THE

CUSPLESS

CENTRALIZED
CHASTAIN

OCCLUSAL

PATTERN

G. PORTER, D.D.S.*
of Dedstry, City, MO.

Uhwsity

of

Katasas City, School

Kansas

PART I THE PROCEDURE

HE IMMEDIATE OBJECTIVE of an occlusion is the provision of an effective chewing mechanism. The long-range objective, of even greater importance, is the preservation of the residual structures in a state of optimum health. The cuspless centralized type of occlusion is a logical approach to attainment of both objectives.

VERTICAL JAW RELATION

Intraoral central bearing plates are attached to bases upon which anterior wax rims have been built (Fig. 1). These are positioned to parallel the mean foundation plane areas of both ridges. The vertical jaw relation is determined by a correlation of physiologic, esthetic, mechanical, and phonetic factors. The rest position is first determined as accurately as possible by using Pleasures* method of measuring from reference points on the nose and chin. This measurement is now decreased 3 or 4 mm. to determine the occlusal vertical position. The wax rims are inserted and trimmed for esthetic length and contour. Parallelism of the central bearing plates and of the underlying ridges is hoped for at this time, The caliper is returned to the face, and all factors are carefully considered. Some revision of thinking may now be in order. If compromise is necessary, it should usually favor the physiologic factors. Phonetic tests are deferred until the time of try-in. The central bearing stylus is now adjusted to maintain this vertical relation, after which a slight reduction in the height of the mandibular wax rim is made. Contact exists now only at the central bearing point, and thus both bases are stabilized.
Read before the American Denture Society, Miami Beach, Fla., Nov. 6, 7954. Received for publication Aug. 23, 1954. *Clinical Professor of Dental Prosthesis. 313

A Gothic arch tracing is scribed by the stylus on the blackened central bcaring plate on the lower base. The bearing plate is then indented at the apt d the tracing which is the centric point. N%h the patient exerting a light ci~siug pressure, and with the stylus in the indentation at the apex of the tracing, plaster is introduced between the bases with a syringe to record centric relation, and to attach the bases to each other in this position. No eccentric checkhitch ;trc made, and a face-bow transfer is not used. Only the unstrained rctruded centric relation of the jaws at the predetermined vertical level is desired. The asscn~hlage, including the casts, is positioned and mounted arbitrarily on an accurate articulator. The articulator is regarded as a maintainer of the static centric jalv TX:lation, and not as a reproducer of functional jaw movements.

Fig. l.-The

intraoral central bearing and tracing device attached prior to securing the jaw relation record.

to the

bases

Fig. Z.-The mandibular working occlusal surfaces are The buccal halves of the teeth are the suhocclusal surfaces. TOOTH ARRANGEMENT AND

lingual

to the ridge

fulcrum.

OCCLUSION

The anterior teeth are positioned for best esthetics and facial support, but without a vertical overlap. There should be no incisal contact in centric occlusion. Posterior teeth are used which possess the following specifications : ( 1) no cusp height ; (2) sharp cutting ridges ; (3) free sluiceways ; (4) working occlusal areas constituted of the lingual halves of the lower teeth; (5) sub-occlusal areas constituted of the buccal halves of the lower teeth ; and (6) balancing~elements to function only for balance in eccentric positions.

CUSPLESS

CENTRALIZED

OCCLUSAL

PATTERN

315

These posterior teeth are aligned over the center of the mandibular ridges, The mandibular working occlusal surfaces are observing Sears basic principles. placed entirely to the lingual side of the ridge fulcrum without encroaching upon the tongue (Fig. 2). The lower level of the subocclusal surfaces of the mandibular teeth creates a reverse occlusal pitch not unlike the Pleasure or Boswell scheme of occlusion, which directs the occlusal forces downward and toward the lingual.
Fig. 3.

Fig. 4. Fig. 3.-The flat occlusal plane paralleling the ridges with the teeth in centric There is no contact of the second molars or of the anterior teeth. Fig. 4.-There is a firm contact of the balancing ramps in protrusive There is a light contact on the anterior teeth in protrusion. or lateral occlusion. positions.

