OCCLUSION IN COMPLETE

DENTURE
PART - II
CONCEPTS OF OCCLUSION

•Monoplane
concept of •Lingualised
occlusion occlusion

Balanced
occlusion
concept
 LINGUALIZED OCCLUSION

DEFINITION:

Occlusal scheme which uses maxillary lingual cusps as the major

functioning occlusal element occluding with non anatomic or semi
anatomic teeth in the lower arch.(Mortar and Pestle effect)
 LINGUALIZED OCCLUSION

 Dr. Alfred Gysi introduced this concept in 1927.

 Pound used the term “Lingualised occlusion”

 An attempt to maintain the esthetic & food penetration advantages of

the anatomic form while maintaining the mechanical freedom of the
non anatomic form.
LINGUALIZED OCCLUSION
OBJECTIVE
 LINGUALIZED OCCLUSION

• Anatomic posterior teeth (33 or 30 degree) are used for the maxillary denture.
• Non-anatomic or semi-anatomic teeth are used for the mandibular denture.(0-
20 degree)
• Lingual cusps of the upper posteriors make contact in centric relation in the
central fossae of the lower posteriors
 LINGUALIZED OCCLUSION

Balancing and working contacts should occur only on the maxillary

lingual cusps.
Upper palatal cusps contact the fossae of the lowers, and will not
contact any lower marginal ridges.
On the balancing side, the maxillary lingual cusps contact the
mandibular buccal cusps as is customary with anatomic tooth arrangement
Narrow occlusal table is preferred when severe resorption of the ridges
has occured
LINGUALIZED OCCLUSION
 LINGUALIZED OCCLUSION

Centric relation position using Protrusive position using

lingualised occlusion lingualised occlusion
 INDICATIONS FOR
LINGUALIZED OCCLUSION

Indicated in patients who place a high priority on esthetics but

non anatomic occlusal scheme is indicated because of oral
conditions such as severe alveolar resorption, a class II jaw
relation or a displaceable supporting tissues
 ADVANTAGES OF LINGUALIZED OCCLUSION

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

tooth form.
• Good penetration of food bolus is possible because of cusps and
therefore vertical forces are reduced on the ridges.
• Bilateral balanced occlusion is readily achieved for a region around
centric relation.
• Vertical forces are centralized on the mandibular teeth.
• Reduces lateral forces because of elimination of steep inclines
ADVANTAGES OF LINGUALIZED OCCLUSION

Monoplane occlusion limits Lingualised occlusion provides

esthetics in premolar region improved esthetics in premolar
region
 BALANCED OCCLUSION

• When forces act on a body in such a way that no motion results,

there is a balance or equilibrium.

• A stable denture base is the ultimate goal , which is difficult to

achieve because of the yielding nature of the supporting
structures.

• Balanced occlusion involves a definite arrangement of tooth

contacts in harmony with the mandibular movement.
 BALANCED OCCLUSION

Definition

• The bilateral, simultaneous, anterior, and posterior occlusal

contact of teeth in centric and eccentric position .(GPT-8)

Goals of BALANCED OCCLUSION

• Simultaneous contacts in centric relation
• Working side contacts
• Balancing contacts in protrusion
• Balancing contacts in lateral excursion
 BALANCE OR EQUILIBRIUM

The following points should be considered while developing balanced

occlusion.
1. The wider and larger the ridge and closer the teeth to the ridge,
greater the lever balance.
2. The smaller and narrower the ridge and farther the teeth from the
ridge , the poorer the lever balance .
 BALANCE OR EQUILIBRIUM

3. The wider the ridge and the narrower the teeth buccolingually, greater
the balance.
4. The narrower the ridge and wider the teeth, the poorer the balance.
5. The more lingual the teeth are placed in relation to the ridge crest,
greater the balance, and more buccal the teeth are positioned, the poorer
the balance.
6. The more centered the force of occlusion anteroposteriorly, the greater
the stability of the base.
 TYPES OF BALANCED
OCCLUSION

1. Unilateral balanced occlusion

2. Bilateral balanced occlusion

3. Protrusive balanced occlusion

4. Lateral balanced occlusion

 UNILATERAL BALANCED
OCCLUSION

• Also called as group function occlusion

• Here teeth on the working side are in contact ,and on nonworking
side are free of contact, during lateral excursion.
• The absence of contact on nonworking side prevent those teeth
from being subjected to the destructive , obliquely directed forces
found in nonworking interferences.
• Not followed during complete denture construction.
 BILATERAL BALANCED
OCCLUSION

• This is a type of occlusion that is seen when simultaneous contact

occurs on both sides in centric and eccentric position.
• Bilateral balanced occlusion helps to distribute the occlusal load
evenly across the arch and therefore helps to improve stability of the
denture during centric, eccentric, or parafunctional movements.
• For minimal occlusal balance, there should be at least three points of
contact on the occlusal plane. More the no. of contacts, better the
balance. Bilateral balanced occlusion (B.O.)
• Can be protrusive or lateral balance.
 PROTRUSIVE BALANCED
OCCLUSION

• This type of balanced occlusion is present when mandible moves

in a forward direction and the occlusal contacts are smooth and
simultaneous anteriorly and posteriorly.
• There should be at least three point of contact in the occlusal
plane.
• This is absent in natural dentition.
 LATERAL BALANCED
OCCLUSION

• In lateral balanced occlusion there will be a minimal simultaneous

three point contact present during lateral movement.

