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OCCLUSION IN COMPLETE DENTURE

PROSTHODONTICS
Dental science is founded for the most part on occlusion.
Occlusion in complete dentures has been a concern since ancient
times when attempts were made to replace lost teeth.
Teeth carved from ivory have been found in mummies dating
back to more than 2,400 years.
Occlusion is a factor that is common to all branches of dentistry.
One must not be deceived and overlook the fact that
accommodative process of nature enable some subects to
overcome certain obstacles and permit them to become
accustomed to things not perfect, so that wearing of denture made
with differing techni!ues is possible.
"t was #$ierre %auchard& 'The founder of modern dentistry(, who
also became the founder of modern prosthesis.
)enerally speaking occlude in medical science means to close.
Occlusion is the contact of lower teeth with the upper teeth.
Definition *O+$,
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Teeth whether natural or artificial are not immobile. .o occlusion
can never be considered a purely static relationship. /atural teeth
move in their sockets and change perceptibly from day to day.
0rtificial occlusion discloses even more apparent movement,
since the teeth move as group on a common base because of
nature of supporting tissues.
0rticulation definition *O+$,
+armonious function of complete dentures is the re!uirement
which e1hibits harmonious occlusal contacts in centric and
eccentric ma1illomandibular relations which is in harmony with
the neuromuscular mechanism and temperomandibular oint in
functional ranges of speaking, mastication and deglutition and
with parafunctional movements.
Therefore occlusion can be e1pressed as the product of occlusal
surfaces of the teeth *T,, muscle activity *2, and the movements
permitted by mandibular oint *3,.
%ormula is O 4 T23
"n complete denture prosthodontics, the dentist has the task of
restoring the occlusion. 0lmost all structures and records of the
natural pattern are permanently destroyed. There e1ists no
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vertical dimension, no centric relation inde1, no normal tonus of
the muscles of the masticatory system.
.o the dentist must establish a satisfactory occlusal pattern.
O+$ 5 Occlusal pattern
MASTICATION
"t is one of the main functions of the stomatognathic system. "t is
also an important factor and a stimulus for normal craniofacial growth.
"t is the first procedure in the process of digestion.
2astication is a learned process, principal masticatory organs are
T66T+. .econdary structures are the tongue, the lips and cheeks, and
the keratini7ed mucosa of the hard palate and the dentoalveolar
structures. 2asticatory structures are activated essentially by the
movement of the mandible, *thus permitting the teeth of the opposing
aws to occlude and produce mechanical reduction of si7e of the food
particles,.
6nergy of this system is supplied by powerful masticatory
muscles, which are8
9 2asseter and medical pterygoid muscles.
9 Temporalis and lateral pterygoid.
:
9 Diagastric, geniohyoid and mylohyoid.
O+$ 5 differences between natural and artificial occlusion.
O+$ 5 ;e!uirements of <D occlusion.
Development of artificial teeth
.earch for an ideal artificial tooth that would provide ma1imum
denture stability and masticatory efficiency and still provide acceptable
esthetic and wearing !ualities has been going on for several centuries.
0mong the principal contributors in the development of posterior
denture teeth of different occlusal forms in last =0 years have been searr,
)yri, +all, %rench and +ardy.
0ll these teeth can be mainly divided into8
-. 0natomic teeth.
2. /on9anatomic teeth.
0natomic tooth is one that is designed to stimulate the natural
tooth form. "t has cusp heights of varying degrees of inclination that will
intercuspate with an opposing tooth of anatomic form. .tandard
anatomic tooth has inclines of appro1imately ::>< or more.
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?hen the cusp incline is less steep than the conventional
anatomic tooth of ::> it can be classified as modified or semianatomic
tooth.
0 non9anatomic tooth is essentially flat and has no cusp heights
to interdigitate with an opposing tooth, occlusal surface is composed of
varying designs of flat planes and sulci to enhance its comminuting
effect.
