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BALANCED OCCLUSION

Dr. Rakshith Hegde

INTRODUCTION

The evaluation of the occlusion is important in the prosthodontics and restorative dentistry because the occlusal surfaces of the teeth to be restored must be functional units of the patients stamatognathic system. It is a term used to describe the contact relationship of the upper and lower teeth. Balanced occlusion in complete dentures can be defined as stable simultaneous contact of the opposing upper and lower teeth in centric relation position and a continuous smooth bilateral gliding from this position to any eccentric position with in the normal range of mandibular function. Balance in complete dentures is unique and manmade. It does not occur in natural teeth, and indeed is not needed, since each tooth is supported independently. It is considered a premature contact on the non working side and is considered pathologic.

The immediate objective of an occlusion is the provision of an effective chewing mechanism. The long-term objective is the preservation of the residual structures in a state of optimum health. When complete dentures are work, the patient expects to be able to function smoothly throughout the range of mandibular motion. The prosthetic teeth must, therefore, be arranged to be not only esthetically pleasing and biologically compatible, but they also must be arranged so that the occlusal surfaces will contact and glide over one another smoothly, without dislodging the denture base.

DIFFERENCES BETWEEN NATURAL AND ARTIFICIAL OCCLUSION 1. The teeth in natural dentition are retained by periodontal tissues that are uniquely innervated and structured. When natural teeth are lost, both the occlusion and the attachment with its proprioceptive feedback mechanism are lost. In complete artificial occlusion, all the teeth are on bases seated on slippery tissues. 2. In natural dentitions, the teeth receive individual pressures of occlusion and can move independently. They can migrate to adjust to occlusal pressures. The artificial teeth move as a unit on their base. 3. Malocclusion of natural teeth may be uneventful for years. Malocclusion on artificial teeth evokes an immediate response and involves all of the teeth and the base. 4. Nonvertical forces on natural teeth during function affect only the teeth involved and are usually well tolerated, whereas in artificial teeth the effect involves all of the teeth on the base. It is usually traumatic to the supporting structures.

5. Incising with the natural teeth does not affect the posterior teeth. Incising with artificial teeth affects all of the teeth on the base. 6. In natural teeth, the second molar is the favored area for masticating hard foods, owing to more favorable leverage and power. Pressures of mastication in the second molar region with artificial dentition will tilt the base and shift it, if it is on an inclined foundation. 7. In natural teeth, bilateral balance is rarely found; if present it is considered balancing side interference. In artificial teeth bilateral balance is generally considered necessary for base stability. Dentists can replace the natural tooth artificially by not its attachments. This presents a new problem, and it seems logical that some changes must be made. The above differences make it necessary to consider occlusion for complete dentures as a special problem with different requirements if it is to function efficiently with the least amount of trauma to the supporting tissues.

REQUIREMENTS OF COMPLETE DENTURE OCCLUSION:


The differences between natural and artificial teeth make it necessary to consider the dentist created occlusion a unique problem. An occlusion has to be designed to function in the compromised situation of the edentulous mouth. It must be designed to also redress the unequal stability of the upper and lower denture base. The lower is inherently less stable in most cases, so the occlusal design and the position of the lower occlusal units are usually given the first consideration in approaching a solution to the problem.

The following requirements should be considered as basis to the solution 1. Stability of occlusion at centric relation position and in an area forward and lateral to it. 2. Balanced occlusal contacts bilaterally for all eccentric mandibular movements. 3. Unlocking the cusps mesiodistally to allow for gradual but inevitable settling of the bases due to tissue deformation and bone resorption. 4. Control of horizontal force by buccolingual cusp height reduction according to residual ridge resistance form and interarch distance. 5. Functional lever balance by favorable tooth-toridge crest position.

6. Cutting, penetrating, and shearing efficiency of occlusal surfaces. 7. Anterior incisal clearance during all posterior masticatory function and bruxing activity. 8. Minimum occlusal contact areas for reduced pressure 9. Sharp ridges or cusps or cusps and generous spill ways to shear and shred food with the minimum of force necessary. 10.These requirements can be most easily applied if the occlusion is divided into three distinct units: (a) incising, (b) working, and (c) balancing. It is possible to establish requirements for these units that will favor function and stability.

Requirements for Incising Units 1. These units should be sharp in order to cut efficiently. 2. They should not contact during mastication. 3. They should have as flat an incisal guidance as possible considering esthetics and phonetics. 4. They should have horizontal overlap to allow for base setting without interference. 5. They should contact only during protrusive incising function.

Requirements for Working Occlusal Units

1. They should be efficient in cutting and grinding. 2. They should have decreased buccal-lingual width to minimize the work force directed to the denture foundation. 3. They should function as a group with simultaneous harmonious contact at the end of the chewing cycle and during eccentric excursions. 4. They should be over the ridge crest in the masticating area for lever balance. 5. They should have a surface to receive and transmit the force of occlusion essentially vertically. 6. They should center the work load near the anteroposterior center of the denture. 7. They should present a plane of occlusion as parallel as possible to the mean foundation plane.

Requirements for Balancing Occlusal Units

1. They should contact on the second molars when the incising units contact in function. 2. They should contact at the end of the chewing cycle when the working units contact. 3. They should have smooth gliding contacts for lateral and protrusive excursions.

