OCCLUSION IN EDENTULOUS

PATIENT
INTRODUCTION
Occlusion is the factor that is common to
all branches of the dentistry.

According to G.P.T.-8 , It is defined as-

1. the act or process of closure of being
closed or shut off,
2. the static relationship between the
incising or masticating surfaces of the
maxillary or mandibular teeth or tooth
analogues.
ARTICULATION
According to G.P.T – 8 , it is defined as the
dynamic contact relationship between the
occlusal surfaces of the teeth during
function.
The force that develop during occlusal
contacts , may vary in magnitude and
direction, it must always be resisted by
supporting tissue. Control of this
resultant force is a basic and perplexing
problem that is controversial, especially
in the field of complete dentures.
Q. How occlusion in dentulous mouth
is different from that in an edentulous
mouth ?
Natural Occlusion Artificial Occlusion
1. Each tooth individually is 1. All the teeth are
supported by periodontal supported by a
tissue and has its common denture base
proprioceptive feedback that rests upon the
slippery tissue i.e.
mucosa
2.Each tooth can move 2. All the teeth move
independently and can as a unit with the
migrate slowly to favorable denture base.
occluding positions.
 Natural Occlusion Artificial Occlusion
3. Incising with the anterior 3. Incising from anterior
teeth does not affect the teeth can potentially cause
posterior teeth. tipping of the denture from
the posterior.
4.Balancing side contact 4. Balancing side contact
rarely found, if present (bilateral balancing)
considered as balancing side necessary for base stability.
interference.
5. Due to proprioceptive 5. Due to lack of
mechanism a person can proprioceptive mechanism
avoid premature contacts any premature contacts and
and interferences. cuspal interference will
dislodge the denture.
6. Malocclusion of natural 6. Malocclusion on artificial
teeth does not evoke any teeth evokes an immediate
immediate response. response and affects all the
teeth and base.
 Natural Occlusion Artificial Occlusion
7. Horizontal thrusts on one 7. The effect is bilateral and
side during mastication are is usually traumatic in
well tolerated and affect nature.
only the side involved.

8. Molars are the power 8. Chewing from II molar

points of masticatory force , region wil shift the denture
esp. II molars which are base if it is on inclined
important for chewing of foundation .
tough food.
 REQUIREMENTS OF COMPLETE
DENTURE OCCLUSION

The difference between the natural and artificial

teeth and the requirements for artificial
occlusion make it necessary to consider the
dentist created occlusion as an unique
problem.
As we all know that mandibular dentures are
inherently less stable than the maxillary
dentures, so the occlusal design and the
positions of the lower occlusal units should be
given FIRST preference.
Acc. To Ortmann (1971) the requirements for
complete denture occlusion are –
 Stability of occlusion in centric relation;
 Balanced occlusion for eccentric contacts;
 Unlocking of the cusps mesiodistally to
accommodate the inevitable settling of the denture
base;
 Control of horizontal force by buccolingual cusp
height reduction according ridge;

 Functional balance by favourable tooth to ridge

crest relation;
 Cutting and shearing efficiency;
 Anterior clearance of teeth during masticatory
function;
 Minimal occlusal stop areas for reduced pressure
during function.
REQUIREMENTS OF THE INCISING UNITS

1. Should be sharp to cut efficiently.

2. Should be out of contact during mastication.
3. Should have as flat an incisal guidance as is
possible.
4. Should have horizontal overlap to allow for setting
of the bases.
5. Should engage only during protrusive incising
function.
 REQUIREMENTS OF WORKING OCCLUSAL
UNITS
1.Should be efficient in cutting and grinding.
2.Should be narrow buccolingually to decrease work force
transfer to denture foundation.
3. Should be over the ridge crest or slightly lingual to it ,
for lever balance.
4.Should have surface to transmit occlusal force
vertically.
5.Should center the work load anteroposteriorly on the
denture foundation.
6.Should present a occlusion as nearly parallel to the
mean foundation plane as is possible.
 REQUIREMENTS OF THE BALANCING
OCCLUSAL UNITS

1. Should contact in 2nd molar region when the

incising units contact during function.
2. Should contact at the end the masticatory stroke
when the working units contact.
3. Should have smooth gliding contact for lateral
and protusive sliding extrusions
 Types of Posterior Teeth
1. Anatomic teeth: Acc. To G.P.T- 8 , this is defined as
artificial teeth that have cuspal inclination greater than
0 degree, and which tend to duplicate natural teeth in
appearance.

