Concept of Occlusion

Concepts of Occlusion Concepts of Occlusion

Vicki C Petropoulos DMD, MSVicki C Petropoulos DMD, MS

Associate Professor of Preventive and Restorative Associate Professor of Preventive and Restorative SciencesSciences

University of PennsylvaniaUniversity of Pennsylvania

School of Dental MedicineSchool of Dental Medicine

AcknowlegementsAcknowlegements

��Many of these images are courtesy of theMany of these images are courtesy of the

American College of American College of ProsthodontistsProsthodontists, UCLA , UCLA

Complete Dentures Educational Complete Dentures Educational

Curriculum CD, 2004.Curriculum CD, 2004.

Learning GoalsLearning Goals

�� To understand differences between To understand differences between natural dentition and complete denture natural dentition and complete denture occlusionocclusion

�� To understand the goals of complete To understand the goals of complete denture occlusion and why balance is denture occlusion and why balance is neededneeded

�� To understand the four types of denture To understand the four types of denture occlusionocclusion

�� To understand HanauTo understand Hanau’’s s QuintQuint

Learning GoalsLearning Goals

�� To understand the different types of To understand the different types of

posterior tooth forms, adv. and posterior tooth forms, adv. and disadvdisadv..

Natural dentitionNatural dentition presents presents in a variety of individual in a variety of individual tooth size, shape, form and tooth size, shape, form and alignment, but ideally exhibit alignment, but ideally exhibit certain characteristic certain characteristic occlusion features.occlusion features.

Natural Occlusion

(organic)

•• Bilateral Posterior Centric Bilateral Posterior Centric ContactContact

•• Anterior GuidanceAnterior Guidance

•• Mutually Protective Mutually Protective Scheme of OcclusionScheme of Occlusion

Natural Occlusion

(organic)

Complete denture Complete denture ““dentitiondentition”” also presents in also presents in a variety of forms, but also a variety of forms, but also exhibit certain common exhibit certain common characteristicscharacteristics

Complete Denture

Occlusion

•• Bilateral centric contactsBilateral centric contacts•• Bilateral eccentric contacts Bilateral eccentric contacts

(balance) to provide stability of (balance) to provide stability of the denture bases during functionthe denture bases during function

Complete Denture

Occlusion

•• Because of compromises Because of compromises

inherent in restoring the inherent in restoring the

edentulous arch, complete edentulous arch, complete

denture tooth forms and denture tooth forms and

arrangements (i.e. occlusion), arrangements (i.e. occlusion),

should be designed to provide should be designed to provide

function and esthetics while function and esthetics while

minimizing denture base minimizing denture base

tipping (lateral) forces tipping (lateral) forces

Complete Denture Occlusion

Fundamental differences of natural and Fundamental differences of natural and complete denture occlusioncomplete denture occlusion

1.1. Sensory feedback mechanismSensory feedback mechanism

2.2. Derivation of :Derivation of :

•• retentionretention

•• stabilitystability

•• supportsupport

3.3. Reaction of supporting structures to Reaction of supporting structures to masticatorymasticatoryforcesforces

1. Sensory Feedback1. Sensory Feedback

Precision of feedback is significantly compromised Precision of feedback is significantly compromised

following loss of teeth and associated structures following loss of teeth and associated structures

(periodontal ligament)(periodontal ligament)

For natural dentition, retention, stability, and support are derFor natural dentition, retention, stability, and support are derived ived

through the through the periodontiumperiodontium which provides; which provides;

�� Sensory feedback mechanismSensory feedback mechanism

�� Difference in reaction of supporting structures to Difference in reaction of supporting structures to masticatorymasticatory forcesforces

�� Differences in load transfer mechanism and physiologyDifferences in load transfer mechanism and physiology

2. Derivation of retention, stability and 2. Derivation of retention, stability and

support for support for natural occlusionnatural occlusion

2. Derivation of retention, stability and support for 2. Derivation of retention, stability and support for complete complete denture occlusiondenture occlusion

Complete dentures receive their retention, stability, and

support from the soft tissues overlying residual bone

(ridges, buccal shelf, palate, etc.).