AXIOMS FOR ARTIFICIAL OCCLUSION


These axioms were published by Sears and have guided the planning of complete denture occlusion for many years: 1.The smaller the area of occlusal surface acting on food, the smaller will be the crushing force on food transmitted to the supporting structures. 2.Vertical force applied to an inclined occlusal surface causes non vertical force on the denture base. 3.Vertical force applied outside (lateral) to the ridge crest creates tipping forces on the base. 4.Vertical forces applied to inclined supporting tissues will cause nonvertical forces on the denture base.

EARLY CONCEPTS OF OCCLUSION Early anatomists such as Andreas vesalius and John Hunter described the static relationship of the human natural dentition. Occlusion became a topic of interest & much discussion in the early years of modern dentistry, as the restorability & replacement of teeth became more feasible. Many authors laid down theories of occlusion Bownwill in 1885 described the equilateral triangle theory based on 3 points of occlusal balance. He was the one who coined the word articulation. In 1893 Walker, recognized that the condylar path is inclined inferiorly because of the articular eminence: the so called condylar inclination.

The concept of a balanced occlusion is often credited to Ferdinand Graf Spee, in 1890, presented his observation on the function of the natural teeth of humans. Spee 1890 introduced the concept of curve of spee. Spee considered the balanced occlusion concept of occlusal organization was born, particularly for complete denture prosthodontics. The focus on balanced occlusion concepts continued into the 20th century. In 1910, Alfred Gysi criticized the continued use of the simple up-and-down hinged articulator. The simplest of the methods had been developed in 1902 by Christensen, who found that he could estimate the condylar inclination of a patient with intraoral wax records, a technique still widely used in restorative dentistry and prosthodontics to this day.

Gysi recognized Bonwills essential contribution with regard to mandibular function. Gysi discovered that the condyle path does not form a straight line, as believed by Bonwill, but follows a more or less curved line or an S-shaped curve. Gysi also took exception to Spees idea of a true center of rotation of the mandible. he believed that mandibular movement is dependent on incisal as well as condylar inclination. Balanced articulation concept advocated bilateral balancing tooth contacts during all lateral and protrusive movements.

CONCEPT OF BALANCED OCCLUSION The concept of a balanced occlusion is based on the premise that stability is provided mechanically to the denture bases on their basal seats. Articulation is needed for stability and comfort of complete denture. In the concept of balanced articulation, the teeth are to glide evenly over each other from the central incisor through the second molar, on the working side of the arch. No single tooth must interfere and cause the others to lift out of articulation. Contacts on the balancing side should exist and must not interfere with the smooth gliding movement on the working side. Posterior contacts must exist simultaneously with contacts on the anterior teeth for protrusive movements.

Studies of swallowing, mastication and parafunctional habits have demonstrated the need for balanced occlusion in complete dentures. Although contacts occur during mastication, these are not most potentially dangerous because of their limited duration. Swallowing and parafunctional movements occur through out the day. The forces transmitted by these lateral excursions are distributed best by balanced occlusion. Devan in 1954 opposed the balanced occlusion concept and stated that simultaneous contact in centric relation is only needed.

According to Bergman and associates occlusal contact is lost after 1 year. The classical example of bilateral balanced articulation dates back to 1914 when Gysi introduced the 33 degree cusp form teeth arranged according to the movements of the articulator. These teeth arranged in balanced occlusion concept were meant to enhance stability and direct the contact forces toward the ridges. Increasing the stability of the dentures by reducing the occlusal table of the lower posterior teeth, while maintaining a balanced concept was advocated by French in 1954. The upper posterior teeth with minimal lingual occlusal inclines of 5 degrees for the first premolars, 10 degrees for the second premolars, and 15 degrees for the first and second molars were used by French. The cuspal inclines were arranged in a curved occlusal plane and permitted a balanced articulation laterally as well as antero posteriorly.

A balanced articulation using nonanatomical teeth was suggested by Sears in the 1920s. A curved occlusal plane antero posteriorly and laterally, or the use of the second molar ramp, provided the needed tooth contacts for the balanced occlusal concept to be developed. Pleasure introduced yet another approach designed to enhance the stability of the lower denture while providing a balanced articulation. According to pleasure a posterior reverse lateral curvature, except the second molars that were set with the customary lateral curvature, provided a balanced articulation.

One dimensional occlusal contact between opposing posterior teeth was advocated by Frush as a linear occlusion that initially could be arranged to a balanced articulation on the dental instrument, followed by intraoral occlusal reshaping procedures to obtain balanced articulation. A blade on the lower posterior teeth contact essentially flat surfaces of the upper teeth set at a light angle to the horizontal. The intent in this arrangement was to eliminate occlusal deflective contacts and provide greater stabilization of the dentures.

Types of Balance of Equilibrium

When forces act on a body in such a way that no motion results, there is balance or equilibrium. This should be a primary consideration of the dentist when considering the forces that act on the teeth and the denture bases with their resultant effect on the movement of the base. A stable base is the ultimate goal. Total stability is not possible because of the yielding nature of the supporting structures, but control of the physical factors that apply to the relationship of the teeth to each other and that apply to the position of the teeth in the denture base as related to the ridge must be understood.