(a) Standard anatomic teeth: Those anatomic teeth

which have cusp inclines of approximately 33o or more
and closely resemble natural teeth.
(b) Modified or semi anatomic teeth: Those anatomic
teeth which have cusp inclines lesser than 33o (I.e. less
steep) and they look somewhat like natural teeth.

2. Non-anatomic teeth: Non-anatomic teeth are flat with

no cusp heights to intercuspate with opposing teeth.
Their occlusal surface has various designs of flat planes
and sulci to enhance their masticatory efficiency.
 ANATOMIC TEETH
The natural teeth in dentulous mouth function in
harmony with their opposing member giving
efficient and comfortable mastication.

However in edentulous mouth these same teeth can

cause trauma , discomfort, and instability to the
bases because of the horizontal components they
generate.

The basic problem initially is the coordination of these

cuspal inclines to harmonize with the mandibular
movements. Even if this is done , with meticulous
records on adjustable articulator, it can not exist for
long when transferred to the mouth.
PROBLEMS OF UNMODIFIED ANATOMIC
TEETH
1. It is mandatory to use an adjustable articulator.
2. Both centric and eccentric records need to be made
for articulator adjustments.
3. Mesio – distal locking will not permit settling of
the bases without development of horizontal
forces .
4. Carefully balanced lateral positions become
unbalanced with settling.
5. The bases need prompt and frequent refitting to keep
the occlusion harmonious.
6. The presence of cusp generate more horizontal force
during mastication.
7. Tooth contacts do not always occur in the same
horizontal position (I.e. the centric recorded). Many
jaw closures also occur anterior and lateral to this
centric position. But due to prominence of the cusps,
there is no freedom of tooth contact during such jaw
closures, hence deflective forces act on the base
during such jaw closures leading to base instability
and increased residual ridge resorption.
 NONANATOMIC TEETH

Acc. To G.P.T – 8 , nonanatomic teeth are defined as

artificial teeth with occluding surfaces that are not
anatomically formed. The term nonanatomic as
applied to artificial posterior teeth , and especially
their occlusal forms , means that such teeth are
designed in accordance with the principles rather
than from the viewpoint of anatomic teeth with
flat occlusal surfaces set to flat occlusal plane.
 ADVANTAGES OF NON-ANATOMIC
TEETH
1. Versatility of use, hence can be used in class II
and III jaw relations also.
2. They are used more easily when variation in
the width of upper and lower jaws indicate a
cross bite setup.
3. Centric occlusion is more of an area and less
of a precise point in these teeth hence they
allow closure of jaws over a broad contact
area.
4. Minimal horizontal pressures are created
because of elimination of inclined planes.

5. Zero degree teeth permit the use of a simplified

and less time consuming technique and offer
greater comfort and efficiency for longer
duration.
6. The accommodate better to the inevitable
negative changes in the ridge that occur
with aging.
According to the Jones ,the use of zero
degree teeth should not only be limited to
the patients with unfavorable prognosis,
and their uses should be extended to
include those patients with favorable
prognosis, because those mouths which
are favorable today will get unfavorable a
decade or two later.
We must not forget the De Van's famous
lines that we be as concerned with
preserving what is left as with the
restoration of what is missing.
 DISADVANTAGES OF NON-
ANATOMIC TEETH
1.Since these teeth are flat hence occlusion
occurs only in 2 dimensions , but the
mandible, due to the incline of condylar path,
moves in three dimensional arcuate path.

Fig 13.25 , 238, winklr

2. Due to flatness of occlusion, bilateral and
protrusive balance is not possible.
But it can be made to develop in monoplane
occlusion with the help of balancing ramps,
tripodization with tilting the 2nd molars, and by
the incorporation of compensating curve.

