CENTRIC AM) ECCENTRIC OCCLUSIONS

VICTOR H. SEARS, D.D.S.

Vallejo, Calif.

of the lower with the upper occlusal surface. Occlu-

0 CCLUSION IS ANY CONTACT
sion may be balanced or unbalanced. Balanced occlusion in centric position
exists with simultaneous contact of the right and left occlusal surfaces when the
teeth are in centric occlusion. Balanced occlusion in lateral position is present with
simultaneous contact of right and left opposing occlusal surfaces when the lower
teeth are moved sideways. Balanced occlusion in protrusive position exists with si-
multaneous contact of the front and back opposing surfaces when the teeth are
moved sagittally. These criteria of balanced occlusion apply to both natural and
artificial teeth. For artificial teeth, they apply to both anatomic and nonanatomic
forms.

APPLICATION ,ACCORDING TO THE SITUATION

The principles of tooth occlusions are the same in all branches of dentistry, but
their application differs according to the situation. Perhaps the greatest difference
of application exists between orthodontics and complete denture prosthodontics.
Essential differences between the two situations have been pointed out,l but
they are given again as a basisfor discussion:
1. Individual natural teeth are held by fibrous attachments in sockets of bone,
whereas prosthetic restorations rest on slippery surfaces.
2. Individual natural teeth move slowly, whereas prosthetic restorations can
be dislodged instantaneously.
3. Individual tooth movement is possiblewith natural teeth, whereas the entire
prosthetic restoration moves as a unit.
4. Malocclusions of natural teeth, especially in young patients, may exist for
years without apparent injury. The samemalocclusions in complete dentures usually
manifest themselvesin a few hours.
5. Malocclusion of a natural tooth is detrimental to its immediate investing
tissues. Malocclusion of a tooth on a complete denture is detrimental to the support-
ing tissuesat other sites than the one underlying the malocclusion.
6. Horizontal pressure from the lingua1 side of a natural upper crown has no
effect on the teeth on the opposite side, whereas such pressure on a prosthetic res-
toration tends to push the teeth on the opposite side horizontally.
7. Vertical pressure on the lingual cusp of a natural tooth has no effect on
the teeth of the opposite side, whereas such pressure applied on the lingual side of
the ridge crest on dentures tends to press the opposite side more firmly toward the
Read before the San Diego County Dental Society, San Diego, Calif.

1029
tissues. Vertical pressure applied on the buccal side of one ridge crest tends to teeter
the dentures, lifting them from the supporting tissues of the opposite side.
8. Interceptive contact of incisors in protrusion has no immediate effect on the
natural posterior teeth, whereas such contact of prosthetic restorations tends to lift
the posterior teeth of both dentures from their supporting ridges.
9. Interceptive contact of second and third molars has no immediate dislodg-
ing effect on the other natural teeth. However, such contact of prosthetic restora-
tions tends to slide the lower denture anteriorly and to lift the anterior teeth from
their supporting ridges.
10. Natural teeth in centric occlusion meet their antagonists throughout the
entire extent of the dental arch, whereas in complete dentures only those teeth near-
est the center of the denture foundation should meet their antagonists.
The problems of balanced occlusion should be treated from different stand-
points because of these differences. An early appreciation of the mechanical ‘re-
quirements for different oral situations better equips the dentist to meet the prob-
lems of tooth form and tooth placement.

ANATOMIC OCCLUSION

The logical place to teach anatomic occlusion is in the department of ortho-

dontics or, better still, in an autonomous department of dental occlusion. This is
the logical place where the instructors are capable of teaching all phases of occlu-
sion with natural teeth. Such instruction would require the use of a highly adjusta-
ble mechanism for controlling the movements of the lower cast of the teeth.
Before deciding the new positions of the individual teeth, the orthodontist
should mount the casts on a suitable dental articulator and adjust the mechanism to
the recorded or anticipated2 centric and eccentric jaw relations of the patient. Test-
ing occlusions with dentures or casts of natural teeth merely held by hand is un-
scientific. Indeed, the anatomic occlusal forms of natural teeth with which the ortho-
dontist deals require more versatile and more exacting articulator adjustments than
do artificial teeth designed especially for the edentulous situation.
The orthodontist is bound by certain anatomic features which have little per-
tinence in denture work. He should align the teeth for pleasing appearance, chew-
ing efficiency, and preservation of the periodontal structures with due regard for
the integrity of the temporomandibular joint and associated structures.

