Jones, P.M. The monoplane occlusion for complete dentures. JADA. 1972.

85(1): 94-100

Purpose: To describe the rationale for, and advantages of monoplane occlusion as well
as the techniques used to create it

Summary

 Posterior denture teeth design has evolved from blocks of porcelain to natural
looking teeth similar in appearance to newly erupted premolars and molars
 Dental schools view ideal denture occlusion as “meshed cusps in centric relation”
and “equalized contacts between upper and lower teeth in eccentric relation
within the range of function” based on the “Spherical Theory of Occlusion”
 Theory first described by Young (1949) where “tooth contacts must be multiple
and in harmony with anatomic guides and functional characteristics”
 Use of the spherical theory was thought to create a balanced occlusion, also
known as “three point contact” or “eccentric balance”
 Balanced occlusion requires multiple eccentric jaw records to set the controls of
the articulator and records are “as unreliable as they are time-consuming”
 Articulator movements are similar to bruxing rather than the chewing cycle
 Many names for nonanatomic posterior teeth: cuspless, noncusped, zero degree,
monoplane, mechanical, flat. Jones prefers “zero degree” to avoid confusion
 Zero degree teeth can be used to create a monoplane occlusion or can be set to
a curve or with balancing units to create a balanced occlusion
 Jones lists examples of increased use of zero degree teeth:
o Major suppliers of teeth create a wide range of occlusal carvings on zero-
degree teeth today (1972) versus only 2 forms in 1940
o Most applicants for the American Board of Prosthodontics Exam in 1970
used zero degree teeth versus 3/30 applicants in 1953
o More dental schools use zero degree teeth (33 schools in 1969) than
before (2 US schools in 1950)
o State board exams do not require traditional setup with anatomic teeth
 Research by several authors suggest that use of balanced occlusion does not
create any “detectable advantages” for patients, the “law of parsimony” (to use
the simpler of two competing theories) supports monoplane occlusion
 All teeth bonded to a denture function as a single unit (versus one natural tooth
functioning as its own unit) so any force on one denture tooth is felt throughout
the mucosa supporting the denture base
 With residual ridge resorption there is some loss of vertical dimension (VDO)
 With anatomic teeth in balanced occlusion, heavier contacts will be generated
on “forward facing inclines of lower teeth against distal inclines of upper teeth”
which may lead to to sliding of denture bases on mucosa and subsequent pain,
inflammation, bone destruction, soft tissue hyperplasia
  A monoplane occlusion will “suffer less derangement” with loss of VDO as the
mandible is not “locked in one position”
 Jones lists advantages of monoplane occlusion
o More adaptable to Class II and Class III malocclusions
o Used more easily in crossbite situations
o Gives patients a “sense of freedom” because the mandible is not “locked
in one position”
o No need to be concerned about CR being a point or area
o Simpler and faster to set-up occlusion
o Better accommodation to residual ridge resorption
 Jones describes a technique for monoplane occlusion with noted differences
from the “traditional” technique being:
o Type of articulator – a “barn-door hinge” type with an incisal guide pin
meets requirements, how casts are related to hinge axis is not important
as long as vertical dimension is not changed without a new CR record
o Upper and lower anterior teeth do not overlap vertically
 Describes method of setting teeth (lower teeth set over the ridge, upper teeth
set buccal) and the 2nd molars as non-functional “space fillers”
 Notes occurrence of processing error (posterior teeth may move) and the
amount of error can be detected with the incisal guide pin
 Remounts will not accomplish anything if an accurate centric relation record was
recorded using a needlepoint tracer
 Advantage of plastic posterior teeth is their ability to wear under function (less
development of slight prematurities after settling of bases)

Critique:
 Written for the JADA, for an audience of general dentists and specialists
 Narrative style review, many explanations and techniques are unreferenced
 Little evidence to support advantages and conclusions (but not much literature
at the time?) Author makes sense of each advantage, focused on its adaptability
to inevitable ridge resorption compared to a balanced occlusal set-up
 Good section on the author’s own technique to set-up monoplane occlusion and
an overview of denture fabrication in general

Bottom Line
This article names some advantages of monoplane occlusion versus balanced occlusion
and gives a good description of how to set-up a monoplane occlusion using zero-degree
teeth.