prosthodontics

You have already know about the selection of teeth. And we are ready to move to the next step:

teeth setting
*upper anterior:
1) Setting of upper central incisor:

A) tooth from the front: the long axis of the tooth diverges slightly from the midline distally and
the incisor edge contact the occlusal table or the horizontal plane, the incisal edge touches the
occlusal plane

B) Tooth from the side: the neck of the central incisor is depressed by 2mm and that create and
angle with vertical plane, and the incisal edge is in line with wax rim.

2) Setting of upper lateral incisor:

A) Tooth from the front: the incisal edge is shorter than the occlusal table by 1 mm, the long axis
is incline more distally than the central incisor.

B) Tooth from the side: the neck of the lateral incisor is more depressed than the central incisor
that create an angle more than that create in the central incisor with vertical plane. So will give
us labial inclination of the tooth.

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3) Setting of upper canine

(Placed at the angle of the mouth)

a) Tooth from the front: the long axis is almost upright, diverges slightly distally.

b) Tooth from the side: the long axis of the tooth is perpendicular on the horizontal
table. And the cusp of the canine touching the occlusal table.

*you can see here the different of inclination between the anterior teeth:

Tooth from the

A B C side:
A) Central incisor

B) Lateral incisor

C) canine

Tooth from the

side:
A) Central incisor
B) Lateral incisor
C) canine

*harmony in the general arrangement of anterior teeth with esthetics

appearance of patents face:
-harmony of the incisal show and the patient age: younger patient shows more incisor
than the older patient.

-harmony of teeth with smiling line of the lower lip: if we extend a line between upper
canine to the other canine should be curved in a similar way to the curvature of the
lower lip regardless of the shape of the upper lip, also the vertical positioning of upper
canine is responsibly for shape of smile line because this line extend from the canine cusp
tip of one side to canine cusp tip to other side; and it should also touches the incisal
edges of central incirsors.

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-harmony of the dental arch form and the form of the residual ridge, the arrangement of
the teeth must be follow the shape of the arch:

arch is square in shape: the central incisors and canine are set on one line; to fit
the shape of dental arch
Arch is taper in shape: the incisors are a greater distance forward from the
canines; and have to be a rotational and lapping of the teeth.
Arch is ovoid in shape: the relationship between the incisor and canine is more
flat, and no rotation because the arch is wider; so it can take more teeth
without rotation of lateral incisor.

Square form

taper form

Ovoid form

-harmony of the long axis of the teeth (central incisors) with the long axis of the
patients face; to give esthetics appearance.to the patient.

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-harmony of the long axis and the midline: asymmetrical symmetry: when we look at the left
side and the right side, they are asymmetrical (not symmetry), but they are symmetrical in
another way; for example: if we look at the right lateral long axis, its slope distally, and when
we look at the left lateral long axis its slope as well distally to the other side (mirror image).

-harmony of the opposing labial and buccal long axes of teeth; setting teeth with long axis
parallel to each other.

-harmony of the long axis between upper and lower teeth; when we look at the long axis of the
lower tooth, its slope distally as well upper tooth so the long axis just appear a continuous line
between upper and lower tooth.

*Lower anterior:
Lower Central incisors:

A) Tooth from the front: the long axis is almost vertical and slight mesial inclination to the
midline (according to incisal edge), less distal inclination than the lateral and canine
(according to root).
B) Tooth from the side: its position labially; which makes an angle with the perpendicular
plane.

Lower lateral incisor:

A) Tooth from the front: the long axis is slightly incline mesially (according to incisal edge),
little distal inclination (according to root).
B) Tooth from the side: the long axis is vertical to the perpendicular plane.

Lower canine:

A) Tooth from the front: the long axis is slightly incline mesially (according to incisal edge),
and more distal inclination (according to root).
B) Tooth from the side: the cusp of canine is depressed lingually.

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 *the cervical third of the canine is prominent because the tooth has lingual inclination,
the tip of the tooth is more depressed lingually.

**Two relationship between upper and lower teeth which are:

1) static: A)vertical overlap (overbite) ,B) horizontal overlap (overjet) between upper
central incisor and lower central incisor.
2) dynamic: during functioning and during (protrusive movement) lower central incisor
slide again on palatal surface of the upper central incisor which is Incisal guidance
(incisal edge of the upper incisor and the incisal edge of the lower incisor) or (is the path
on the lingual surface of the maxillary anterior teeth along which the mandibular
anterior teeth glide).
Incisal guidance angle: angle between the incisal guidance and the horizontal plane.so
in the complete denture we need this angle shallow as much as possible it shouldnt be
greater than 15 degree. If its greater than 15 degree will make a separation of posterior
teeth.(balance occlusion.