PROSTHETIC OCCLUSION

Until the dental schools in the United States establish autonomous depart-
ments of dental occlusion as has been done elsewhere, the departments of prostho-
dontics must teach the essentials of both natural and nonanatomic tooth forms and
tooth positions.
Some of the essentials of tooth occlusion in the making of complete dentures
are (1) smooth-gliding opposing surfaces, (2) absence of interference in horizontal
movement, (3) lever balance, (4) balanced occlusion in centric position, and (5)
balanced occlusion in the eccentric positions. Tests in many hundreds of mouths
leave little doubt that all five of these are important. However, only the require-
ments of balanced occlusion in centric and eccentric positions will be discussed.
Volume 10
Number 6
CENTRIC AND ECCENTRIC OCCLUSIONS 1031

MERITS OF I’ROSTHETIC BALANCED OCCLUSION

It is sometimes claimed that there is no need for eccentrically balanced occlu-

sions for complete dentures. Some theoretic considerations are involved, but ,the
best way to resolve this question is to make tests in the mouths of patients. The
tests should be for comfort, stability, and efficiency of the dentures, and subse-
quently for the condition of the tissues underlying the dentures.
With respect to bilateral balanced occlusion, it has been argued that because
the teeth of the balancing side are held apart by food on the working side, the
balancing surfaces have no effect. A phrase has been coined to bolster the argu-
ment-“enter bolus, exit balance.”
Whatever validity there may be to the argument of “enter bolus, exit balance,”
carefully conducted tests show that dentures can be made more satisfactory by bal-
ancing the occlusion in all functional jaw relations. On inserting dentures with
newly balanced occlusions, it is not uncommon for a patient to remark, “You tight-
ened them, didn’t you ?” This reaction should not be surprising, because if every
closure brings the right and left sides together simultaneously, the dentures are
pressed evenly against their basal seats.
In many hundreds of tests, most patients reported increased comfort and sta-
bility of dentures with balanced occlusions. A few patients noticed no difference, but
none found the change detrimental. Part of the explanation for the lack of unanimity
is that other variables were present, such as smooth gliding of opposing surfaces,
absence of cuspal interference, and lever balance.

BALANCED OCCLUSION IN GENERAL

Centric occlusion is the contact position of the lower teeth against the upper
teeth at which all horizontal centripetal movements end. Any horizontal deviation
from this position results in eccentric occlusion. Centric occlusion of the teeth
should coincide with centric jaw relation. Although the two positions can be ma.de
to coincide exactly with each closure on a sturdy articulator, this is not true in the
patient’s mouth.
The mandible is not a part of a precision machine and does not always close
at exactly the same place .4 Leaning the head will cause the mandible to close some-
what in the direction of the lean.5 Even without this tilt there is often a slight shift
away from the “center” position. Posselt writes of his tests, “. . . In no case were
the functional positions situated on the hinge movement paths.“B
A degree of freedom should be provided in the occlusion at centric jaw relation.
The opposing teeth should meet in a restricted area rather than at a point. This pro-
vision is especially important if cusp inclines are present to cause horizontal shifting
of the dentures when the teeth are closed away from the exact centric occlusion.

NONCHEWING OCCLUSION

This horizontal freedom of movement near centric occlusion is especially im-

portant when no food is present. There are two phases of balanced occlusion. The
first and perhaps the more important phase pertains to tooth occlusion without in-
terposed food. The second phase pertains to tooth occlusion with interposed food.
1032 SEARS J. Pros. Den.
Nov.-Dec., 1960

Fig. l.-The anatomic scheme of occlusion maintains all of the upper lingual cusps in contact
with the lower buccal cusps on the balancing side.