3. They appear dull and unnatural to some patients

and may create a psychological problem
concerning function and esthetics.
4. The vertical component present in mastication
and nonfunctional movements is not provided
for , so that this form loses shearing efficiency.
5. They cannot be corrected much by occlusal
grinding without impairing their efficiency.
6. They don't function efficiently unless the
occlusion surface provides cutting ridges and
generous spillways (sluiceways).
7. If for phonetic and esthetic demands, a deep
vertical overlap is required and overjet cannot
be increased beyond a limit, then the
monoplane occlusion has potential for anterior
interference during, due to absence of cusp lift.
 BALANCE AS RELATED TO COMPLETE
DENTURE

When forces act on a body in such a way that no

motion results, then there is balance or
equilibrium. This should be the primary aim of
the dentist I.e. to achieve a stable base. In order
to do so the following axioms have to be
followed: by Sears
1. The wider and larger the ridge and closer the
teeth are to the ridge, the greater the balance.
2. Conversely, the smaller and narrower the ridge
and farther the teeth from the ridge, the poorer
the balance.
4. The wider the ridge and narrower the teeth
buccolingually, the greater the balance.
5. Conversely, the narrower the ridge and
wider the teeth, the poorer the balance.
6. The more lingual ( with in limits provided
by the tongue) the teeth are placed in relation
to alveolar ridge crest, the greater the
balance.
7. The more buccal the teeth are positioned,
the poorer the balance.
 TYPES OF BALANCE
Balance may be lever or occlusal and unilateral,
bilateral, or protrusive.

1. UNILATERAL LEVER BALANCE

This is present when there is balance of the base
on its supporting structures when bolus food is
interposed between the teeth on one side and a
space exits between the teeth on the opposite
side. Following points encourages the lever
balance-
a) Teeth placement should be such that to direct the
resultant force on the functioning side over the
ridge or slightly lingual to it.
b) Having the denture base cover as wide an
area on the ridge as possible.
c) Placing the teeth as close to the ridge as
other factors will permit.
d) Using as narrow a buccolingual width
occlusal food table as practical.

2. UNILATERAL OCCLUSAL BALANCE

This is present when the occlusal surfaces of

teeth on one side articulate simultaneously
as a group , with a smooth uninterrupted
glide.
3. BILATERAL OCCLUSAL BALANCE

This is present when there is equilibrium on

both sides of the denture due simultaneous
contact of the teeth in centric and eccentric
occlusion. It requires a minimum of three
contacts to establish a plane of equilibrium.
This balance is dependent on the interaction
of the incisal guidance, plane of occlusion,
angulations of teeth, compensating curve, and
condylar guidance.
4. PROTRUSIVE OCCLUSAL BALANCE

This is present when the mandible moves essentially

forward and the occlusal contacts are smooth and
simultaneous in the posterior both on right and
left sides and on the anteriors.

It is slightly different from bilateral balance in that i

requires a minimum of three contacts, one on eac
side posteriorly and one anteriorly, and is
dependent on interaction of the same factors as
bilateral occlusal balance.
This entire concept of balanced occlusion
must be considered in terms of the
following:
1) The tooth size and position in relation to
the ridge size and shape.
2) The extent of denture base coverage.
3) Occlusal balance with stable contacts at
the retruded border position and in an
area (long centric) anterior to it.
4) Right and left eccentric occlusal balance
by simultaneous contacts at the limit of
functional and parafunctional activity.
5) Intermediate occlusal balance for all
positions between centric occlusion and all
other functional or parafunctional
excursions to the right, left and protrusive.
this balance is probably the most important
, as it allows for smooth uninterrupted
tooth contacts in the dynamics of daily
mandibular movements.
ADVANTAGES OF BILATERALLY
BALANCED OCCLUSION
Prime gave the concept of “ ENTER BOLUS EXIT
BALANCE” which implies that introduction of food
on one side will prevent the teeth of opposite side
from contacting and hence occlusal balance is
impossible during mastication.

However Sheppard (1964) later gave the concept of

ENTER BOLUS ENTER BALANCE according to
which even while chewing, the teeth cut through the
bolus and come in contact with each other, for few
fractions of a second. Hence the stability of the
denture is maintained during various movements of
mandible during chewing.
 Moreover, the bilateral balanced occlusion is even
more important during functional and the
parafunctional activities like swallowing of the
saliva, closing to seat the denture and bruxing of
the teeth during times stress,etc.

