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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
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
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
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.
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.
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
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
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
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.
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.