One reason that balanced occlusion is important in the absence of food is

that the teeth are brought together so frequently between meals. Since closures
are not always at the same horizontal position, it is necessary to give attention to
the occlusions that occur “at and near” centric jaw relation. The beneficial effect
of balanced occlusions “at and near” centric jaw relation in the absence of food
may explain why some dentists who use flat plane teeth have questioned the value
of balanced occlusion in eccentric positions. 7*8 When flat plane teeth are balanced
at the exact centric position, they are almost of necessity also balanced in the slightly
eccentric positions.
The same statement cannot be made for opposing teeth with cusps that mesh.
The steeper the cuspal inclines and the more precise the meshing, the greater is the
dislodging effect when the teeth occlude in eccentric occlusions. It is because of this

Fig. Z.-Not all of the posterjor teeth are necessary to maintain balanced occlusion on the
balancing side. The removed teeth are not necessary to ensure balancing contacts.
 CENTRIC AND ECCENTRIC OCCLUSIONS 1033

Fig. 3.- With flat plane teeth, the upper bicuspids are not needed for lateral balancing contacts
and are arranged to assure greatest denture stability in the working position.

dislodging effect with precisely meshing teeth that the rotary grinder mounted on
the articulator assures the patient more comfortable and more stable dentures.”
When the clearance produced by the rotary grinder is enough to accommo-
date the slightly eccentric closures of the teeth in the absence of food, the harmful
effects of meshing teeth are partly overcome. The improvement obtained with a
rotary grinder is greatest in dentures with tightly meshed steep cusps.

LATERAL BALANCED OCCLUSION

In this discussion, it will be assumed that centric occlusion of the teeth is in

harmony with centric jaw relation and that lateral jaw relations produced cor-
responding lateral tooth occlusions.

Fig. 4.-The upper bicuspids and the upper second molar, as well as the lower bicuspids and
Arat molar, have been removed to show that a protrusive balancing contact can be obtained with-
out them.
 J. Pros. Den.
Nov.-Dec., 1960

Balanced occlusion in lateral positions is produced by causing some surface

on the balancing side to maintain contact while the teeth of the working side are
together. With cusp teeth, it has been standard practice to maintain the lingual
cusps of all of the bicuspids and molars of the balancing side in contact (Fig. 1).
However, this is not necessary. The lower second molar and the upper first molar
are the only teeth needed to maintain lateral balancing contacts (Fig. 2).
With flat plane teeth, balanced occlusion in lateral positions is assured with
the same two molars (Fig. 3). The lower first molar and all of the bicuspids can
then be set to their best positions for chewing without having to tilt them at
undesirable angles. It is clearly an advantage to set the working surfaces independ-
ently of the balancing surfaces so that each tooth can best discharge its function.

Fig. 5.-Flat plane posterior teeth are set so that the lower second molar and the upper
first molar maintain protrusive balancing contact. The other teeth are set independently to
assure greatest denture stability when they are in the working positions.

The upper second molar should be out of contact in all or nearly all of its
occlusal surface. Because occlusal pressure on the lower second molar is unfavor-
able to denture stability except when this tooth is used to produce lateral and pro-
trusive balancing contacts, the upper second molar should ordinarily be omitted
or made subocclusal.10Omitting the upper second molar makes it possible for the
lower second molar to maintain a balancing contact in the protrusive and lateral
positions without carrying any of the load at the centric position,

PROTRUSIVE OCCLUSION

The need for balanced occlusion in full protrusion is less imperative than
that of the centric and lateral positions. However, this contact is easily obtained
with either flat plane or cusp teeth.
Although a protrusive balancing contact in the position of incision is me-
chanically advantageous, sometimes the full advantage cannot be attained because
of’ conflicting requirements of appearance. When the anterior teeth are set with
E:E,“,‘6” CENTRIC AND ECCENTRIC OCCLUSIONS 1035

considerable vertical overlap for esthetic reasons, it is sometimes not advisable to

produce balanced occlusion in full protrusion. The dentist must decide whether
to give dominance to esthetics or mechanics. This holds true with flat plane teeth
as well as with cusp teeth.
As with balanced occlusion in lateral positions, the key teeth for balanced
occlusion in protrusive positions for both anatomic and nonanatomic schemes of
occlusion are the lower second molar and the upper first molar. All of the other
posterior teeth can be disregarded in this connection (Figs. 4 and 5).
The lower second molars, as they glide on the upper first molars, produce
balanced occlusions in all eccentric positions. The lingual tilt of the lower second
molar assures a lateral balancing contact, while the anterior tilt produces a pro-
trusive balancing contact.11v*2

