errors in the transfer of maxillomandibular relation records to the articulator

• Ill-fitting temporary record bases

• Change of the vertical dimension of occlusion on the articulator

• Incorrect arrangement of the posterior teeth

• Failure to close the flasks completely during processing, or use of too much pressure in closing
the flasks

• Occlusion errors may be the result of unavoidable changes in the denture base material.
 CONCLUSION

• The basic principles of occlusion must be understood by every prosthodontist and

intelligently applied regardless of what system of occlusion is used.

• Irresponsible selection and use of teeth in complete denture construction can

produce forces that will compromise the stability of the bases, traumatize the oral
supporting structures and accelerate the rate of bone resorption.

• So the various theories and concepts of occlusion should be considered for

individual cases and the most suitable occlusal scheme should be provided, which
meet the need of the patient, and which is in harmony with patients’ orofacial
strucures.
 REFERENCES

• Winkler, Sheldon.Diagnosis and Treatment planning in Complete

dentures Essentials of Complete Denture Prosthodontics. St. Louis: Mosby Year
Book, 1988:217-260

• Zarb, George A., Charles L. Bolender, and Steven E. Eckert. Speech consideration

with Complete dentures.Prosthodontic Treatment for Edentulous Patients:
Complete Dentures and Implant-Supported Prostheses. St. Louis: Mosby, 2004:6-
22

• Fenn, Liddelow, and Gimsons.Applied anatomy.Clinical dental prosthetics.London ;

Boston : Wright, 1989:224-246

• Rahn, Arthur O, John R. Ivanhoe, Kevin D. Plummer, and Charles M.

Heartwell. Textbook of Complete Dentures. Shelton, Conn: People's Medical
Publishing House, 2009:142-158
• John J Sharry. Complete denture prosthodontics. New York, Blakiston Division,
McGraw-Hill.1968

• Harold R. Ortman. The role of occlusion in preservation and prevention in

complete denture prosthodontics.J Prosthet Dent.1971;25:121-137

• Philip M. Jones. The monoplane occlusion for complete

dentures.JADA.1972;85:95-100

• Joseph S. Landa. Biologic significance of balanced occlusion and balanced

articulation in complete denture service.J Am Dent Assoc.1962;65:491-495

• B.R. Lang. Complete denture occlusion. Dent Clin N Am .2004;48:641–665

• Peter J. Mack . A discussion of some factors of relevance to the occlusion of
complete dentures. Australian Dental Journal.1989;34:122-128

• Clare w. Sager. Posterior occlusion in complete denture construction.J Prosthet

Dent.1957;7:457-464

• Stanley G. Standard. Establishing plane of occlusion in complete denture

construction.J Am Dent Assoc.1957;54:845-847

• Sears VH: Principles and Techniques for Complete Denture Construction. St Louis,
CV Mosby, 1949:122-123

• V Rangarajan. Concepts of occlusion in prosthodontics: A literature review, part

I.Journal of Indian Prosthodontic society.2016;16:8-14.