Patient with balanced occlusal design do not upset

the normal static , stable , and retentive position of
their denture

Balanced occlusion thus will make such episode less

damaging to the supporting structures during the
times of stress.
 FACTORS AFFECTING BALANCED
OCCLUSION
As described by the Rudolph L.Hanau there are
five factors involved in balanced occlusion of CD.
These factors are:
1. Condylar guidance
2. Incisal guidance
3. Plane of occlusion
4. Compensating curve
5. Inclination of the cusps.
Vincent r. Trapozanno (1963) criticized Hanau `s Five
factors of occlusion , and concluded that only three
factors out of five are important, viz, Condylar
guidance, incisal guidance, and cusp angulation.
CONDYLAR GUIDANCE
As defined by G.P.T-8, it is mandibular guidance
generated by the condyle and articular disc
traversing the contour of glenoid fossae.
There is controversy that whether condylar path is
precise or not. However some studies says some
thing different.
Kurth (1954) claims that condylar path is not same
for varying incisal guidance.
Payne (1951) has shown that mandible can move to
follow steep cusps, modified cusps and zero degree
teeth when there is posterior harmony and no
anterior interference is present.
Weinberg (1976) has demonstrated that the condylar
path may vary with the variable pressure of
occlusion.
As stated by Hanau ( and agreed by Trapozzanno)
the condylar guidance is the factor
edentulous patient presents and can no way
be modified by the operator.
Factors which determine the registration of condylar
guidance are –
a) Shape of the bony contour of glenoid fossae;
b) Muscles attaching to the mandible ;
c) Limitation of the movement by attached
ligaments.
d) The registration method used. i.e. If registration
method require bases to rest on tissue of
mandible and maxilla, the REALEFF can
modify the recordings.
INCISAL GUIDANCE
As defined by G.P.T- 8 it is the influence of the
contacting surfaces of the mandibular and
maxillary anterior teeth on mandibular
movements.
And incisal guide angle is
defined as 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.
 As it is more near to masticating teeth surfaces
( as compared to condylar guidance) it has a
dominant influence on contacting surfaces of
the teeth posterior to it.
In C.D construction it is largely under the control
of the dentist , the limitations governing it
are-
a) Ridge relation,
b) Arch shape,
c) Ridge fullness
d) Interridge space
e) Phonetics and esthetic requirements of the
patients.
Originally Hanau described 2 incisal
guidance viz sagittal protrusive I.G and
lateral I.G.

Coming to lateral I.G, is determined by

considering the relationship of all
incisors and cuspids , both maxillary and
mandibular ( in pure right and left lateral
movements ) .
Trapozanno( 1963) defined it as the steepest
angle formed with the horizontal plane by
drawing a line between the incisal edges of the
maxillary and mandibular incisors and cuspids of
both right and left segments when the teeth are in
centric occlusion

For C.D construction Incisal guidance should be

as flat as esthetics and phonetics will permit.
 PLANE OF OCCLUSION
 Acc. To G.P.T -8 it is defined as the average
plane established by the incisal and occluding
surfaces of the teeth . Generally , it is not a
plane but represents planer mean of the
curvature of these surfaces.

 This plane is established in anterior region by

the height of lower cuspid which coincides
with the commissure of the mouth and in the
posterior region by the center ( Winkler) or
junction of posterior and middle third of the
retromolar pad ( Boucher).
 These landmarks also provide a physiologically and
functionally acceptable anteroposterior inclination
of the occlusal plane that is nearly parallel to the
lower mean foundation plane.
 These landmarks also creates an occlusal plane
essentially parallel to the ala-tragus line( Camper`s
plane).
 Okane (1979) showed that when occlusal plane is
parallel is to the ala – tragus line, the closing force
during maximum clenching was greater than when
it was altered by +/- 5 degree.
• Its position can be altered only slightly without
creating serious functional problem.
• Its role is not as important as are the other
determinants.
 COMPENSATING CURVE

Acc. To G.P.T -8 , it is defined as (1) the anterio-

posterior curving (in median plane) and the
medio-lateral curving ( in frontal plane) within
the alignment of occluding surfaces and incisal
surfaces of artificial teeth used to develop
balanced occlusion.
(2) the arc introduced in the construction of
complete denture to compensate for the opening
influence produced by the condylar and insical
guidance's during lateral and protrusive
mandibular excursive movements.
 Fig 6 , 131 ortman article
Or 1328 245 wink