The application of these physical laws can be expressed by the following axioms: 1. The wider and larger the ridge and the closer the teeth are to the ridge, the greater the lever balance. 2. Conversely, the smaller and narrower the ridge and the farther the teeth from the ridge, the poorer the lever balance. 3. The wider the ridge and the narrower the teeth buccolingually, the greater the balance. 4. Conversely, the narrower the ridge and the wider the teeth, the poorer the balance. 5. The more lingual (inside) the teeth are placed in relation to the ridge crest, the greater the balance. 6. The more buccal (outside) the teeth are positioned, the poorer the balance. 7. The more centered the force of occlusion anteroposteriorly, the greater the stability of the base. Balance may be unilateral, bilateral, or protrusive.

Unilateral lever balance

This is present when there is equilibrium of the base on its supporting structures when a bolus of food is interposed between the teeth on one side and a space exists between the teeth on the opposite side. This state of equilibrium is encouraged by the following: 1. Placing the teeth so that the resultant direction of force on the functioning side is over the ridge or slightly lingual to it. 2. Having the denture base cover as wide an area on the ridge as possible. 3. Placing the teeth as close to the ridge as other factors will permit. 4. Using as narrow a buccolingual width occlusal food table as practical.

Bilateral occlusal balance This is present when there is equilibrium on both sides of the denture due to simultaneous contact of the teeth in centric and eccentric occlusion. It requires a minimum of three contacts for establishing a plane of equilibrium. The more contacts, the more assured the equilibrium. This type of balance is dependent on the interaction of the incisal guidance, the plane of occlusion, the angulation of the teeth (tilt and inclination), the cusp angulation (height), the compensating curve, and the inclination of the condylar path.

Protrusive occlusal balance This is present when the mandible moves essentially forward and the occlusal contacts are smooth and simultaneous in the posterior both on right and left sides and on the anterior teeth. It is slightly different from bilateral balance in that it requires a minimum of three contacts, one on each side posteriorly and one anteriorly, and is dependent on the interaction of the same factors as bilateral occlusal balance.

This total concept of balanced complete denture occlusion must be considered in terms of the following
1. The tooth size and position in relation to the ridge size and shape. 2. The extent of denture base coverage. 3. Occlusal balance with stable contacts at the retruded border position and in an area (long centric) anterior to it. 4. Right and left ecce4ntric occlusal balance by simultaneous contacts at the limit of functional and parafunctional activity. 5. Intermediate occlusal balance for all positions between centric occlusion and all other functional or parafunctional excursions to the right left, and protrusive. This balance is probably the most important, as it allows for smooth uninterrupted tooth contacts in the dynamics of daily mandibular movements.

The concepts of occlusal balance have generally been accepted and limited to the factors controlling the contacts of the teeth from centric to eccentric jaw positions. In the preceding paragraphs, lever balance has been introduced as an important part of the total concept of occlusal balance. It is possible to have one without the other. For example, the teeth could b e set in good relationship to the ridge with lever balance to stabilize the dentures operating during mastication until the teeth contact. After the teeth contact, it is occlusal balance that assumes the dominant role in balance. It is also possible to have perfect occlusal contact balance that completely stabilizes the denture bases during nonfunctional mandibular activity when the teeth are articulated together. However, if they are not properly related tot he ridge in arch form or occlusal plane height, the denture base will be unstable when forces of mastication are applied to the teeth when they are apart. It is important that both aspects of balance, one due to tooth position and one due to tooth contact, complement one another for total denture base stability.

Advantages of Bilateral Occlusal Balance 1. Bilateral simultaneous contact help to seat the denture in a stable position during mastication, swallowing and maintain retention and stability of the denture and the health of the oral tissues. 2. Due to cross-arch balance, as the bolus is chewed on one side, the balancing cusps will come close or will contact on the other. 3. Denture bases are stable even during bruxing activity.
Disadvantages of Balanced Occlusion 1. It is difficult to achieve in months where an increased vertical incisor overlap is present. 2. It may tend to encourage lateral and protrusive grinding habits. 3. A semi adjustable or fully adjustable articulator is required.

Trapazzsana (1960) studied masticatory performance of balanced and non balanced occlusion in complete denture patients and concluded that masticatory efficiency with Balanced occlusion was only slightly greater but the stability was definitely enhanced.

FACTORS AFFECTING BALANCED OCCLUSION

To obtain balanced occlusion on the mouth, balanced articulation must be developed on the articulator.
The Laws of articulation for Balanced Occlusion: Rudolph L Hanau (1925) first described the factors affecting balanced occlusion. 1. Horizontal condylar inclination 2. Compensating curve 3. Protrusive incisal guidance 4. Plane of orientation 5. Buccolingual inclination of tooth axes 6. Sagittal condylar pathway 7. Sagittal incisal guidance 8. Tooth alignment 9. Relative cusp height.

Later Hanau he combined the original nine factors and reduced them to five.