Denture Bearing Surface

•• RetentionRetention

�� Resistance to dislodgment forces in a vertical Resistance to dislodgment forces in a vertical

direction away from the bearing surfacedirection away from the bearing surface

Denture Bearing SurfaceDenture Bearing Surface

•• StabilityStability

�� Resistance to laterally oriented dislodgment forcesResistance to laterally oriented dislodgment forces

Denture Bearing SurfaceDenture Bearing Surface

•• SupportSupport�� Factors of the Bearing Surface which resist forces Factors of the Bearing Surface which resist forces

in a vertical direction towards the bearing surfacein a vertical direction towards the bearing surface

Natural occlusion

Physiologic levels of tension results in

alveolar bone apposition (such as that

transmitted by loading the periodontal

ligament through natural dentition)

Complete denture occlusion

Non-physiologic compression as may

occur under denture bases results in

further residual ridge resorption (RRR)

3. Reaction of supporting structures

•• Mobile bases on mucosaMobile bases on mucosa

•• Teeth move as an unitTeeth move as an unit

•• Malocclusion affects entire base Malocclusion affects entire base immediatelyimmediately

•• NonNon--vertical forces affect all vertical forces affect all teeth and are traumaticteeth and are traumatic

•• Incising affects all teeth attached Incising affects all teeth attached to baseto base

•• Bilateral balance is often desired Bilateral balance is often desired for base stabilityfor base stability

•• Decreased tactile senseDecreased tactile sense

•• Retained in PDLRetained in PDL

•• Units move independentlyUnits move independently

•• Malocclusion effects not Malocclusion effects not immediateimmediate

•• NonNon--vertical forces affect only vertical forces affect only teeth involved and usually teeth involved and usually well toleratedwell tolerated

•• Incising doesnIncising doesn’’t affect t affect posteriorsposteriors

•• Bilateral balance is rareBilateral balance is rare

•• Tactile sensitivityTactile sensitivity

Natural DentitionNatural Dentition Denture Denture ““DentitionDentition””

Summary

SummarySummary•• Goal of complete denture occlusion is preservation of Goal of complete denture occlusion is preservation of

structure and restoration of function and estheticsstructure and restoration of function and esthetics

•• Consequences of tooth loss create anatomic changes Consequences of tooth loss create anatomic changes which result in differences in derivation of retention, which result in differences in derivation of retention, stability and support between natural and complete denture stability and support between natural and complete denture teethteeth

•• The differences in the design of natural and complete The differences in the design of natural and complete denture occlusion are the consequence of differences in denture occlusion are the consequence of differences in the derivation of retention, stability and support.the derivation of retention, stability and support.

•• Complete denture form and tooth placement is Complete denture form and tooth placement is biomechanical in naturebiomechanical in nature

The Edentulous StateThe Edentulous State

�� Residual ridge reductionResidual ridge reduction

�� Compromised reflex adaptabilityCompromised reflex adaptability

�� Possible increase in parafunctional Possible increase in parafunctional

movementsmovements

�� Increased risk of maladaptive dentureIncreased risk of maladaptive denture--

wearing experiencewearing experience

OcclusionOcclusion

�� Denture occlusion is not just about the Denture occlusion is not just about the

occlusal plane.occlusal plane.

�� The setting of teeth includes orientation of The setting of teeth includes orientation of

the plane, shaping and positioning of the the plane, shaping and positioning of the

arch, inclinations and rotations for arch, inclinations and rotations for

esthetics, and the mechanics for obtaining esthetics, and the mechanics for obtaining

proper tooth inclination.proper tooth inclination.

OcclusionOcclusion

�� The dentist has the power to establish all The dentist has the power to establish all

factors of occlusion in a complete denture factors of occlusion in a complete denture

except the condylar path.except the condylar path.

Chewing with DenturesChewing with Dentures

�� During mastication the teeth make contact During mastication the teeth make contact

on the chewing side and the nonon the chewing side and the non--chewing chewing

side.side.

�� Tissue resiliency and denture movement Tissue resiliency and denture movement

during function account for the higher during function account for the higher

frequency of nonfrequency of non--chewing contactschewing contacts

Types of Denture OcclusionTypes of Denture Occlusion

�� BalancedBalanced

�� The preferred occlusal schemeThe preferred occlusal scheme

��Monoplane (Monoplane (NeutrocentricNeutrocentric))

��Monoplane with balanceMonoplane with balance

�� Lingualized occlusionLingualized occlusion

Is Is ““BalanceBalance”” necessary?necessary?

