Philosophies of Occlusion for Implants

Implant Occlusion
Single Crown Fixed Partial Dentures Full arch prostheses (screw retained) Overdentures

Many Philosophies of Occlusion No definitive scientific studies to prove: one type of tooth form one type of occlusal scheme to be clearly preferred by patients to be more efficient than another

Tooth Forms

Occlusal Schemes

Anatomic Non Anatomic

Canine Guidance (Mutually Protected) Group Function Lingualized (Balanced) Monoplane

Denture Tooth Forms and Occlusal Forms

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Occlusion & Implants

Evidence Based Review

Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

No Preferred occlusal scheme Clinicians advocate axial loading of implants, but no evidence, at present, demonstrating benefits

Occlusion & Implants

Evidence Based Review

Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

No evidence at present that progressive occlusal loading of implant is beneficial occlusal overload is detrimental to implants

Absence of Scientific Evidence

Not proof against!

Follow best available clinical principles Do not build in heavy non-axial loading or overloading

Clinical Principles for Occlusion

Based on Clinical Experience Not Scientific Evidence

General Principles
Improve denture stability or axial loading of single teeth

Centric contacts on flat surfaces, not inclines

General Principles
Center over lower ridge

Posterior Overjet to Avoid Cheek Biting

1-2 mm

1-2 mm Nonanatomic setup

Anatomic setup

General Principles
Improve denture stability or single tooth loading

Center occlusal contacts over ridge

Simultaneous posterior contacts in centric

General Occlusal Principles

For overdentures or full arch prostheses opposing a CD: No anterior contacts in centric

Minimizes anterior resorption

Grazing anterior contacts in excursions

Incising

Occlusal Schemes

Canine Guidance Group Function Lingualized Monoplane

Single Teeth FPDs Dentures

Crowns or FPDs
Either canine guidance or group function works - no preference Use what the patient has Use what would be easiest

Overdentures or Full Arch Prostheses

ALL Occlusal Schemes Devised to Maximize Denture Stability

Lingualized Occlusion
Maxillary cusped tooth Mandibular cuspless or shallow cusped tooth Maxillary lingual cusp balances like a mortar in a pestle

Lingualized Occlusion
Lingual cusp contacts opposing central fossae
Mandibular cuspal inclines are shallow (0, 10) Less lateral displacement

Lingualized Occlusion
How Stability is Improved

Simultaneous bilateral anterior and posterior in all excursions

Tilting forces theoretically neutralized

Enter Bolus Exit Balance?

Many patients chew bilaterally

Biting forces maximum close to intercuspation (where balance most effective)

Non-functional aspects (swallow)

Point of Loading Affects Stability

Browning, 1986

Loaded centrally, M, D, L, B
M

B caused unseating
B

Central loading better than distal loading

D

Lingualized Contacts

Working Side

Only buccal cusp contact is inner incline of mandibular teeth (balancing)

Balancing Side

IIF Rule

IIF you have contacts on the Inner Inclines of Functional cusps they are balancing contacts
B L B Working Contacts

L Inner Inclines (inside of cusp) Outer Inclines(outside of cusp)

Test!

Rules for Balancing Contacts

Balancing contacts should be lines, not points Balancing contacts should never be heavier than working contacts

Balanced Occlusion (Lingualized)

Indirect evidence that balanced occlusion may: reduce ridge resorption (Maeda & Wood , 1989) allow for increased functional forces in excursions (Miralles et al, 1989)

Lingualized Cusp Angles

Always use steep cusped maxillary tooth (33) When condylar guidance is steeper use more cusp angle in mandible (10)

Lingualized Occlusion

Balance cannot be set without an articulator Clinical remount on an articulator - fewer adjustments

Condylar Inclination

Posterior teeth separate as working condyle moves forward (and downward) Anterior teeth contact Closer to condyle, more separation More anterior separation of Premolars if steep anterior guidance

Effect of Mandible Moving Downward During Excursions

Maintaining Balancing Contacts

Change occlusal plane angle Increase compensating curves Increase cusp angles or effective cusp angles

Checking for Balance

Feels Smooooooth in excursions

- Fingers on max. canines - Check on articulator

Assess Contacts:
Centric Stops Excursions

Improving Denture Occlusion

Most important cusp - maxillary lingual Mandibular buccal cusps more lateral - more tipping

When Not to Balance

Difficulty in obtaining repeatable centric record

incoordination, muscle splinting

Dramatic malocclusions Severe ridge resorption lateral forces displace the denture Implants tend to negate this factor

Monoplane Occlusion
Cuspless teeth set on a flat plane with 1.5- 2 mm overjet No cusp to fossa relationship No anterior contacts present in centric position No overbite

Monoplane Occlusion
How Stability is Improved

Elimination of cusps

Lateral forces reduced, improving stability Simplifies denture tooth arrangement

Monoplane Occlusion
With Condylar Inclination

Monoplane Occlusion
With Condylar Inclination

Ensure Teeth Set Over Ridge

Minimize tilting/tipping Maximize stability Minimize contacts on buccal of flat cusps

Monoplane Occlusion

Functional, but unesthetic Not balanced - flat Zero degree teeth can be balanced if condylar inclinations are shallow

Monoplane Occlussion - When?

Jaw size discrepancies, malocclusions

cross-bite, Cl II, III Minimal ridge reduces horizontal forces implants help Uncoordinated jaw movements

Summary

No definitive studies to show one type of occlusion is best Follow established clinical principles Assess each case - adapt to clinical situation Continue to read the literature