15.

Concepts of Complete Denture

Occlusion

Michael Hamada DDS

Division of Advanced Prosthodontics,
Biomaterials and Hospital Dentistry
UCLA School of Dentistry

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 Differences between Natural and Complete
Denture Occlusion
Natural Dentition Denture “Dentition”
 Retained in PDL  Mobile bases on mucosa
 Units move  Teeth move as an unit
independently  Malocclusion affects
 Malocclusion effects not entire base immediately
immediate  Non-vertical forces affect
 Non-vertical forces all teeth and is traumatic
affect only teeth  Incising affects all teeth
involved and usually attached to base
well tolerated  Bilateral balance is often
 Incising doesn’t affect desired for base stability
posteriors  Decreased tactile sense
 Bilateral balance is rare
 Tactile sensitivity
Goals of Complete Denture Occlusion
 Minimize trauma to the
supporting structures
 Preserve remaining structures
 Enhance stability of the
dentures
 Facilitate esthetics and speech
 Restore mastication efficiency
to a reasonable level
Types of Complete Denture Occlusion

 Bilateral balance
 Neutrocentric

We prefer bilateral balance because this type of occlusal

arrangement limits tipping of the dentures during
parafunctional movements,
Bilateral Balanced Denture Occlusion

The stable simultaneous contact of

opposing upper and lower teeth in
centric relation position with a smooth
bilateral gliding contact to any eccentric
position within the normal range of
mandibular function, developed to
lessen or limit tipping or rotation of the
denture bases in relation to the
supporting structures.
Bilateral Balanced Denture Occlusion
 Traditionally bilateral balance was
achieved with anatomic posterior
denture teeth. However, it can be
achieved with nonanatomic teeth using
balancing ramps or by manipulating
the compensating curve.
 Bilateral Balanced Denture Occlusion
with Anatomic Posterior Denture Teeth

Protrusive Balancing Working

 Bilateral Posterior
Centric Contact
 Centralized Forces
 “Balanced” Occlusion
to minimize tipping
Centric
 Monoplane with Balancing Ramps
Working Balancing

Bilateral balanced occlusion can Protrusive

also be obtained with
nonanatomic posterior teeth if
balancing ramps are employed. In
all lateral excursions you should
observe at least three points of
contact bilaterally if bilateral
balance is to be achieved.
 Lingualized Opposing Monoplane with
Balancing Ramps
Working Balancing

 A similar concept is used when lingualized maxillary teeth

oppose nonanatomic teeth in the mandible.In all lateral
excursions you should observe at least three points of contact
bilaterally to maintain bilateral balance.
 Monoplane Occlusion
(Neutrocentric Concept)
This concept of occlusion assumes that the anterior-
posterior plane of occlusion should be parallel to the
denture foundation area and not dictated by condylar
inclination.

The plane of occlusion is completely flat and level.

There is no curve of Wilson or Curve of Spee
(compensating curve) incorporated into the set up.
There is no vertical overlap of the anterior teeth.
When using this concept of occlusion the patient is
instructed not to incise the bolus. With this tooth
arrangement DeVan noted that “the patient will
become a chopper, not a chewer or a grinder.”
 Monoplane Occlusion
(Neutrocentric Concept)

Centric
Balancing

At balancing and protrusive positions there is separation of

the denture teeth in the posterior regions leading to tipping
of the dentures. This may be disadvantageous in the
patients exhibiting parafunctional grinding habits
 Hanau’s Quint
 Five Factors Affecting Occlusal Balance
• Condylar Inclination
• Incisal Guidance
• Occlusal Plane Inclination
• Compensating Curve
• Cuspal Inclination
 Hanau’s Quint
 Inter-relationship of these five factors may
be described by Theilman’s Formula
 In order to maintain a balanced occlusion:
Condylar Inclination x Incisal Guidance
C=
OccPlane x Cuspal Inclination x CompCurve
 Hanau’s Quint
Factors controlled by the dentist
 Of these five factors, the patient presents
you with Condylar Inclination
 Occlusal Plane cannot be altered substantially
since functional requirements dictate its
position and orientation
 The remaining three factors can be controlled
by the dentist