The five factors are 1. Condylar guidance 2. Compensating curve 3. Relative cusp height 4. Incisal guidance 5. Plane of orientation

1. Condylar guidance Condylar guidance is a mandibular guidance generated by the condyles traversing the contours of the glenoid fossa. The condylar guidance and incisal guidance the end controlling factors. The condylar path is determined on the patient by a protrusive record and set on the instrument. In the edentulous patient only one factor that is the condylar inclination is determined by the patient. It acts as a posterior control factors. The dentist has no control over the condylar inclination, and cannot change or modify it to fit a particular occlusion. Among several factors that can influence the articulation of teeth during movements, the factors of condylar guidance and incisal guidance play extremely important role. The inclination of the condylar guidance and inclination of the incisal guidance control the movement of the articulator where as the orientation of the plane may be changed by the dentist during the development of the occlusion to meet the needs of the patient.

2. Incisal Guidance Incisal guidance is the influence of the contacting surfaces of the mandibular and maxillary anterior teeth on mandibular movements or the influence of the contacting surfaces of the guide pins guide table on articulator movements. It is the anterior controlling factor. Incisal guidance is a variable factor until esthetics has been established. After that it becomes a fixed factor. The incisal guidance is usually expressed in degrees of angulation from the horizontal by a line drawn in the sagittal plane between the incisal edges of the upper and lower incisor teeth when closed in centric occlusion. It ranges any where from 0 degree to greater than 45 degrees. Because of its proximity to the masticating tooth surfaces, it has a dominant influence on the contacting surfaces of the teeth posterior to it. If the incisal guidance is steep, it requires steep cusps, a steep occlusal plane, or a steep compensating curve to effect the occlusal balance. Because of steep inclined planes, this type of occlusion is detrimental to the stability and equilibrium of the denture base.

For complete dentures the incisal guidance should be as flat (0 degrees) as esthetics and phonetics will permit because of reduction of lateral inclines. When the arrangement of the anterior teeth neccessitates a vertical overlap, a compensating horizontal overlap should be set to prevent dominant incisal guidance (anterior interference) from upsetting the occlusal balance on the posterior teeth. The incisal guidance should never exceed the condylar guidance. If it is greater than the condylar guidance a possible compensating curve cannot be used. In maximum intercuspation, the anterior teeth, are usually arranged without contact. Contact between anterior teeth will occur when the mandible moves in a lateral or Protrusive direction during articulation. The greater the horizontal overlap the lower the angle of inclination as long as the vertical overlap remains the same. The posterior teeth are closer to the action of the incisal inclination than to the action of the condylar inclination. There fore a greater influence is exerted on the teeth by the incisal inclination than by the condylar guidance. Since the condylar guidance and incisal guidance have been established, the plane of occlusion, compensating curve and cuspal inclination must be harmonized with these factors.

Plane of Occlusion : Orientation of the plane: The average plane established by the incisal and occlusal surfaces of teeth. This is established in the anterior by the height of the lower cuspid, which is nearly coincident with the commissure of the mouth and in posterior by the height of the retromolar pad. The use of these anteroposterior land marks creates an occlusal plane essentially parallel to the alatragus line. Its position can be altered slightly. The orientation of the plane is selected by the dentist to be in harmony with the lateral borders of the patients tongue and medial roll of the buccinator muscle. The orientation of occlusal plane becomes the third fixed factor of occlusion. By positioning the anterior teeth correctly for esthetics appearance, and locating the posterior end of the occlusal plane approximately by two thirds of the way up the retromolar pad, the dentist fixes the orientation of the occlusal plane.

Any necessary alterations for balancing the occlusion must therefore be made by occlusal reshaping of the tooth mold selected for the occlusion because the inclination of the cusps and prominence of the compensating curves, are features that are already established in the occlusal forms of the posterior artificial teeth. When a tooth is positioned in the oriented plane and in the appropriate location (i.e the mandibular first molar) the cusp inclinations and the compensating curves already developed in the carving and manufacturing of the tooth may not be in harmony with the articulation requirements of the dental instrument. Occlusal reshaping is the only method to reestablish harmony between the occlusal surfaces of the teeth and the movements of the articulator. Okane showed that were the occlusal plane is parallel to alatragal line the closing force during maximum clenching was greater than when it was altered plus or minus 5.

Inclination of the cusps: The fourth factor of occlusion refers to the angle between the total occlusal surface of the tooth and the inclination of the cusp relating to that surface. If the long axis of the tooth is perfectly vertical the plane of reference (horizontal) will be at right angles to the vertical axis of the tooth. The basic inclination of the cusp is made steeper when the distal end of the lower teeth is set higher than the incisal end. The cuspal inclination can be reduced when the distal end of the lower teeth is set lower than the incisal end. Cuspal inclination is an important determinant of balanced occlusion as they modify the effect of the plane of occlusion and the compensating curve.

Compensating Curve:

It is the fifth factor of occlusion. It is the most important factor in establishing the balanced occlusion. Compensating curve is the anteroposterior curvature and the mediolateral curvature in the alignment of the occluding surfaces and incisal edges of artificial teeth that are used to develop balanced occlusion. This curve compensates for the opening that occurs in the posterior region when a protrusive movement is made. Occurrence of this space is called Christensens Phenomenon. Compensating curve also compensates for the opening that occurs when lateral movement is made. It is determined by the inclination of the posterior teeth and their vertical relationship to the occlusal plane so that the occlusal surface results in a curve that is in harmony with the movement of the mandible as guided posteriorly by the condylar path. A steep condylar path requires a steep compensating curve for occlusal balance. A lesser compensating curve for the same condylar guidance would result in a sleeper incisal guidance (anterior guidance) which would cause loss of molar balance. The factor of compensating curve is valuable because it allows the dentist to alter the cusp height without changing the form of the manufactured teeth.