Balanced Balanced

occlusion occlusion

NonNon--balanced balanced

occlusionocclusionvsvs

Protrusive positionProtrusive position Protrusive positionProtrusive position

Is Is ““BalanceBalance”” Necessary?Necessary?

““Bolus inBolus in””

““Balance outBalance out””

To Balance or Not to BalanceTo Balance or Not to Balance

�� But do we need balanced occlusion?But do we need balanced occlusion?

Brien LangBrien Lang

�� ““There is little scientific support to select There is little scientific support to select

an an occlusalocclusal concept, however a report by concept, however a report by

Brewer (1963) found in a 24 hour test Brewer (1963) found in a 24 hour test

period that teeth contact during chewing period that teeth contact during chewing

(10 (10 minsmins) were much less than tooth ) were much less than tooth

contacts during non chewing (2contacts during non chewing (2--4 hours). 4 hours).

This suggests a need for balanced This suggests a need for balanced

articulation especially during articulation especially during parafunctionparafunction””

�� Balanced denture teeth provide denture Balanced denture teeth provide denture

stabilization during stabilization during parafunctionalparafunctional jaw jaw

movements by ensuring even pressure in movements by ensuring even pressure in

all parts of the arch.all parts of the arch.

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

��We spend 2We spend 2--4 hours/day in parafunction 4 hours/day in parafunction

and only 10 minutes/day in functionand only 10 minutes/day in function

Objective of Balanced Objective of Balanced

OcclusionOcclusion�� To create stability of the denture bases To create stability of the denture bases during eccentric movementduring eccentric movement

�� Instability of the bases leads to:Instability of the bases leads to:

�� Irritation of the hard and soft tissuesIrritation of the hard and soft tissues

�� Excessive denture movementExcessive denture movement

�� Unequal distribution of forcesUnequal distribution of forces

�� Potential for more rapid loss of osseous Potential for more rapid loss of osseous supportsupport

When do we Achieve Balanced When do we Achieve Balanced

Occlusion?Occlusion?

�� At the final try in, we will verify the Jaw At the final try in, we will verify the Jaw

Relationship RecordRelationship Record

�� At that point we will do a protrusive record At that point we will do a protrusive record

to set the condylar inclinationto set the condylar inclination

�� Balance will be achieved in the labBalance will be achieved in the lab

Types of Denture TeethTypes of Denture Teeth

�� Artificial teeth can beArtificial teeth can be

�� Anatomic (30 degrees or greater)Anatomic (30 degrees or greater)

�� SemiSemi--anatomic (30 to 0 degrees)anatomic (30 to 0 degrees)

�� Nonanatomic (0 degrees)Nonanatomic (0 degrees)

AdvantagesAdvantages

�� AnatomicAnatomic

�� More estheticMore esthetic

�� Supposed higher Supposed higher

chewing efficiencychewing efficiency

�� Ease in achieving Ease in achieving

balanced occlusionbalanced occlusion

�� NonanatomicNonanatomic

�� Easier to setEasier to set

�� Kinder to edentulous Kinder to edentulous

ridgesridges

DisadvantagesDisadvantages

�� AnatomicAnatomic

�� More time consuming More time consuming

to setto set

�� May cause more/faster May cause more/faster

bone resorptionbone resorption

�� NonanatomicNonanatomic

�� UnaestheticUnaesthetic

�� Supposed to decrease Supposed to decrease

chewing efficiencychewing efficiency

BalanceBalance

�� Balance can be achieved with anatomic Balance can be achieved with anatomic

OR monoplane teeth.OR monoplane teeth.