SUMMARY

The problems of occlusion extend into nearly all branches of dentistry. While
the principles involved are the same, their application should be different according
to the situation. The dentist should not fall into the error of trying to make the
same application in all situations.
The examples of orthodontics and prosthodontics show the need for recogniz-
ing the similarities and the differences in applying the same principles to different
situations. Such recognition should bring about more realistic teaching in the
dental schools and more rational procedures in dental practice.
The occlusion for complete dentures should be balanced “at and near” centric
jaw relation for protection of the ridges when there is no interposed food. With
cusp teeth, this balanced occlusion “at and near” centric relation is obtainable with
a rotary grinder. With flat plane teeth, this mechanism is not needed. The occlusion
should be balanced at habitual lateral relations used in chewing as well as some-
times in the protrusive position.
Using only the lower second and the upper first molars for establishing lateral
and protrusive balancing contacts solves the problem of maintaining balanced occlu-
sion in eccentric positions. At the same time, this method permits the independent
arrangement of the other teeth for better direction of the closing force during
chewing.

REFERENCES

1. Sears, V. H. : Occlusion: The Common Meeting Ground in Dentistry, J. PROS. DEN.

2:15-21,1952.
2. Sears,V. H. : MandibularCondyleMigrationsas Influencedby Tooth Occlusions,J.A.D.A.
45:179-192,1952.
3. MacMillan, H. W.: Clinical Application of Unilateral Balanceto Prosthetic Dentistry,
J.A.D.A. 18:1029-1034Z 1931.
4. Moyers, R. E.: SomePhysiologic Considerations of Centric and Other Jaw Relations,
J. PROS. DEN. 6:183-194,19.56.
5. Sears,lY9H.: Suggestions for Accurate Preparationfor Plate Work, D. Digest 25:82-86,
6. Posselt,U:: Occlusal Relationshipin Deglutition and Mastication, Transactionsof the
EuropeanOdontologicalSociety,1958.
7. DeVan, M. M.: An Analysis of StressCounteractionon the Part of Alveolar Bone,With
a View to Its Preservation,D. Cosmos77:109-123,1935.
 J. Pros. Den.
1036 SEARS Nov.-Dee., 1960

8. Kurth, L. E.: Methods of Obtaining Vertical Dimension and Centric Relation: A Prac-
tical Evaluation of Various Methods, J.A.D.A. 59:669-673, 1959.
9. Upp, R. W. : U. S. Patent No. 1,180,745, April 25, 1916.
10. Sears, V. H.: Let’s Sink the Upper Second Molar, Cal, March, 1942, pp. 8-10.
11. Sauser, C. W.: Posterior Occlusion in Complete Denture Construction, J. PROS. DEN.
7:456-464, 1957.
12. Nepola, S. R.: Balancing Ramps in Prosthetic Occlusion, J. PROS. DEN. 8:776-780, 1958.
646 WASHINGTON ST.
VALLEJO, CALIF.

MODERN EQUIPMENT HELPS DENTISTS TREAT MORE PATIENTS

High-speed cutting instruments are enabling dentists today to treat more patients in less
time and in more comfort, both for dentist and patient, according to the American Dental
Association,
Reporting on a newly released survey of dental practice, which was conducted for 1958, the
Association said two of every three dentists reported having high- or super-speed cutting
instruments.
The instruments are classified in four speeds: low (under 10,000 revolutions per minute),
intermediate (10,000 to 30,000 rpm), high (30,000 to lOO,@O rpm), and super (over 100,000
rpm). Until after World War II, almost all dentists used low speed.
In the current study, nearly half of the dentists reported using super speeds while two-thirds
reported either high or super speeds. Younger dentists tend to use high and super speeds most
often.
Concerning the effects of the speeded-up instruments, more than half of the dentists who re-
sponded found it enabled them to treat more patients, one-third found it reduced office hours,
and a significant number found that it did both. It was also emphasized that patient comfort was
greatly increased and dentist fatigue greatly lowered.