Curve of space is the anteroposterior curve found in natural dentition which passes through the tip of the canine and buccal cusp tips of posterior teeth. This line forms a part of the circle, which passes through the head of the condyle. Mediolateral curve results from the inword inclination of the lower posterior teeth making the lingual cusp lower than the buccal cusp as the mandibular arch and buccal cusps higher than the lingual cusps on the maxillary arch. In natural dentition, the curve of Monson passes through the tips of buccal and lingual cusps of maxillary first molar. In the first premolar region the curve is in the opposite direction this is called anti Monson curve.

In 1937, Pleasure suggested the use of non anatomic teeth forms and setting the premolars and first molar in anti Monson curve and second molar in Monson curve. This combination of Monson and anti Monson curves are referred as Pleasure curve. Out of these five factors of balanced occlusion the dentist can control only four factors since the condylar path is fixed by the patient. Of the four he can control the incisal guidance and the pale of occlusion can be altered only a slight amount because of esthetic and physiologic factors. The important working factors for the dentist to manipulate are the compensating curve and cuspal inclination.

Factors of protrusive balance : 1. The inclination of the condylar path. 2. The inclination of the incisal guidance chosen for the patient. 3. The inclination of the plane of occlusion set to physiologic factors. 4. The compensating curve set to harmonize with (1) and (2). 5. The control of cusp heights and tooth inclination of the posterior teeth.

Factors of Lateral balance:

1. The inclination of the condylar path on the balancing side. 2. The inclination of the incisal guidance and the cuspids lift. 3. The inclination of the plane of occlusion on the balancing side and the working side. 4. The compensating curve on the balancing side and the working side. 5. The buccal cusp heights or inclination of the teeth on the balancing side. 6. The lingual cusp heights or inclination on the working side. 7. The Bennett side shift on the working side.

TRAPOZZANO CONCEPT: He reviewed Hanaus five factors and decided that only three factors were actually concerned in obtaining balanced occlusion. He eliminated the plane of orientation since its location is highly variable within the available inner ridge space. He also suggested that the occlusal plane can be located at various heights to favor a weaker ridge. Trapozzano saw no need for a compensating curve, as it is redundant. when the cuspal angulation which will produce a balanced occlusion has been determined.

BOUCHER CONCEPT: Boucher disagreed with Trapozzanos concept that the occlusal plane could be located at various heights to favor a weaker ridge, and he recommended that the occlusal plane be oriented exactly as it was when the natural teeth are present. He believed that this must be done to conform to anatomic and functional needs. Boucher, unlike Trapozzano, felt there was a need for a compensating curve and stated, The value of the compensating curve is that it permits an alteration of cusp height without changing the form of the manufactured teeth If the teeth themselves do not have cusps, the equivalence of cusps can be produced by using a compensating curve. Bouchers concept is that (1) there are three fixed factors: the orientation of the occlusal plane, the incisal guidance, and the condylar guidance; (2) the angulation of the cusp is more important than the height of the cusp; and (3) the compensating curve enables one to increase the effective height of the cusps without changing the form of the teeth.

THE LOTT CONCEPT: Lott* studied Hanaus work and clarified the laws of occlusion by relating them to the posterior separation that is the resultant of the guiding factors. He stated the laws as follows: 1. The greater the angle of the condyle path, the greater is the posterior separation. 2. The greater the angle of the overbite (vertical overlap), the greater is the separation in the anterior region and the posterior region regardless of the angle of the condyle path. 3. The greater the separation of the posterior teeth, the greater, or higher, must be the compensation curve. 4. Posterior separation beyond the ability of a compensation curve to balance the occlusion requires the introduction of the plane of orientation. 5. The greater the separation of the teeth, the greater must be the height of the cusps of the posterior teeth.

LEVINS CONCEPT: Levins concept is quite similar to Lotts but eliminated the plane of orientation and showed how the four factors of articulation are related in protrusive and lateral movements. The laws of articulation are used as an aid in understanding the balancing of occlusion for complete dentures. As explained by Lott guiding factors produce a separation of posterior teeth which must be prevented by the controlling factors. This occurs in both protrusive and lateral movements. The concept of posterior seperation is an important goal for achieving bilaterally balanced denture occlusion.

He named the four factors a Quad and their essentials are as follows: 1. The condylar guidance is fixed and is recorded from the patient. The balancing condylar guidance includes the working condyle Bennett movement, which may or may not affect lateral balance. 2. The incisal guidance is usually obtained from the patients esthetic and phonetic requirements. However, it can be modified for special requirements, e.g., a reduction of the incisal guidance is considered to be helpful when the residual ridges are flat. 3. The compensating curve is the most important factor for obtaining balance. Monoplane or low cusp teeth must employ the use of a compensating curve. 4. Cusp teeth have the inclines necessary for obtaining balanced occlusion but nearly always are used with a compensating curve.