��With anatomic teeth it is generated by the With anatomic teeth it is generated by the

tooth arrangementtooth arrangement

��With monoplane teeth it is generated by a With monoplane teeth it is generated by a

balancing rampbalancing ramp

Verify contacts in working excursionsVerify contacts in working excursions

Lack of working side contacts may be the result of:Lack of working side contacts may be the result of:•• Poor buccal centricPoor buccal centric

•• Insufficient curve of WilsonInsufficient curve of Wilson

•• Working interferences in the 2Working interferences in the 2ndnd molar regionmolar region

•• Balancing interferences on the opposite sideBalancing interferences on the opposite side

**Check these in the Check these in the order citedorder cited..

Verify contacts during balancing excursionVerify contacts during balancing excursion

Lack of balancing side contacts may be the result of:Lack of balancing side contacts may be the result of:•• Poor lingual centricPoor lingual centric

•• Working interferences on the opposite side, particularly in the Working interferences on the opposite side, particularly in the

22ndnd molar regionmolar region

BalancingBalancing ProtrusiveProtrusive

WorkingWorking

�� All things being considered, the most All things being considered, the most

successful denture wearers are usually successful denture wearers are usually

those who have a good patient/provider those who have a good patient/provider

relationship and a good, positive outlook relationship and a good, positive outlook

and good and good neuroneuro--musculature control.musculature control.

Always RememberAlways Remember……

Dentures are not a replacement for teethDentures are not a replacement for teeth……

Dentures are a replacement for no teeth.Dentures are a replacement for no teeth.

OcclusionOcclusion

�� The static relationship between the The static relationship between the

incising or masticating surfaces of the incising or masticating surfaces of the

maxillary and mandibular teeth or tooth maxillary and mandibular teeth or tooth

analogsanalogs

Five Determinants of Five Determinants of

Mandibular MovementsMandibular Movements

�� Right TMJRight TMJ

�� Left TMJLeft TMJ

�� TeethTeeth

�� Tissues/nerve impulses (proprioception)Tissues/nerve impulses (proprioception)

�� CNSCNS

Planes of ReferencePlanes of Reference

Mandibular MovementMandibular Movement

�� RotationRotation

�� Around the terminal hinge axisAround the terminal hinge axis

�� TranslationTranslation

�� Condyle glides along the posterior incline of Condyle glides along the posterior incline of

the tuberclethe tubercle

Mandibular OpeningMandibular Opening

Types of MovementTypes of Movement

�� BorderBorder

�� FunctionalFunctional

�� Speaking (phonetics)Speaking (phonetics)

�� Chewing (mastication)Chewing (mastication)

�� Swallowing (deglutition)Swallowing (deglutition)

�� ParafunctionalParafunctional

�� BruxingBruxing

�� clenchingclenching

Denture ForcesDenture Forces

�� The amount of force generated with a The amount of force generated with a

denture vs. natural occlusion is denture vs. natural occlusion is

approximately only 16 %!!!!!approximately only 16 %!!!!!

Posterior Determinants of Posterior Determinants of

OcclusionOcclusion

�� Shape of articular eminenceShape of articular eminence

��Medial walls of glenoid fossaMedial walls of glenoid fossa

�� Shape of condylesShape of condyles

Anterior Determinants of OcclusionAnterior Determinants of Occlusion

�� Vertical overlap of anterior teethVertical overlap of anterior teeth

�� Horizontal overlap of anterior teethHorizontal overlap of anterior teeth

�� Lingual concavities of maxillary anterior Lingual concavities of maxillary anterior

teethteeth

Anterior Determinants of OcclusionAnterior Determinants of Occlusion

Role of Anterior TeethRole of Anterior Teeth

�� In a normal occlusal relationship the In a normal occlusal relationship the

maxillary and mandibular canines contact maxillary and mandibular canines contact

during lateral movements.during lateral movements.

Dynamic Occlusal ContactsDynamic Occlusal Contacts

�� Any movement of the mandible from the Any movement of the mandible from the centric occlusion position that results in centric occlusion position that results in tooth contact is termed tooth contact is termed eccentriceccentric..

�� There are three basic eccentric There are three basic eccentric movementsmovements

�� ProtrusiveProtrusive

�� LaterotrusiveLaterotrusive

�� RetrusiveRetrusive

ProtrusiveProtrusive

�� The mandible moves forward from the The mandible moves forward from the

centric occlusion positioncentric occlusion position

�� The predominant protrusive contact occurs The predominant protrusive contact occurs

between the maxillary and mandibular between the maxillary and mandibular

anterior teeth.anterior teeth.