The occlusal pattern is oriented and limited to occupy only the horizontal foundation areas of the ridges. The bicuspids and first molars will usually fill this .segment, but additions or omissions of teeth may be made. A flat occlusal plane, paralleling the mean foundation planes of both jaws, is developed on the entire working occlusal pattern. This complies with the principle of applying force at right angles to the support. Balancing elements or ramps are provided by inclining the occlusal surfaces of the lower second molars upward at about a 30 degree angle, as advocated by Hardy. The upper second molars are set out of any possible occlusal contact and are frequently omitted. The occlusion is thus centralized from all aspects, antero-posteriorly and bucco-lingually (Fig. 3). At the time of the try-in, a careful check is made to assure a firm contact of the

IAancing ramps in the various positional closures iPig. 4). lf necessary, alttrations are made to assure l~osterior halance with a light sitnultaneous ini isal contact. After the correction of any dimensional change incident to processing [he dentures, the occlusion is perfected at the chair (Fig. 5:). A central bearing point. device is attached to the dentures with modeling plastic. Starting with a slightly open position, premature occlusal contacts are detected and reduced. Progressivr reduction of the height of the central hearing point ant1 sl~~9htspot grinding result in further refinement of thr occlusal halancc. These procedures4 are productive of an effective chewing mechanism which is conducive to a prolonged health of the supporting structures.

Fig. EL-Occlusal view of the finished dentures. The working occlusal surfaces in white, the subocclusal areas in black, and balancing surfaces are shaded, PART THE VERTICAL

are shown

II

RATIONALE JAW RELATION

The correct vertical relation cannot be ascertained by the consideration of any one factor. The patients sense of tonic muscle balance and free-way space is sometimes unreliable, and if it is accepted as the sole criterion, it will often dictate too short a vertical jaw relation. Satisfactory ridge or mean foundation plane parallelism is frequently unattainable even though it is highly desirable.

Volume 5 Number 3

CUSPLESS

CENTRALIZED

OCCLUSAL

PATTERN

317

Increasing the vertical jaw relation to produce the most pleasing and youthful iacial appearance is often not only futile, but it may be destructive to the undc-rlying bone. Phonetic tests after the teeth are set will occasionally suggest an error of judgment. Only by weighing all factors can the most favorable vertical position of the mandible be assured.
CENTRIC JAW RELATION

Even though, as stated by BOOS, the greatest power point is not always at the position of the apex of the Gothic arch tracing, the precise centric relation should be determined as the starting point. Its value as the final destination of the chewing cycle is of paramount importance. If the Gothic arch centric relation is not accepted, it may be discovered later, with dismay, that the other functional or acquired positions were merely misinterpretations. Some application of a tracing is the only sure and demonstrable method qf ascertaining centric relation. The central bearing intraoral tracing appliance, while not infallible, is simple and effective, if it is used properly. The stability of the bases of the occlusion rims is enhanced, and fewer variables are present than by most other methods.
THE ARTICULATOR

It should be realized that sagittal or other articulator adjustments exert only an infinitesimal influence on the limited occlusal paths. These translatory excursions are entirely nonfunctional as shown by Boswell and Kurth. Articulator reproduction of the functional chewing cycles is manifestly impossible, and has not even been attempted. The mounting of casts in orientation with the hinge axis certainly can be of no value in the development of a cuspless occlusion in complete dentures. Craddock and Symmons have shown that errors obviated by use of the face-bow cannot be detected clinically. There can be no objection to such procedures, however, as they constitute an innocuous pastime for the dentist.
POSTERIOR TEETH AND OCCLUSION