-the incisal guidance angel depend on vertical overlap (overbite) or the

horizontal overlap (overjet) between the upper and lower incisors, so if they
change, the angle will be different. (the dimension of the triangle will change
so the angle also will change.

**Two relationship and the eccentric occlusion between upper and lower
teeth; how should the upper and lower anterior teeth be arranged:

Anterior teeth are set with a minimal overlap(over bite) for about .5-1 mm, and the
overlap(overjet) around 1-2 mm to make an incisal angle as shallow as possible.

No contact between upper and lower anterior teeth; there is a separation between them no
contact at centric acclusion; equidistance overjet; we measure horizontal overlap from the
lower canine to the upper canine ,from the lower lateral to the upper lateral , from the lower
central to the upper central, to the other side must be equal. (even distance from the left side to
the right side).

Shallow incisal guidance: is to enhance intra stability when we talk about balance acclusion.

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 Here we are talking about the overbite and overjet which interact with each other
to give us incisal angle:

-the triangle at the central: forming an angle 15 degree

-the triangle at the upper right: overjet increase and the overlap fixes; the angel is reduced.

-the triangle at the upper left: overjet fixed and the overbite decrease; the angle is reduces.

-the triangle at the lower left: overjet fixed and the overbite increase; the angle is greater.

-the triangle at the lower right: overjet decrease and the overbite decrease; the angle is
greater.

In order to obtain a shallow incisal angle; either increase overjet or decrease overbite.

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*upper posterior:
First premolar:

A) Tooth from the front: the long axis is perpendicular to the horizontal plane or occlusal
table.
B) Tooth from the side: we can notice that the buccal cusp touching the horizontal plane or
occlusal table while the palatal cusp is shorter than the buccal cusp or there is a space
so it doesnt touch the horizontal plane or occlusal table (refer to arrow).

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Second premolar:

A) Tooth from the front: the long axis is perpendicular to the horizontal plane or occlusal
table.
B) Tooth from the side: we can notice that the buccal cusp and the palatal cusp are in
contact with the occlusal table or the horizontal plane. (Refer to arrow).

First molar:

A) Tooth from the front: the long axis is slope distally (according to crown) and
mesially (according to root).
B) Tooth from the side: all the cusps are not contact with the horizontal plane
except mesiopalatal cusp; so the mesiobuccal cusp is about 0.5mm higher than
the occlusal table while the distobuccal cusp is much higher than the MBC;
around 1mm.

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 First premolar and second premolar and the first molar from the occlusal
surface:

A line: line extend and touch the buccal surface of the first premolar and second premolar and
the MB surface of first molar, and this line will continuous with the distal surface of the
canine.(refer to arrow)

That mean there is a continuation of arrangement or arch shape between the anterior
teeth and the posterior teeth.

Second Molar
- Long axis slopes buccally (because we can see the occlusal surface) a bit more than first molar
(front view)

- Long axis slopes distally a bit more than first molar (side view)

- All four cusps do not touch the lower occlusal rim but the mesiolingual cusp is the nearest.

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B- LINE
This second line contacts buccal cusps of first molar with
buccal cusps of second molar.
The two lines (A & B) will achieve the curve of the arch
that is required.

SETTING MANDIBULAR TEETH - GENERAL STEPS TO ACHIEVE

Long axis of all lower teeth must be perpendicular to the occlusal table which
means no inclination in all posteriors
these teeth are set in centric occlusion (maximum intercuspation/contact
between upper and lower teeth). No spaces should be seen specially in posterior
teeth, but the over-jet should be present anteriorly (prevent cheek biting).
in order to produce this max intercuspation, you either reduce marginal ridges of
upper and lower teeth, or slight spacing in upper teeth.
should allow sufficient, equidistant buccal over-jet in order to prevent cheek
biting.
we always start with the lower first molar in setting
lower first molar is placed over the crest of the lower ridge and its central fossa
occludes with the mesio-palatal cusp of the upper first molar
You need to look at the relationship between upper and lower teeth in centric
occlusion (table in the slides). For example: (1)palatal cusp of upper first
premolar occludes with the distal triangular fossa or distal marginal ridge of
lower first premolar (note that we talk about maxillary lingual cusps because
they are the functional cusps of upper teeth).
(2) For second premolar, palatal cusp of upper tooth contacts distal triangular
fossa of lower second premolar (3) For the first molar, the mesiopalatal cusp of
the upper contacts central fossa of lower first molar and the distolingual cusp of
the upper contacts distal marginal ridges of lower first molar and mesial
marginal ridge of second molar.