THE INFLUENCE OF CONDYLAR GUIDANCE AND INCISAL GUIDANCE ON CUSPAL INCLINATION: To incline the teeth to develop a balanced occlusion one needs an adjustable articulator with some additional features. It should (1) receive a kinematic face-bow transfer, (2) adjust to individual intercondylar distance, (3) have an adjustable guide table, and (4) have the condylar elements in the mandibular bow and the condylar guides attached to the maxillary bow (Arcon principle). To adjust the articulator requires (1) a centric relation record, and (2) an eccentric protrusive record. Right and left lateral relation records are desirable if the articulator is capable of accurately accepting and being adjusted to the records. If the articulator will not receive the lateral records and is tracking or Hanau type of instrument, use the formula suggested by Hanau to adjust the lateral condylar guidance: L= H + 12 8

The maxillary cast is transferred from the patient to the articulator with a face-bow. When the actual hinge axis is located, use the kinematic face-bow. When the Bergstrom or Whip Mix articulators are used, a special face-bow using the external auditory meatus as point of orientation for the opening axis is used. When the casts have been properly mounted on the articulator, the antero-posterior and mediolateral positions of the teeth are determined. Vertical positions of the incisal edges of the anterior teeth and the occlusal surfaces of the posterior teeth are established on a plane from the lower lip line to the bottom of the top third of the retromolar pad. This position on the retromolar pad is used to allow the mandibular molars space to be inclined in a vertical direction when the teeth are altered for balance and not to exceed the top of the pad. The maxillary and mandibular anterior teeth are positioned for esthetics, and the posterior teeth are positioned in centric occlusion on the plane for the trial denture .When the accuracy of the centric relation record has been verified, the vertical dimension of occlusion has been determined, and the positions of the teeth have been accepted for esthetic purposes, the protrusive relation record is made and the articulator is adjusted for condylar guidance.

To balance the occlusion, the teeth are inclined to harmonize with the three controlling end factors, the right and left condylar inclinations and the incisal guidance. Condyle paths are peculiar to each individual, and the dentist has no control over horizontal or lateral inclinations. The dentist can in no way modify the condyle path. When the condylar inclinations have been registered and the articulator has been set, it is not the right of the dentist to increase or decrease the articulator settings. The sagittal incisal guide angle is the angle formed with the horizontal plane by drawing a line in the sagittal plane between incisal edges of the maxillary and mandibular central incisors when the teeth are in centric occlusion. The term incisal guidance refers to the influence on mandibular movements of the lingual surfaces of the maxillary anterior teeth. The incisal guidance may be expressed in degrees from the horizontal plane. The lateral incisal guide angle may be defined as the steepest angle formed with the horizontal plane by drawing a line between the incisal edges of the maxillary and mandibular incisors and cuspids of both the right and left segments when the teeth are in centric occlusion.

The inclination of the cusps of posterior teeth is influenced by the distance from the condylar guidance and the incisal guidance. When the teeth are closer to the condylar guidance the cuspal angulation is influenced by the condylar guidance and when the teeth are moved forward closer to the incisal guidance, the inclination of the cusp is influenced by the incisal guide angle. The inclination of the cusps should be parallel with the mandibular path. The rotational center of the mandibular path has been determined by lines drawn at right angles to the condylar path from the center of the condyle and to the incisal guide table from the point of incisal guide table from the point of incisal guide pin. The point where these lines meet is the rotation center for the path of mandibular movement on that side. The rotation center constantly changes as the mandible travels its path, but as the mandible moves, any given point on it moves along with it and maintains the same relationship to each successive rotation center. When the incisal guidance angle is very shallow, the resultant center of rotation will be above the mandible. When the incisal guide angle exceeds the condylar guidance angle, the resultant center of rotation will be below the mandible.

A steep incisal guidance angle needs steeper cusps on the posterior teeth which compromises the stability of the denture base. For complete dentures, the incisal guidance should be as flat as esthetics and phonetics will permit. With the given amount of vertical overlap the incisal guidance angle can be made flatter by increasing the horizontal overlap. It can also be made less steep by reducing the vertical overlap. During lateral balancing movements, the cuspal inclination of the posterior teeth should be parallel with the path of mandibular movements. The center of rotation of mandible during lateral balanced movement can be established drawing lines right angles to the buccal inclines of the lower lingual cusp on the working side and lingual inclines of the lower buccal cusp on the balancing side and a line drawn at right angles to the balancing side condylar path incline. When the mandible is moved laterally, the working side cuspal inclines are less steeper than the balancing side inclines and the cuspal inclination of the posterior teeth increases towards the incisal guidance. This difference is due to the fact that the condyle on the working side neither rises nor falls but merely rotates.

BALANCED OCCLUSION

THE IMPORTANCE OF CHRISTENSENS PHENOMENON IN CUSPAL INCLINATION In order to understand the relationship between the inclination of the condylar guidance and the cusp angulation, it is important to clarify the theory of the christensens phenomenon using the occlusion rims with flat occluding surfaces, a wedge shaped cleft is formed between the posterior part of the occlusal rims during a forward protrusive movement. This is due to forward and downward movement of the condyles. The cleft formed is called the Christenson Phenomenon. The projection on a sagittal plane of the angle between the occlusal rims in connection with the Christensen phenomenon is called Christensen angle. Christensens angle is an angle formed between the upper and lower occlusal rims in the anterior region when the mandible is moved forward.