Boucher has stated that research should be done to find out, not to prove. There has been, as yet, no valid, large-scale research Lmdertaken to establish the relative merit of various tooth forms. Commendable projects, such as inaugurated 1)~ Paynell and Trapozzano and Lazzari,l should be carried on and greatly expanded. The effect of various tooth forms on residual tissues should receive foremost consideration. Until this is accomplished, clinical observation, experience, and logic must serve as guides. All physical laws and logic favor the acceptance of the cuspless, centralized, nonanatomic concept of occlusion. It is just too much to expect of the mucosa, which is trapped between the denture base and the bone, to withstand the clash of the humps and bumps of cusped occlusion. The final and irrefutable argument in favor of cuspless occlusion lies in the question : What happens when inevitable resorptive bone change, however slight, occurs? Can anyone deny that cusped teeth must then contact on the inclines of the cusps with the resultant diversion of vertical forces into traumatic horizontal forces.

318

PORTER

If no cusps are present, no harm will result and the greatest power point GU~[ be utilized freely without much loss of chewing efficiency. Final spot grinding and equilibration in the mouth, using centralized pressure, compensates for undetectable variances in yielding tissues in a manner otherwise impossible. A minimum of grinding should be done, and the basic occlusal pattern must be preserved. Thus, it is possible to develop a better bilateral and protrusive balance than by the use of any adjustable articulator. This occlusal haf-ante, while probably not of great functional value, is nevertheless highly important in all nonmasticatory closures. This is especially true during neurologic excursions, as described by Shanahan. Even though the value of balancing ramps has heen questioned by KurthI and others, Yurkstas and Emerson have demonstrated that they do make contact during mastication.
SUMMARY

While the case in favor of the cuspless centralized occlusal pattern has not yet been proved by the eye witness of research, circumstantial evidence strongly points to both the ineffectiveness and destructiveness of the anatomic type 4 occlusion. Many dentists are following the lead of such thinkers as Sears, Hardy, DeVan, French, Jones, Kurth, Moses, and Pleasure in the procession away iron7 the imitators of the cusp-studded anatomic curve of Spee. The feasibility of the cuspless centralized occlusal pattern should be more carefully explored and evaluated.
REFERENCES

1. Pleasure, M. A.:
2. 3. 4. 5. 6.

7.
8. 9. 10. 11.

12.
13.

Correct Vertical Dimension and Free-way Space,J.A.D.A. 43:160-163, 1951. Sears, V. H.: The Need for Basic Principles in Denture Construction, J.A.D.A. 41:X%540, 1950. Hardy, I. R.: Technique for the Use of Non-anatomic Acrylic Posterior Teeth, D. Digest 48 :562-S& 1942. Porter, C. G.: Simplicity Versus Complexity, J. PROS. DEN. 2:723-729, 1952. Porter, C. G.: Vertical Relation-The Enigma of Complete Denture Construction, Dental Survey 26:806-808, 1950. Boos, R. H. : Occlusion From Rest Position, J. PROS. DEN. 2:575-588, 1952. Boswell, J. V. : Practical Occlusion in Relation to Complete Dentures, J. PROS. DF.s. 1:307-321, 1951. Kurth, L. E.: Mandibular Movements in Mastication, J.A.D.A. 29:1769-1790, 1942. Craddock, F. W., and Symmons. H. F.: Evaluation of the Facebow, J. PROS. Der;. 2:633-642, 1952. Boucher, C. 0.: Through the Eyes of the Editor, J. PROS. DEN. 3:443, 1953. Payne, S. H. : A Comparative Study of Posterior Occlusion, J. PROS. DEN. 2:661-666, 1952. Trapozzano, V. R., and Lazzari, J. B.: An Experimental Study of the Testing of Occlusal Patterns on the Same Denture Bases, J. PROS. DEN. 2:440-457, 1952. Shanahan, T. E. J.: Physiologic and Neurologic Occlusion, J. PROS. DEN. 3:632-632.
1953.

14. Kurth, L. E.: Personal communication. 15. Yurkstas, A. A., and Emerson, W. H.: A Study of Tooth Contact During Mastication With Artificial Dentures, J. PROS. DEN. 4:X8-174, 19.54.
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