It is determined by the inclination of the posterior

teeth and their vertical relationship to the
occlusal plane so that the occlusal surface
results in a curve that is in harmony with the
movement of the mandible as guided by the
condylar path posteriorly and incisal guidance
anteriorly.
 A steeper condylar path requires a steeper
compensating curve .A lesser compensating
curve for steeper condylar guidance would
result in steeper incisal guidance acting as
anterior interference, causing loss of molar
balancing contacts.

 The primary function thus of compensating

curve is to provide balancing contacts for
protrusive mandibular movements.Without this
curve it would be necessary to incline the entire
occlusal plane at an angle.
With compensating curve it is possible to produce
eccentric balance in monoplane occlusal
scheme, which is otherwise said to be deficient
in this.
The compensating curve incorporated in a
properly oriented plane of occlusion starts with
the first molar by raising it at distal and
continuing this initiated curve with further rise
in the 2nd molar. The radius of the curve is the
result of the guiding influence of the angle of
the incisal and condylar guidance.
Acc. to Boucher (1963) the value of
compensating cusp is that it permits an
alteration of the cusp height without
changing the form of the manufactured
teeth .It is means for making cusps longer
or shorter to produce steeper or flatter
cusps, simply by inclining the long axis
of the teeth to conform to the end
guidances.
 INCLINATION OF THE CUSPS

 It is also a determinant, as it modifies the effect of

the plane of occlusion and the compensating curve.
 The angulation of the cusp is more important than
te height of the cusps per se.
 The mesiodistal cusp heights that interdigitate lock
the occlusion so that reposition of the teeth due to
setting of the base cannot take place.To prevent this
problem, it is advocated that all mesiodistal cusp
heights be eliminated in anatomic type teeth.With
the teeth so modified, only the buccolingual
inclines need be considered as determinants of
balanced occlusion.
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 .
 TYPES OF OCCLUSION SCHEMES

Now let us discuss the three main occlusal

schemes i.e Monoplane occlusion,
Classical bilaterally balanced occlusion ,
and Lingulized occlusion .
It is of interest to note that none of the
occlusal scheme has been proved to be
superior to other (for all presenting
conditions of edentulous mouths),
although one type of scheme may offer
some advantages over other.
 MONOPLANE OCCLUSION
Acc. To G.P.T -8 ,it is defined as an occlusal
arrangement wherein the posterior teeth have
masticatory surfaces that lack cuspal height .
Hall (1929) is credited for the introduction of Zero
degree teeth calling them inverted cusp tooth, but
these teeth have the problem of clogging of food in
the depressions onto the occlusal surfaces.
Myerson later designed a cusp less teeth
with series of transverse buccolingual
ridges and sluiceways between them.
 ADVANTAGES OF MONOPLANE
OCCLUSION / ZERO DEGREE TEETH
1. Versatility of use, hence can be used in class II and
III jaw relations also.
2. This is used more easily when variation in the width
of upper and lower jaws indicate a cross bite setup.
3. Centric occlusion is more of an area and less of a
precise point in these teeth hence they allow closure
of jaws over a broad contact area.
4. Minimal horizontal pressures are created because of
elimination of incline plane.
5. Zero degree teeth permit the use of a simplified and
less time consuming technique and offer greater
comfort and efficiency for longer duration.
6. They accommodate better to the inevitable negative
changes in the ridge that occur with aging.
As far as balanced occlusion is concerned in
monoplane occlusion two important concepts
prevail-
A) Non Balanced occlusion (in centric relation
only) E.g Neutrocentric concept.

B) Balanced occlusion in centric relation and

lateral excursions
This can be achieved with the use of
compensating curve, balancing ramps,
Tripodization by tilting the 2nd maxillary and
mandibular molars, and using monoplane
with zero overbite ( but this will compromise
phonetics and esthetics.)
NEUTROCENTRIC CONCEPT

This is an important example in first category.

Acc. to DeVan the main objectives of
neutrocentric concept are-
I – Neutralization of the inclines and,
II – Centralization of the occlusal forces acting on
the denture foundations.