OCCLUSAL SCHEMES USED IN COMPLETE DENTURE CONSTRUCTION: Many types of posterior teeth have been designed to meet the needs of various philosophies of complete denture occlusion. They are divided into 2 main groups. The anatomic and the non anatomic, Zero degree or cuspless. Advantages of Anatomic Teeth: 1. It penetrates food more easily. 2. It resists the rotation of denture base through cusp interdigitation. 3. It provides better esthetics. 4. It acts as a guide for proper jaw closure. Disadvantages: 1. It causes more occlusal dishormony during setting and difficult to correct any adjustment. 2. Precise jaw closure and base stability required for interdigitation. 3. It causes increased horizontal forces. 4. Difficult to adapt to abnormal jaw relationships.

Advantages of Non Anatomic Teeth: 1. It does not lock the mandible in one position. 2. It permits the use of less time consuming techniques. 3. It minimizes horizontal stress because of the absence of inclined planes. 4. It adapts easily to class II and III jaw relations. 5. More easily adjusted after changes in vertical and horizontal relations. 6. It is easier to arrange in cross bite. Disadvantages: 1. Poor esthetics. 2. It decreases masticatory efficiency. 3. It is more difficult to obtain balanced occlusion. 4. It requires more horizontal forces to chew food.

TECHNIQUES FOR ARRANGING BALANCED OCCLUSION:

CUSP

TEETH

IN

Contacts in Balanced Articulation: There should be a working and balancing contacts that are in harmony with the guidance of the condylar inclination and incisal guidance. Working side: Upper lingual cusps pass between modified triangular ridges of the lower lingual cusps that run either to the marginal ridge or to the groove between the cusps of the lower molars.

Balancing Side: Upper lingual cusp inclines rides over lower buccal (lingual facing inclines) cusp inclines diagonally.

Protrusive Contacts: Incisal edges of the mandibular anterior teeth contact with the lingual surfaces of maxillary anterior teeth. The mesiobuccal and the lingual cusp ridges of the mandibular teeth contact the distobuccal and lingual cusp ridges of the maxillary teeth. In protrusive excursion the lingual cusps of the upper right and left second molars should glide up the distal inclines of the lower second molars. Contacts between the mesiolingual cusp of the upper second molar and the distal marginal ridge of the lower second molar should exist in protrusive balance when the upper and lower central teeth are in edge to edge relation. If protrusive contact is not present the compensating curve should be increased, that is the second molars should be elevated at the distal ends.

ARRANGING POSTERIOR TEETH FOR BALANCED OCCLUSION: Whether one uses anatomic or non anatomic tooth forms, certain basic requirement for arrangement are essential. Because the lower denture is more susceptible to displacing forces than the upper, teeth must be so arranged on the lower denture that all retentive advantage is gained. This means that the teeth cannot be set so far buccally that the cheeks will lift the denture, nor so for lingually that the tongue will lift it. Therefore, lower posterior teeth have to be placed so that they are located over the center of the ridge. The arrangement of upper teeth must be such that they occlude with the lowers. When non anatomic forms are used, the upper teeth can usually be arranged so that they occlude with the lowers and still aid in the retention of the maxillary denture. This is possible because the flat surfaces do not demand a specific buccolingual position of the opposing tooth.

When anatomic forms are used, the upper tooth, because intercuspation, must be set in a definite buccolingual relation to the lower, and this location does not always aid retention of the upper. The anterior teeth are set with a minimal vertical overlap of 0.5 to 1mm and 1 to 2mm of horizontal overlap to establish a low incisal guidance. In the normal relation, one must decide whether to set all the maxillary teeth or all the mandibular teeth first. If all the maxillary teeth are placed first, the mesiodistal width of the lower first premolar must often be lessened. If all the mandibular teeth are set first, a diastema may result between the upper cuspid and first premolar. Rarely does the intercuspation take place so that all teeth fit the available space without alteration in form or without resulting diastema.

Depending on whether one considered a diastema or a tiny tooth the more unpleasant, one may sit lower or upper teeth first. Setting the lower teeth first is perhaps a little easier for two reasons.

1. The teeth can be set over the more important lower ridge directly. 2. It provides better control of the orientation of the plane of occlusion both mediolaterally and superoinferiorly. If a non arcon articulator such as the Hanau H2 is used the relation of the compensating curve to the condylar and incisal guides can easily be seen because the lower cast is directly attached to that part of the instrument which carries the guides. The criteria used as a guide for the setting of the lower posterior teeth are given below.

Anteriorly: The position and height of the first right and left premolar are determined by the lower anterior teeth, which were checked to be in proper phonetic and esthetic position. This determines the ridge relation, length, and incisal guidance of the anterior teeth. The lower canine and first premolar, should be at or very near the level of the commissure of the mouth at rest and should support the corner of the mouth and the modiolus. Posteriorly: The last posterior tooth should be over foundation tissue that is firm and does not slope steeply upward. This is usually just anterior to the apex of the retromolar pad.