Condylar Inclination x Incisal Guidance

C=
OccPlane x Cuspal Inclination x CompCurve
 Hanau’s Quint
Factors controlled by the dentist
 Of these five factors, the patient presents
you with Condylar Inclination
 Occlusal Plane cannot be altered substantially
since functional requirements dictate its
position and orientation
 The remaining three factors can be controlled
by the dentist
Condylar Inclination x Incisal Guidance
C=
OccPlane x Cuspal Inclination x CompCurve
 Hanau’s Quint
 Within the confines of esthetics and
phonetics, minimize Incisal Guidance in
Complete Dentures to minimize inclined
tipping forces
 Adjust remaining factors to maintain balance

Condylar Inclination x Incisal Guidance

C=
OccPlane x Cuspal Inclination x CompCurve
 Posterior Tooth Forms

Lingualized
Monoplane – neutrocentric
Monoplane with balancing ramps
Lingualized opposing monoplane
Semi-anatomic
Anatomic (30 degree)
Posterior Tooth Forms
Anatomic Tooth Forms
Nonanatomic Tooth Forms
Semi-anatomic Tooth Forms
 Goals of Complete Denture Occlusion
 Minimize trauma to the
supporting structures
 Preserve remaining
structures
 Enhance stability
 Esthetics, Speech and
Mastication
 Enhance mastication
In addition we would like to decrease lateral
forces to the residual ridges.
General Concepts of Denture Occlusion
 Common Features
• Functional anatomy is the main determinant of
denture tooth position
• Simultaneous, bilateral posterior contact in centric
relation (centric occlusion)
• Centralization of centric occlusal forces over the
mandibular residual ridges
 Buccal-Lingually

 Anterior-Posteriorly
 Is “Balance” necessary?
Protrusive position Protrusive position

Balanced vs
Non-balanced
occlusion occlusion
Is “Balance” Necessary?

“Bolus in”

“Balance out”
 Is “Balance” Necessary?

“Society is made up of happy neurotics,

unhappy neurotics, and a few psychotics,
and some of each become partially or
totally edentulous.”
Theodore Berg, Jr., D.D.S.

* Balance is for Parafunctional

Movements
 Is “Balance” Necessary?
Tests of Balanced and Non-balanced
Occlusions
Trapozzano, V. R.: JPD 10: 476-487, 1960.

1) No patient preference
2) Balanced slightly more efficient
3) Percentage of patients using
eccentric movements during
mastication is small
 Is “Balance” Necessary?

“Simplification of Occlusion in Complete

Denture Practice: Posterior Tooth
Form and Clinical Procedures”
Dale Smith: DCNA 14: No. 3; July, 1970.

1) Advocates cuspless teeth primarily

for ease of use
2) May use balanced occlusion but
can’t prove that it is necessary
Balance and the Monoplane Occlusion

Minimize vertical overlap within the

dictates of esthetics and phonetics
Balance and Monoplane Occlusion

Minimize vertical overlap within the

dictates of esthetics and phonetics
 Bilateral Balance
 Anatomic posterior teeth vs Lingualized
 Bilateral balance with anatomic denture teeth

Balancing side
 Lingualized Occlusion
Centric Occlusion

Conventional Lingualized

Theoretically, there should be

less lateral displacement of the
denture and less lateral forces
during function when using
lingualized posterior denture
teeth.
Setting the Maxillary Posteriors
The lingual cusp tips
should be in contact with
the central fossae of the
opposing mandibular
teeth. The cuspal inclines
of the mandibular teeth
are relatively flat,
resulting in potentially
less lateral forces and
displacement during
function.
 Lingualized Occlusion

Working Side

Centric Occlusion
Balancing Side
Lingualized Occlusion
 Lingualized Occlusion
Indications for use
 High esthetic demands
 Severe mandibular ridge
atrophy
 Displaceable supporting
tissues
 Malocclusion
 Previous successful denture
with Lingualized Occlusion
Advantages
 Good esthetics
 Freedom of non-anatomic
teeth
 Potential for bilateral
balance
 Centralizes vertical forces
 Minimizes tipping forces
 Facilitates bolus
penetration (mortar and
pestle effect)
Complete Denture Occlusion

 Investigators have not shown one type of

denture occlusion to be :
• superior in function
• safer to oral structures
• more acceptable to patients
 Complete Denture Occlusion
 Neuromuscular control may be the
single most significant factor in the
successful manipulation of complete
dentures under function

 Tongue function
and denture
wearing experience