In order to attain these objectives, it is necessary

to reduce the size and number of teeth and to
abandon attempts to secure balancing contacts
in eccentric positions beyond the range of
masticatory stroke.
 The neutrocentric concept should not be
identified with that of the advocates of
nonanatomic teeth, who merely dispense
with cuspation.
 It is dangerous to discard cusps without
neutralizing other factors of articulation,
that is;
1)Orientation of occlusal plane.
2)Compensating curve.
3)Incisal guidance.

 These factors concern inclines of

arrangement of teeth, whereas cusps are
related to inclines of form.
 There is only one factor of articulation which
cannot be neutralized, ie., the condylar
guidance, but which fortunately can be
circumvented by a plan involving neutrocentric
concept.

 If the patient can be persuaded to avoid incising

with artificial teeth, there is no need to be
concerned with the sagittal condylar incline.

 When incision is avoided and no projection

exists above and below the occlusal plane, the
condylar inclination on the articulator may be
set at zero.
 Stability is a tooth-bone relationship while
retention is a tooth-mucosa borne relationship.

 Stability is not necessary for function; a denture

to function needs only to be retained.

 When a denture is unstable however, the patient

may not be able to maintain the initial chewing
performance due to chaffing and irritation of the
mucosa.

 Furthermore, an unstable denture may prove

traumatic to the ridge bone, in time causing its
resorption.
According to DeVan, the five factors involved in the
relation of the teeth to dental foundation are:
(a) POSITION
There is probably no single tooth factor as important as
position.

Acc. to DeVan posteriors should be positioned in as

central position on the foundation as allowed by the
tongue, this way denture will be more stable due to
enhanced lever balance, and more of the osseous
foundation will be saved by the harmful tensile and
shearing forces acting on bone and the overlying
mucosa.

Clinical observations support the opinion that balancing

contacts in eccentric positions don't nullify the
unstabilizing effect of an off-ridge setup
 Acc. to DeVan the employment of lateral
balance intensifies rather than alleviates the
problem of stabilizing the denture.

 Eccentric balance does help to maintain

retention; but if the use of inclines is essential
for its establishment, then bilateral balance
causes a decrease in stability.

 Balancing inclines shift the denture farther

toward the side of the mastication, preventing
its dislodgement while increasing its side
displacement.
B) PROPORTION

DeVan recommends reduction in the proportion

of the artificial teeth as compared to size of
natural teeth.

Reduction in proportion is necessary to develop

centralization of forces, Reduction of frictional
forces developing on occlusal surfaces which
will transfer to the underlying mucosa and
bone.
Reduction by 40% in width is possible without
serious diminution of the food table.
 C) PITCH

Pitch is synonymous with inclinations or tilt .

 In neutrocentric concept the plane of

occlusion should be oriented so that it is
midway and parallel to mean foundation planes
of the maxilla and the mandible.

 The compensating curve should be neutralized

so that posteriors are placed on a plane rather
than on spherical surface.
D) FORM

 Artificial posterior teeth should be devoid of

projecting cusps.

 Contacting occlusal lines should be on a

single plane.

 This arrangement will avoid interference from

TMJ and their inclines.
E) NUMBER OF TEETH

DeVan recommends reduction in no. of teeth

from 8 per denture to 6 per denture.

 This will aid in stability by freeing the lower

ridge molar incline of occlusion.

 Elimination of 2nd molar will result in

establishment of centralization and reduction in
occlusal area.
The 2nd category in monoplane occlusion involves
bilateral balance in centric and eccentric relations.

A) WITH COMPENSATING CURVE

Acc. to this concept –

a) No. of posterior teeth should be 3, i.e. mandibular
1st premolar should be omitted.