ProtrusiveProtrusive

Laterotrusive (Working)Laterotrusive (Working)

��Most function occurs on the working side Most function occurs on the working side (lateral movement) the side to which the (lateral movement) the side to which the mandible is shifted.mandible is shifted.

��Working contacts and crossWorking contacts and cross--tooth contacts tooth contacts occur on the working side.occur on the working side.

��Working contacts occur between the inner Working contacts occur between the inner inclines of max buccal and outer inclines inclines of max buccal and outer inclines of mand buccal.of mand buccal.

Mediotrusive (NonMediotrusive (Non--working)working)

�� Formerly balancing contacts, but now the Formerly balancing contacts, but now the

teeth disclude.teeth disclude.

�� Potential sites of contact on the inner Potential sites of contact on the inner

inclines of maxillary lingual and inclines of maxillary lingual and

mandibular buccal cusps.mandibular buccal cusps.

��Mediotrusive contacts are interferences.Mediotrusive contacts are interferences.

LaterotrusiveLaterotrusive

RetrusiveRetrusive

HistoryHistory

�� Bilateral Balanced OcclusionBilateral Balanced Occlusion

�� Based on theories related to denturesBased on theories related to dentures

�� Became apparent these principles did not Became apparent these principles did not

apply to fixed prosthodonticsapply to fixed prosthodontics

�� Resulted in premature wear, mobile teeth and Resulted in premature wear, mobile teeth and

gingival gingival cleftingclefting

�� The preferred occlusal scheme for denturesThe preferred occlusal scheme for dentures

Unilateral Balanced OcclusionUnilateral Balanced Occlusion

�� Group FunctionGroup Function

�� Earlier rehabs were modified by eliminating Earlier rehabs were modified by eliminating

balancing contactsbalancing contacts

�� Led to the functionally generated path or Led to the functionally generated path or ““wax wax

chewchew--inin”” techniquetechnique

�� Importance of incisal guidance discovered Importance of incisal guidance discovered

and incorporated into the occlusal schemeand incorporated into the occlusal scheme

�� Results in tipping forces on a dentureResults in tipping forces on a denture

Group FunctionGroup Function

�� Based on the philosophy that the more Based on the philosophy that the more

teeth to share the load the betterteeth to share the load the better

�� Incisal guidance established firstIncisal guidance established first

�� Spreads working side contact over 3 or more Spreads working side contact over 3 or more

teeth in each archteeth in each arch

�� These teeth should be adjacent to each otherThese teeth should be adjacent to each other

�� Involves buccal cusps onlyInvolves buccal cusps only

Group FunctionGroup Function

Centric RelationCentric Relation

�� The maxillomandibular relationship in The maxillomandibular relationship in which the condyles articulate with the which the condyles articulate with the thinnest avascular portion of their thinnest avascular portion of their respective disks with the complex in the respective disks with the complex in the anterior superior position against the anterior superior position against the shapes of the articular eminence. shapes of the articular eminence.

�� This position is independent of tooth This position is independent of tooth contactcontact

Centric RelationCentric Relation

�� The most important factor to remember is The most important factor to remember is

that it is REPEATABLE!!!that it is REPEATABLE!!!

Optimum Functional OcclusionOptimum Functional Occlusion

�� CRCR------for purposes of this lecture it is the for purposes of this lecture it is the

most superoanterior position.most superoanterior position.

�� CR=CO with even and simultaneous CR=CO with even and simultaneous

contact of all posterior teethcontact of all posterior teeth

REVIEWREVIEW

�� Mobile bases on mucosaMobile bases on mucosa

�� Teeth move as an unitTeeth move as an unit

�� Malocclusion affects entire base Malocclusion affects entire base

immediatelyimmediately

�� NonNon--vertical forces affect all teeth vertical forces affect all teeth

and is traumaticand is traumatic

�� Incising affects all teeth attached Incising affects all teeth attached

to baseto base

�� Bilateral balance is often desired Bilateral balance is often desired

for base stabilityfor base stability

�� Decreased tactile senseDecreased tactile sense

�� Retained in PDLRetained in PDL

�� Units move independentlyUnits move independently

�� Malocclusion effects not Malocclusion effects not

immediateimmediate

�� NonNon--vertical forces affect only vertical forces affect only

teeth involved and usually well teeth involved and usually well

toleratedtolerated

�� Incising doesnIncising doesn’’t affect t affect

posteriorsposteriors

�� Bilateral balance is rareBilateral balance is rare

�� Tactile sensitivityTactile sensitivity

Natural DentitionNatural Dentition Denture Denture ““DentitionDentition””