Canine guided disocclusion in Anterior & posterior teeth contact seen

natural teeth during lateral excursion- working side
 BALANCED OCCLUSION:

In centric occlusion,

In protrusive position
In right lateral position,
NEED FOR BALANCED OCCLUSION

Denture Stability

Comfort Preservation of
underlying bone

Increased
Even distribution
Masticatory
of occlusal forces
efficiency

Reduces
localized stress
concentration
 FACTORS EFFECTING
BALANCED OCCLUSION

As described by the Rudolph L.Hanau there are five factors

involved in balanced occlusion of CD.

“ Hanau’s Quint ”
1. Condylar guidance
2. Incisal guidance
3. Plane of occlusion
4. The compensating curve
5. Inclination of cusps
 FACTORS EFFECTING
BALANCED OCCLUSION

INCISAL CONDYLAR CUSP PLANE OF COMPENSATING

GUIDANCE GUIDANCE INCLINATION OCCLUSION CURVE

A BALANCE OF THESE 5 FACTORS IS REQUIRED

FOR BALANCED OCCLUSION
 CONDYLAR GUIDANCE

Mandibular guidance generated by the condyles traversing the

contours of the glenoid fossa.

Only factor given by the patient

Obtained by means of protrusive registration

• It is mandibular guidance generated by the condyle and articular
disc traversing the contour of glenoid fossae.
• The posterior determinent of mandibular movement
• The angle formed by an imaginary horizontal line at the superior
head of the condyle and the path that the condyle will pass through
during function
• Condylar pathway depends on bone
Contour of T.M.J.,
Muscle of mastication,
Ligament of T.M.J. and
Neuromuscular control of the patient.
Method of registering
• Average condylar guidance is about 25-30 degree.
 CONDYLAR GUIDANCE

As stated by Hanau the condylar guidance is the factor

edentulous patient presents and can no way be
modified by the operator.
 INCISAL GUIDANCE

• Established by the horizontal and vertical overlaps of the

anterior maxillary and mandibular teeth.
• Is the angle formed by the intersection of the plane of occlusion
and a line within the sagittal plane determined by the incisal
edges of the maxillary and mandibular central incisors when the
teeth are in maximum intercuspation.
 INCISAL GUIDANCE
 In complete dentures the incisal guidance should be as flat as
possible as the esthetics and phonetics permit.
 It is directly proportional to vertical overlap and indirectly
proportional to horizontal overlap.
 If the incisal guidance is steep, it requires steep cusps, a steep
occlusal plane, or a steep compensating curve to affect an
occlusal plane
• On average it is about 10-20 degree.
 INCISAL GUIDANCE

 Incisal guidance depends upon following factors:

• Phonetic
• Esthetic
• Shape of residual ridges
• Ridge relation
• Inter-alveolar distance
 INCISAL GUIDANCE

Steep incisal guidance

Steep cusps,steep occlusal plane or a steep compensating curve to

affect an occlusal balance.
Condylar guidance and incisal guidance are the two end
controlling factors.
 ORIENTATION OF THE OCCLUSAL PLANE

Plane of orientation (Hanau) : Vertical location of the anteroposterior

alignment of the occlusal plane in the space between upper and lower
ridges.
• This plane is established
 In anterior region by the height of lower cuspid which coincides
with the commissure of the mouth
 In the posterior region by the height of the retromolar pad.
 Also related to Ala-tragus line
 Its role is not as important as are the other determinants.
 INCLINATION OF THE CUSPS

• Refers to the angle between the total occlusal surface of the tooth
and the inclination of the cusp in relation to that surface.
 INCLINATION OF THE CUSPS

• If the condylar guidance is steep, higher cuspal height tooth are used
to gain in balanced occlusion.
• Effective cuspal angle can either be increased or decreased by mesial
or distal tilt of tooth.
 COMPENSATING CURVE

• The anteroposterior & lateral curvatures in the alignment of

occluding surfaces & incisal edges of artificial teeth which are
used to develop balanced occlusion”
• It is an important factor for developing balanced occlusion
• Determined by the inclination of posterior teeth and their
vertical relationship to the occlusal plane so that the occlusal
surface results in a curve.
 COMPENSATING CURVE

• There are two types of compensating curves namely:-

- Anteroposterior Curves
- Lateral Curves
• The curve should be in harmony with the movements of the
mandible guided by the condylar path
 ANTEROPOSTERIOR COMPENSATING CURVE

• Curve of Spee is defined as, “Anatomic curvature of the occlusal

alignment of teeth beginning at the tip of the lower canine &
following the buccal cusps of the natural premolars & molars,
continuing to the anterior border of the ramus
 ANTEROPOSTERIOR COMPENSATING CURVE

• It compensates for opening called as “CHRISTENSEN’S

phenomenon” that occurs in posterior region when protrusive
movements are made.

• When the patient moves the mandible forward the posterior

teeth set on this curve will continue to remain in contact
MEDIO-LATERAL CURVE OR CURVE OF WILLSON:

It is transverse curve made by lingual inclination of posterior teeth

Steep condylar path requires a steep compensating curve for
occlusal balance
• Out of the five factors , only four can be controlled by the
dentist.

• The incisal guidance and plane of occlusion can be altered but

only slightly because of esthetic and phonetic limitations.

• The main factors which can be used and changed effectively are
compensating curve and inclinations of the cusps of the teeth .
 ADVANTAGES OF BALANCED
OCCLUSION

1. Denture stability
2. Enhanced retention
3. Enhanced patient comfort
4. Maintenance of the integrity of supporting
tissue
 SUMMARY

 A search for ideal concept or theory is still underway

 Biologic , Physiologic and mechanical principles need to be

considered and carefully co-ordinated in this new manmade
occlusion
 REFERENCES

• Boucher’s – treatment of edentulous patients, 13 th edition Pg.

298-329

• Essentials of complete denture – Shelden Winkler, 2nd

edition, Pg. 217-285