b) Antero-posterior comp. curve begins at the DMR

of the 2nd premolar and continues till 2nd molar.
The amount of this curve is dependent on steepness
of the condylar guidance, but is rarely more than
more than 20 degree from horizontal. This curve is
used to provide the needed tooth structure for
protrusive balancing contacts
c) Mediolateral compensating curve is also needed
to achieve lateral balanced contacts. This curve is
initiated from first replacement tooth and
continued till the second molar. The degree to
which the facial cusps are elevated to establish
this curve will vary with the condylar and incisal
guidances. The curve usually does not exceed 5-
10 degree.
 B) WITH BALANCING RAMPS
Balancing ramps provide a tripodization of the denture
base.
As the patient moves the mandible from centric relation
to protrusive or lateral positions, there is smooth
contact anteriorly on the teeth and posteriorly on the
ramps.
The balancing contacts
give improved Nimmo
horizontal stability to the art fig 2
dentures. Esthetics and
phonetics are greatly
enhanced because there
is more freedom in
placing anterior teeth.
The ramps can be developed after the final try-in
of the waxed dentures or at the time of
clinically remounting the dentures at the
insertion appointment
The procedure is performed on a properly
adjusted articulator.
This technique can be applied to existing dentures
by clinical remount.

Working contacts Balancing contact

C) WITH TILTING THE SECOND
MOLARS
Acc to C G Porter, mandibular second molar is
inclined to provide contact with maxillary
dentures in all excursions.
The maxillary molars are also inclined but left out
of centric contact.
He recommended the use of French
modified posterior teeth which have sub-
occlusal surfaces of mandibular buccal
cusps directing the occlusal force
downward and lingually.
 LINGUALIZED OCCLUSION
Acc. to GPT-8, lingualized occlusion is defined as the
form of denture occlusion in which the maxillary
lingual cusps articulate with the mandibular
occlusal surfaces in centric, working and balancing
mandibular positions.
Although S. H. Payne(1941) has being credited
for being the first one to describe, it was Gysi
who used this scheme approximately 20 years
earlier.
The advantages of lingualized occlusion are:
1) Occlusal forces can be directed lingually
without placing the teeth lingually
2) It is specially useful where esthetic
demands of the patient is high but
presenting oral conditions indicate non-
anatomic teeth, e.g., severe ridge
resorption, class II & III jaw relationships
and highly displaceable supporting
tissues.
3) The chewing efficiency is comparable to
anatomic (semi) and definitely superior to
zero degree teeth.
4) As mesiodistal locking is eliminated by
grinding the transverse ridges of the cusp teeth,
freedom is provided in the occlusion to
accommodate for the settling of denture base.
5) The lateral thrust control (during
functional and para-functional
movements) is provided by grinding the
buccolingual inclines, which is based on
the shape and prominence of the ridge
and its ability to withstand lateral forces.
6) The para-functional habits are usually confined
to a zone of activity around centric relation.
The lingualized occlusion provides for smooth
balancing contacts with excursive movements
of 2-3mm around centric relation, owing to
creation of common central fossa in mandibular
posteriors by selective grinding of transverse
ridges in the process of mesiodistal unlocking.
CHARACTERISTICS ANATOMIC LINGUALI NEUTRO
ZED CENTRI
C
ESTHETICS + + -
EASE OF + + -
PENETRATION
DENTURE STABILITY + + -
(in parafunct movt )
SIMPLER TECHNIQUE - + +
DECREASED LATERAL - + +
FORCES
EASE OF - + +
ADJUSTMENT
CLASS II & III CASES - + +
STABILITY WITH - + +
CENTRALIZED &
NEUTRALISED FORCE
 PLEASURE CURVE
In 1937, Dr. Max Pleasure described a reverse
occlusal scheme in which the posterior teeth are
set with buccal tilt providing total lever balance
during function.

But with this

scheme, there is no
buccal rise on
occlusal surface, so
a balancing contact
is not possible.
Later Pleasure himself modified his
occlusal scheme by incorporating both a
buccal tilt for lever balance, and lingual
tilt for occlusal balance.
This is called Pleasure curve.
Buccal tilt is given at the premolars , no tilt
at first molars and a lingual tilt to second
molars.
This scheme is specially beneficial for
patients with class II jaw relation.
The lever balance obtained in the premolar
area is nearly at the anterio-posterior
center of the denture foundation
coinciding with the zone where class II
patient functions during light to heavy
intermediate chewing.
The first molar occlusal surface directs the
force directly to the ridge .
Lingual tilt of the second molar provides a
buccal rise to its occlusal surface to
provide for a lateral balancing contact.

A compensating curve is developed in the

first and second molar area to provide for
protrusive balance.