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Compensating curves: Two curves created in artificial teeth
while setting to stimulate curve of spee and Monson, as they exist
naturally. Those two
cruves are: A =
Anteroposterior curve
similar to curve of
spee, B= lateral curve
similar to curve on
Monson

LATERAL CURVE ANTEROPOSTERIOR CURVE

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BALANCED OCCLUSION AND ARTICULATION

It's a good idea to revise on the meaning and

significance of incisal and condylar guidance now.
Imagine those vehicles following the path of the
road (its curvature). The same situation occurs
when the mandible protrudes. The condyle will
have to follow the path of the fossa going down
and forward in order to produce the protrusion.
That's the condylar guidance.

Next, lets say after those cars moved in the curvature, a bump
faced in their way. This bump represents the sliding of mandibular
teeth on the lingual surfaces of maxillary teeth. That's the incisal
guidance. This incisal path should achieve a certain criteria in
order for the success of denture. Let's take an example, if the
sliding was so steep,

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then the lower posterior teeth will not contact the upper, and so
the denture will dislodge. No stability was provided

This means that we should be careful about producing the

required incisal guidance angle, which should be a shallow angle.
Controlling of the over-jet and over-bite will produce the required
incisal guidance angle as we said earlier.

The thing is that why do we care for incisal guidance and condylar
guidance? The answer lies behind that the mandible in real life is
not static, but is dynamic. Think about grinding food, which
produces dyamic mandible movement involving protrusion and
lateral movements. Those are the horizontal movements
produced (lateral + protrusive movements i.e. eccentric). Vertical
movements also take place.

So let's talk a bit more about the horizontal relations (centric and
eccentric relations). Centric relation have many definitions, but a

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simple one describes the position of the maximum retrusion of
the mandible in which lateral movements can be produced. It may
or may not coincide with maximum intercuspation. While
producing the complete denture, we do it so that centric relation
= maximum intercuspation.

The eccentric relations describes the lateral and protrusive

movements produced as mentioned.

Now let's go back to our main topic concerned with balanced

occlusion. In order for all those dynamic movements to be
achieved and be successful, we must ensure that the denture
remains stable and does not dislodge by keeping teeth in contact
together to provide support.

Balanced occlusion means that there should be a bilateral, even

contact between upper and lower teeth in the intercuspal
position i.e in a static position. In other words, it's also called a
simultaneous contact.

In average value articulator, we obtain the balanced occlusion but

not the balanced articulation because you will need to record the
condylar guidance angle exactly as it is in the patient.

Balanced articulation is actually the same idea of bilateral, even

contact between upper and lower teeth, but this is during
movement like sliding for protrusion movement (changing from
centric position to eccentric) i.e a dynamic relation.

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 Example - during lateral movement
if mandible moves to the right, then the right side is the working
side and the left side should be the balancing side (in order to
prevent dislodgment - that's only one advantage actually).

One more thing to note is that the condyle that moves is not the
one on the working side but on the balancing side. Working side
condyle show minimal movement in position only.

In this figure, A is the balancing

side and B is the working side.
Note that during this lateral
movement of the mandible,
buccal cusps of upper meet
buccal cusps of lower and lingual cusps of upper meet the lingual
cusps of upper on the working side. However, on the balancing
side, the palatal cusp of upper meet the buccal cusp (the lingual
incline part of the buccal cusp) of the lower.

Example - during protrusion movement

in the same way, we should achieve the contacts between
teeth, so that the incisal edges meet anteriorly and at the
same time have posterior contact of teeth to avoid
dislodgement. The more posterior contacts, the better,

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but if we can achieve at least one on each side then it will
do the job.
Advantages of Balanced Occlusion:
1) allows the denture to be seated during activities such as eating, speaking etc.

2) If the denture is unseated properly, it will keep moving with different activities,
and this will lead to soreness and inflammation, and will also accelerate the bone
resorption.

3) Enhance retention and stability during activities (actually this is related to

point 1).

Factors that influence Balanced Occlusion:

We have incisal and condylar guidance on one side. And we have

cusp angles, orientation of occlusal plane, and compensating
curves on the other side. The reason we put them in separate
groups is because increase in one side will need to be balanced by
a decrease on the other side and so on.

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