O+$90natomic and non9anatomic teeth.
Occlual Scheme ue! in complete !enture
Dentures are mechanical devices and are subect to principles of
physics *mechanics,, i.e., inclined plane and liver. These forces will
operate whether or not we recogni7e them. ;ather than let them operate
uncontrolled, it is the responsibility of the dentist to control them in
order to enhance function, stability and comfort.
O+$9 0natomic teeth 5 indications, advantages, disadvantages
semianatomic and non9anatomic teeth 5 "ndication, advantages,
disadvantages.
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CONCEPTS O" OCCLUSION
$hilosophy is an art of forming, inventing and fabricating
concepts. <oncept is a logistic application. <oncepts of occlusion for
complete dentures fall into two broad categories8
-. /on9balanced occlusion.
2. @alanced occlusion.
Non #alance! occluion
a, .pherical theory.
b, Organic occlusion.
c, Transiographics.
d, /eutrocentric occlusion.
O+$ 5 /on balanced occlusion emphasi7es that8
a$ Spherical theor% &'on Spee$
The lower teeth move over the surface of the upper teeth as over
the e1ternal surface of the sphere with a radius of 4 inches. Therefore, it
involves the positioning of teeth with anteroposterior and mediolateral
A
inclines in harmony with the spherical surface. "t is sometimes referred
to as having monsoon curve.
#$ Or(anic occluion
"t is that aw movement where in any aw movement away from
centric occlusion will result in separation of all posterior teeth. "t was
achieved by contouring the cingulum of anterior teeth. The aim of this
occlusion is that muscles and oints should determine the mandibular
position without tooth guidance.
c$ Neutrocentric concept &Devan$
"t maintains that antero9posterior plane of occlusion, should be
parallel with plane of denture foundation and not dictated by hori7ontal
condylar guidance. Thus the teeth are not inclined to form compensating
curves.
)ALANCED OCCLUSION
@alanced occlusion involves a definite arrangement of tooth
contacts in harmony with mandibular movement. "f the positions,
dimensions and occlusal surfaces of the teeth are such that during
functional aw movements, mandibular cusp blades contact ma1illary
cusp blades throughout, those dentures can perform their masticatory
B
function most effectively and their occlusion may be termed as #$lanned
occlusion or @alanced occlusion&.
O+$ 5 @alanced occlusion.
@alance in complete dentures is uni!ue and man made. "t does
not occur in natural teeth and is not needed, since each tooth is
supported independently. 0n average edentulous patient does and not
re!uire a balanced occlusion in order to wear a prosthesis successfully.
"n certain individuals with a low pain threshold, unusual
masticatory habits and or eccentric non9masticatory movements,
dentures will not be tolerated unless the occlusion established
accommodates their idiosyncraces, in such cases balancing is
imperative. ?hen forces act on a body in such a way that no motion
results there is balance, or e!uilibrium. This should be the primary
consideration of the dentist when considering forces that act on teeth
and the denture bases. 0 stable base is the ultimate goal. Total stability
is not possible because of yielding nature of supporting tissues.
+owever the physical factors that apply to the relationship of the teeth to
each other and to the position of the teeth in the denture base as related
to the ridge must be understood.
O+$9 factors.
O+$ 5 unilateral lever balance.
C
Dnilateral occlusal balance.
@ilateral occlusal balance.
$rotrusive occlusal balance.
Obectives of balanced <D occlusion.
$arameters to success of occlusal balance.
Determinant or la* of protruive occluion
-, <ondylar guidance8 "t is the posterior and
controlling factor of mandibular or articulator movements. "t is the
mechanical e!uivalent on the articulator. "t is the guiding influences
to the condylar of the mandible during eccentric aw movements. "t
represents the angle of downward and forward movement of the
condyles relative to a1is orbital plane. This factor is obtained by
means of protrusive registration. The pathways followed by the
condyles are inherent for the patient and are not under the control of
the dentist.