Differences between Natural and Differences between Natural and

Complete Denture OcclusionComplete Denture Occlusion

Goals of Complete Denture OcclusionGoals of Complete Denture Occlusion

�� Minimize trauma to the Minimize trauma to the supporting structuressupporting structures

�� Preserve remaining Preserve remaining structuresstructures

�� Enhance stability of the Enhance stability of the denturesdentures

�� Facilitate esthetics and Facilitate esthetics and speechspeech

�� Restore mastication Restore mastication efficiency to a reasonable efficiency to a reasonable levellevel

Types of Complete Denture OcclusionTypes of Complete Denture Occlusion

�� Bilateral balanceBilateral balance

�� NeutrocentricNeutrocentric

We prefer bilateral balance because this type of We prefer bilateral balance because this type of occlusalocclusal

arrangement limits tipping of the dentures during arrangement limits tipping of the dentures during

parafunctionalparafunctional movements,movements,

Bilateral Balanced Denture OcclusionBilateral Balanced Denture Occlusion

The stable simultaneous contact of The stable simultaneous contact of

opposing upper and lower teeth in opposing upper and lower teeth in

centric relation position with a smooth centric relation position with a smooth

bilateral gliding contact to any eccentric bilateral gliding contact to any eccentric

position within the normal range of position within the normal range of

mandibular function, developed to mandibular function, developed to

lessen or limit tipping or rotation of the lessen or limit tipping or rotation of the

denture bases in relation to the denture bases in relation to the

supporting structures.supporting structures.

Bilateral Balanced Denture OcclusionBilateral Balanced Denture Occlusion

�� Traditionally bilateral balance was achieved Traditionally bilateral balance was achieved

with anatomic posterior denture teeth. with anatomic posterior denture teeth.

However, it can be achieved with However, it can be achieved with

nonanatomicnonanatomic teeth using balancing ramps or teeth using balancing ramps or

by manipulating the compensating curve.by manipulating the compensating curve.

Bilateral Balanced Denture Occlusion with Bilateral Balanced Denture Occlusion with

Anatomic Posterior Denture TeethAnatomic Posterior Denture Teeth

�� Bilateral Posterior Bilateral Posterior Centric ContactCentric Contact

�� Centralized ForcesCentralized Forces

�� ““BalancedBalanced”” Occlusion Occlusion to minimize tippingto minimize tipping

ProtrusiveProtrusive BalancingBalancing WorkingWorking

CentricCentric

Monoplane with Balancing RampsMonoplane with Balancing Ramps

WorkingWorking BalancingBalancing

Bilateral balanced occlusion can also be Bilateral balanced occlusion can also be

obtained with obtained with nonanatomicnonanatomic posterior teeth posterior teeth

if balancing ramps are employed. In all if balancing ramps are employed. In all

lateral excursions you should observe at lateral excursions you should observe at

least three points of contact bilaterally if least three points of contact bilaterally if

bilateral balance is to be achieved. bilateral balance is to be achieved.

ProtrusiveProtrusive

Lingualized Opposing Monoplane with Lingualized Opposing Monoplane with

Balancing RampsBalancing Ramps

�� A similar concept is used when A similar concept is used when lingualizedlingualized maxillary maxillary teeth oppose teeth oppose nonanatomicnonanatomic teeth in the mandible. In teeth in the mandible. In all lateral excursions you should observe at least all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral three points of contact bilaterally to maintain bilateral balance. balance.

WorkingWorking BalancingBalancing

Monoplane Occlusion Monoplane Occlusion

((NeutrocentricNeutrocentric Concept)Concept)

This concept of occlusion assumes that the anteriorThis concept of occlusion assumes that the anterior--posterior plane posterior plane

of occlusion should be parallel to the denture foundation area aof occlusion should be parallel to the denture foundation area and nd

not dictated by condylar inclination.not dictated by condylar inclination.

