A BALANCING

APPLIANCE

FOR COMPLETE

DENTURES

G. DAL PONT, M.D.D. Belluno, Italy

is commonly designated as lack of retention. Without a certain amount of vertical movement of the entire denture base corresponds to the soft tissue resiliency and may be considered physiologic. The movement on the soft tissues causes a hydraulic pressure phenomenon that favorably distributes the stress on the supporting hard structures.

V loss of retention,
INSTABILITY

EWICAL

INSTABILITY

DENTU:RE

A prosthetic restoration that rests on soft tissue follows certain physical laws that apply to a solid body floating on a fluid medium (mucous membrane). A peripheral force on the denture creates a turning :movement with a depression of the pushed side and a rising of the opposite side (Fig. 1). The first m.olar regions are of special importance in stability because they represent the transverse axis of the denture base. Because of the movements of torsion on this axis, the anterior residual alveolar base and the bone distal to the tirst molars atrophy to a greater extent than the Elone in the first molar regions.1 The most common means to reduce these denture movements are (1) positioning the anterior teeth so that there will be no interference with the lower anterior teeth during function and (2) the use of flat cusp teeth. Accordingly, various forms of posterior teeth have been developed (French, Sears, Hiltebrant, Heintz). Generally, the lower tooth has a narrow section that acts as a pestle on the upper tcsoth, which is concave and functions as a mortar (Fig. 2). It is impossible to transfer to dentures the laws that regulate natural teeth. The occlusal surface of a denture has little in common with that of natural teeth and must be considered functionally as a complete masticatory unit that can be stabilized only in its baricenter.213 G,ysis concept that centric occlusion is preserved by the contact of all artificial teeth with pronounced cusps has been reviewed. Mastication does not occur with teeth in contact. On the contrary, food is chewed with the teeth out of contact initially, the teeth approach each other closer during the trituration stage, and the teeth come automatically into centric occlusion at deglutition.2-5 One method of arranging the teeth consists of placing only the second bicuspids and first molars into occlusal contact. These teeth have special importance in the stability of complete dentures, since they are located where upper and lower alveolar ridges meet on the sagittal plane-the point which is the masticatory Saricenter (Fig. 3). The second molars are usNed only to increase the tissue support of the denture and do not make occlusal contact. The distal part of the
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A.

B.

Fig. 1.-A force acting on one end of a floating body creates a rotating movement. A, The displacing motion caused by a peripheral force on a Aoating body. I?, The analogous behavior of a complete denture supported on soft tissue.

Fig. 2.--The

posterior

teeth are designed to reduce denture

movements

on the supporting

tissues.

Fig. 3.-The solid line indicates the upper residual cates the lower residual alveolar ridge. The masticatory dental arches.

alveolar ridge; the line of dashes indibaricenter is the junction point of both

second molars is turned buccally to create more space for the tongue. The first bicuspids are placed out of occlusion approximately 0.5 mm., and the lower anterior teeth are placed 1 to 2 mm. from the upper teeth with sufficient vertical overlap that bala.ncing contacts are maintained in the protrusive movements (Fig. 4). Heintz2 states that even though occlusal contact takes place only on the masticatory center, almost all patients develop centric occlusion at this point in a short time.

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DAL PONT

May-June, 1961

J. Pros.

Den.

B.

Fig. 4.-A, The arrangement of teeth as suggested by Heintz permits occlusal contact only at the masticatory baricenter. B, The contact at the masticatory center is established with the balancing plates.

A.

p7

Fig. 5.-A, The dentures are in centric occlusion. B, A lack of balancing contacts in the protrusive position allows the posterior part of the denture to tip down. C, The balancing contacts in the p-rotrusive position are maintained by the balancing plates.

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BALANCING

PLATES

In an attempt to overcome the problems connected with denture displacement, balancing plates are placed in the occlusal surfaces of the tteeth in the masticatory centers. The purposes of the balancing plates are 1:1) better distribution of forces over the whole denture base (Fig. 4)) (2) better denture stability on the sagittal and frontal planes, during mandibular protrusion and incision (Fig. 5)) (3) better trituration of food even when flat cusp teeth are used, and (4) longer lasting denture stability because of diminished stress on the supporting tissues. I

t
Fig. B.--The

internal sections

of the

tpalancing

plate.

CONSTRUCTION

OF

BALANCING

PLATES

The balancing plate may be compared to a stress breaker. The device consists of a plate moving in an airtight case. Two springs are inserted inside the plates into cylindric holes in the base of the case. The springs hold the plate approximately 2.5 mm. out of the case when the jaw is in rest position (Fig. 6). During

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DAL PONT

J. Pros. Den. May-June, 1961

Fig. I.-The

external

view of the balancing

plate.

each masticatory stroke, the plate is pressed by the (opposing occlusal surfaces into its seat, and in the following opening of the jaws, the plate returns to the original position. Two metal cylinders are placed into the springs to eliminate dead spaces and prevent food stagnation in the appliance. The appliances are inserted in the lower first molars of complete dentures with self-curing acrylic resin so that the moving plate is just out of contact with the opposing teeth when the jaw is in rest position. The cusps of the upper first molars are ground to a.llow free movement of the balancing plates in lateral and protrusive mandibular excursions (Figs. 7 and 81
ADDITIONAL USES

The balancing: plates are useful for treating some nervous habits, such as bruxism, especially when their origin is the lack of confidence of the patient in the vertical stability of the dentures. The devices are indicated also for masticatory in-

Fig. 8.- The balancing

plates are inserted into the lower

first molar teeth.

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Number 3

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sufficiency caused by the use of cuspless teeth, muscular atrophy, or the inability of the supporting tissues to absorb the normal masticatory stress. Patients who wear dentures with balancing plates report improved functional ability in the mastkation of food.
SUM MARY

13alancing appliances that are inserted in the first molars of the lower denture have been described. The balancing plates improve the functional and biologic properties of the dentures.
REFERENCES

1. Frohlich, E. : Gewebsverlnderungen ald Folge schleimhautgetragener Prothesen, Deutsche zahn. Ztschr. 2:107, 1952. 2. Heintz, U.: Die totale Prothese in Lichte neuer Forschungen, Deutsche zahn. Ztschr. 1:35, 1952. 3. Ruspa, F. : La ritenzione della protesi totale, Riv. ital. stomat. 6:931, 1958. 4. Roberts, A. L.: Present-Day Concepts in Complete Denture Service, J. PROS. DEN. 6:9OO913, 1959. S. Felu-, C. : Kauflachengestaltung an totalen Prothesen, Deutsche zahn. Ztschr. 2:454, 1953.
PIAZZA MAZZINI BELLUN~, ITALY

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