2, "ncisal guidance8 "t is the anterior end controlling
factor. *"t is the gliding influences, which results from the positional
relationship of upper and lower anterior teeth when the mandible is
moved into eccentric relation to the ma1illa while the anterior teeth
remain in contact,.
E
"ncisal guidance influences the protrusive articular movement and
is interdependent with condylar guidance. "t should never e1ceed the
condylar guidance.
"n short, it is the effect that the contact of upper and lower
anterior teeth have on movement of mandible. "t depends on the e1tent
to which the upper anterior teeth overlap the lower anterior teeth in both
hori7ontal and vertical direction. "t is e1pressed in degrees of
angulations from the hori7ontal by a line in the sagittal plane between
the incisal edges of upper and lower incisal teeth when closed in centric
occlusion.
The greater the vertical overlap of anterior teeth, the steeper the
incisal guidance and greater separation will occur between posterior
teeth on a forward movement. "f the incisal guidance is steep, it re!uires
steep cusps, a steep occlusal compensating curve to effect an occlusal
balance. This type of occlusion is detrimental to the stability and
e!uilibrium of denture base. %or complete dentures the incisal guidance
should be as flat as esthetics and phonetics will permit.
<hristianson(s phenomenon8 it is best demonstrated when the
ma1illary and mandibular occlusal rims are used when making a
protrusive haw registration for complete dentures. <ompensation for the
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phenomenon during balanced articulation may be made by the
adustment of all the features e1cept condylar guidance.
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+$ Plane of orientation or occluion
The inclination of plane of occlusion is generally established in
the patients mouth in reference to ala9tragal line or campers line and on
the articulator in reference to facebow mounting. "ts position can be
slightly altered without creating serious problems.
,$ Cup Hei(ht an! inclination
These are important determinants as they modify the effect of
plane of occlusion and the compensating curve. <uspal inclination refers
to the angle between the total occlusal surface of the tooth and the
inclination of cusp to that surface. The inclination of the cusp is made
steeper when the distal end of a lower tooth is set9higher than mesial
end. The tipping of teeth can produce a compensatory curve and make
the effective height of the cusps greater or less.
-$ Compenator% curve.
"t refers to the anteroposterior and lateral curve produced in the
alignment and arrangement occluding surface and incisal edges in
artificial teeth. "t compensates for the opening called as <hristiansen(s
phenomenon.
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<urve of .pee refers to anteroposterior compensating curve. "t is the
anteroposterior curved arrangement of the occlusal surfaces and incisal
edges of natural teeth in sagittal plane when viewed from buccal aspect.
2ediolateral curve or curve of ?ilson is the transverse curve made by
lingual inclination of posterior teeth. "t was called as 2anson(s curve in
the past.
)ennet Shift.
"t is the bodily lateral movement or lateral shift of the mandible
during lateral aw movement. "t is the movement responsible for lateral
chewing stroke and the movement during which the greatest lateral force
is e1erted. %or this reason it is e1tremely important that the articulating
surfaces are in strict harmony with the side shift, if not any discrepancy
will result in most destructive lateral forces.
)alancin( Ramp in Non/anatomic CD occluion &OHP$
/on9anatomic teeth have no cusp inclines. Therefore balancing
contacts must be obtained by other means. "t can be achieved by the use
of customi7ed balancing ramps placed posterior to the most distal
mandibular molar.
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@alancing ramps provide a tripodi7ation of dentures as the patient
moves from centric position to protrusive or lateral positions.
+ence with various philosophies and concepts putforth, one could
conclude that8
-. There is no method to ascertain that any one concept of occlusion
will satisfy all the re!uirements of edentulous patients.
2. There is no method to ascertain that any particular form of
posterior tooth is more efficient than the other form.
:. "t is not possible to predict reaction of basal seat tissue to
complete denture treatment.
4. <linical observation and evaluation should be classified out
precisely.
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