The plane of occlusion is completely flat and level. There is nThe plane of occlusion is completely flat and level. There is no o

curve of Wilson or Curve of Spee (compensating curve) curve of Wilson or Curve of Spee (compensating curve)

incorporated into the set up.incorporated into the set up.

There is no vertical overlap of the anterior teeth.There is no vertical overlap of the anterior teeth.

When using this concept of occlusion the patient is instructed nWhen using this concept of occlusion the patient is instructed not to ot to

incise the bolus. With this tooth arrangement incise the bolus. With this tooth arrangement DeVanDeVan noted that noted that

““the patient will become a chopper, not a chewer or a grinder.the patient will become a chopper, not a chewer or a grinder.””

Monoplane OcclusionMonoplane Occlusion

((NeutrocentricNeutrocentric Concept)Concept)

CentricCentricBalancingBalancing

At balancing and protrusive positions there is separation of At balancing and protrusive positions there is separation of

the denture teeth in the posterior regions leading to tipping the denture teeth in the posterior regions leading to tipping

of the dentures. This may be disadvantageous in the of the dentures. This may be disadvantageous in the

patients exhibiting patients exhibiting parafunctionalparafunctional grinding habits grinding habits

HanauHanau’’s s QuintQuint

�� Five Factors Affecting Occlusal BalanceFive Factors Affecting Occlusal Balance

�� Condylar InclinationCondylar Inclination

�� Incisal GuidanceIncisal Guidance

�� Occlusal Plane InclinationOcclusal Plane Inclination

�� Compensating CurveCompensating Curve

�� CuspalCuspal InclinationInclination

HanauHanau’’s s QuintQuint

�� InterInter--relationship of these five factors may be relationship of these five factors may be

described bydescribed by TheilmanTheilman’’ss FormulaFormula

�� In order to maintain a balanced occlusion:In order to maintain a balanced occlusion:

C=Condylar Inclination

OccPlane

x Incisal Guidance

x Cuspal Inclination x CompCurve

HanauHanau’’s s QuintQuint

�� Of these five factors, the patient presents you with Of these five factors, the patient presents you with

Condylar InclinationCondylar Inclination

�� Occlusal Plane cannot be altered substantially since Occlusal Plane cannot be altered substantially since

functional requirements dictate its position and functional requirements dictate its position and

orientationorientation

�� The remaining three factors can be controlled by The remaining three factors can be controlled by

the dentistthe dentist

C=Condylar Inclination

OccPlane

x Incisal Guidance

x Cuspal Inclination x CompCurve

Factors controlled by the dentistFactors controlled by the dentist

HanauHanau’’s s QuintQuint

�� Of these five factors, the patient presents you with Of these five factors, the patient presents you with

Condylar InclinationCondylar Inclination

�� Occlusal Plane cannot be altered substantially since Occlusal Plane cannot be altered substantially since

functional requirements dictate its position and functional requirements dictate its position and

orientationorientation

�� The remaining three factors can be controlled by The remaining three factors can be controlled by

the dentistthe dentist

C=Condylar Inclination

OccPlane

x Incisal GuidanceIncisal Guidance

x CuspalCuspal InclinationInclinationx CompCurveCompCurve

Factors controlled by the dentistFactors controlled by the dentist

HanauHanau’’s s QuintQuint

�� Within the confines of esthetics and phonetics, Within the confines of esthetics and phonetics,

minimize Incisal Guidance in Complete Dentures to minimize Incisal Guidance in Complete Dentures to

minimize inclined tipping forcesminimize inclined tipping forces

�� Adjust remaining factors to maintain balanceAdjust remaining factors to maintain balance

C=Condylar Inclination

OccPlane

x Incisal GuidanceIncisal Guidance

x CuspalCuspal InclinationInclinationx CompCurveCompCurve

LingualizedLingualized

Monoplane Monoplane –– neutrocentricneutrocentric

Monoplane with balancing rampsMonoplane with balancing ramps

Lingualized opposing monoplaneLingualized opposing monoplane

SemiSemi--anatomicanatomic

Anatomic (30 degree)Anatomic (30 degree)

Posterior Tooth FormsPosterior Tooth Forms

Posterior Tooth FormsPosterior Tooth Forms

Anatomic Tooth FormsAnatomic Tooth Forms

SemiSemi--anatomic Tooth Formsanatomic Tooth Forms

NonanatomicNonanatomic Tooth FormsTooth Forms

General Concepts of Denture OcclusionGeneral Concepts of Denture Occlusion

�� Common FeaturesCommon Features

�� Functional anatomy is the main determinant of denture Functional anatomy is the main determinant of denture tooth positiontooth position

�� Simultaneous, bilateral posterior contact in centric relation Simultaneous, bilateral posterior contact in centric relation (centric occlusion)(centric occlusion)

�� Centralization of centric occlusal forces over the Centralization of centric occlusal forces over the mandibular residual ridgesmandibular residual ridges

•• BuccalBuccal--LinguallyLingually

•• AnteriorAnterior--PosteriorlyPosteriorly

Balance and the Monoplane OcclusionBalance and the Monoplane Occlusion

Minimize vertical overlap within the

dictates of esthetics and phonetics

Balance and Monoplane OcclusionBalance and Monoplane Occlusion

Minimize vertical overlap within the

dictates of esthetics and phonetics

Bilateral BalanceBilateral Balance

�� Anatomic posterior teeth Anatomic posterior teeth vsvs LingualizedLingualized

Bilateral balance with anatomic denture teethBilateral balance with anatomic denture teeth

Balancing sideBalancing side

Lingualized OcclusionLingualized Occlusion

LingualizedLingualizedLingualizedLingualizedLingualizedLingualizedLingualizedLingualizedConventionalConventionalConventionalConventionalConventionalConventionalConventionalConventional

Centric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric Occlusion

Theoretically, there should be Theoretically, there should be

less lateral displacement of the less lateral displacement of the

denture and less lateral forces denture and less lateral forces

during function when using during function when using

lingualizedlingualized posterior denture posterior denture

teeth.teeth.

LingualizedLingualized OcclusionOcclusion

The lingual cusp tips The lingual cusp tips

should be in contact with should be in contact with

the central fossae of the the central fossae of the

opposing mandibular opposing mandibular

teeth. The teeth. The cuspalcuspal

inclines of the mandibular inclines of the mandibular

teeth are relatively flat, teeth are relatively flat,

resulting in potentially resulting in potentially

less lateral forces and less lateral forces and

displacement during displacement during

function. function.

Lingualized OcclusionLingualized Occlusion

Balancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing SideBalancing Side

Working SideWorking SideWorking SideWorking SideWorking SideWorking SideWorking SideWorking Side

Centric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric OcclusionCentric Occlusion

Lingualized OcclusionLingualized Occlusion

�� Good estheticsGood esthetics

�� Freedom of nonFreedom of non--anatomic teethanatomic teeth

�� Potential for bilateral balancePotential for bilateral balance

�� Centralizes vertical forcesCentralizes vertical forces

�� Minimizes tipping forcesMinimizes tipping forces

�� Facilitates bolus penetration Facilitates bolus penetration

(mortar and pestle effect)(mortar and pestle effect)

�� High esthetic demandsHigh esthetic demands

�� Severe mandibular ridge atrophySevere mandibular ridge atrophy

�� Displaceable supporting tissues Displaceable supporting tissues

�� MalocclusionMalocclusion

�� Previous successful denture with Previous successful denture with

Lingualized OcclusionLingualized Occlusion

Indications for useIndications for use AdvantagesAdvantages

Lingualized OcclusionLingualized Occlusion

�� Investigators have Investigators have notnot shown one type of shown one type of

denture occlusion to be : denture occlusion to be :

�� superior in functionsuperior in function

�� safer to oral structuressafer to oral structures

�� more acceptable to patientsmore acceptable to patients

Complete Denture OcclusionComplete Denture Occlusion

IN SUMMARY:IN SUMMARY:

Complete Denture OcclusionComplete Denture Occlusion

�� Neuromuscular control may be the single Neuromuscular control may be the single

most significant factor in the successful most significant factor in the successful

manipulation of complete dentures under manipulation of complete dentures under

functionfunction

�� Tongue function and Tongue function and

denture wearing denture wearing

experienceexperience