Buccally: The teeth should not displace the buccal mucosa, but make passive contact with it. In this position the buccinator muscle will not forcibly move the lower denture by its action against the buccal surfaces of the teeth. All areas of the posterior teeth that are buccal to the ridge crest should be kept out of occlusal contact for centric and working mandibular positions. This lingualizes the occlusion and prevents lever activity that would tip the denture base. Lingually: The lower posterior teeth should not crowd the tongue or interfere with its normal function. The lingual cusps of the natural molars are approximately in vertical allignment with the mylohyoid ridge. This is a reliable guide for determining the lingual limit of the artificial posterior teeth.

Occlusal Plane: The anterior height of the occlusal plane is determined by the lower anterior teeth and the commissure of the mouth as described. The posterior height of the occlusal plane should be at the level of the center of the retromolar pad. These landmarks provide a physiologically and functionally acceptable anteroposterior inclination of the occlusal plane that is nearly parallel to the lower mean foundation plane. The use of these anteroposterior landmarks also creates on occlusal plane essentially parallel to the alatragus line.

Compensating Curve: The primary function of this curve is to provide balancing occlusal contacts for protrusive mandibular positions. The compensating curve incorporated in a properly oriented plane of occlusion starts with the first molar by raising it at the distal and continuing this initiated curve with further rise in the second molar. The radius of the curve necessary to achieve balance is the result of the guiding influence of the angle of the incisal guidance and the angle of the condylar path.

Lateral Plane of the Teeth: The lower natural teeth are inclined slightly to the lingual, which creates a transverse curve of the occlusal surfaces from side to side. This is called the Monson curve, which has about an eight-inch diameter for normal dentition. This lingual inclination gives prominence to the lower buccal cusps in the transverse horizontal plane and brings them into heavy occlusal contact with the uppers in lateral working position.

PREPARATION OF ANTEROPOSTERIOR GUIDES A mark should be placed on the distal shoulder of the lower cast as a projection of a line running from the incisal tip of the mandibular canine to the apex of the retromolar pad. Evaluate this reference line in relation to the arch form as in if any gross discrepancy exists between the position of the reference line and the ridge crest, the position of the lower canines should be reevaluated. The following procedures and criteria for setting the lower posterior teeth apply to anatomic, modified anatomic, and nonanatomic teeth.

Mandibular Premolars: Using a hot spatula, prepare a heated wax bed for the first and second premolars. Set the teeth into this wax and manipulate into position so that the occlusal height matches the plane established by the mandibular anterior teeth, with the buccal and lingual cusps horizontal. The central fossae should be in line with the anteroposterior reference line. A small amount of warmed wax should now be placed on the maxillary cast so that the position of the maxillary first premolar can be checked. The maxillary first premolar should be set so that its lingual cusp occludes on the marginal ridges of the mandibular first and second premolars. The upper first premolar position should also be compatible with the occlusal length of the maxillary cuspid and the maxillary arch form.

Mandibular Molars: The compensating curve will start with the first molar. The mesial cusps are on the plane established by anterior teeth and bicuspids. The distal cusps of the first molar are raised about o.5 mm above this plane. The buccal and lingual cusps are set at the same height to make the transverse plane horizontal. The central fossa is aligned with the canine-retromolar pad reference line. The second molar continues the cuspal elevation of the compensating curve. The proper elevation of the second molar can be judged by extending the curve created by the first and second molar. This imaginary extension should run parallel to the condylar inclination. The buccal lingual cusps are horizontal and the central fossa is aligned with the canine-retromolar pad reference points. The same procedure is repeated for setting the lower teeth on the opposite side. The alignment and cuspal heights must be symmetric on the two sides. The marginal ridges of adjacent teeth should be at the same height to present a smooth transition from tooth to tooth. This will minimize subsequent grinding to create a smooth common central fossa mesiodistally.

Grinding the Mandibular Teeth: This grinding is most effectively accomplished after the teeth are set. The complete mesiodistal unlocking of cusped teeth by grinding the transverse ridges is necessary to provide freedom in the occlusion to accommodate for the settling of the denture bases. After grinding with a smooth concentric stone, there is a smooth confluent occlusal plane mesiodistally free of any cusp tripping ridge. Modification by grinding the buccolingual inclines to control lateral thrust during functional and nonfunctional mandibular movements is based on the shape and prominence of ridge and its ability to withstand lateral forces. The lower ridge is usually considered first; however, the grinding, as was the selection of teeth, is based on the weaker of the two residual ridges. When the ridge is flat, the grinding modification is abandoned and a flat nonanatomic tooth is used.

SETTING THE MAXILLARY POSTERIOR TEETH: Before the posterior teeth are set, the incisal guide pin should be set and checked for the proper occlusal vertical dimension. The incisal guide pan should be adjusted to provide for anterior clearance in lateral and protrusive excursions. The lateral inclination of the incisal guidance should never be steeper than the buccolingual inclination of the modified anatomic teeth. The incisal guidance inclination should never be steeper than the inclination of the condylar path. Shallow incisal guidance makes it easier to obtain a balanced occlusion.

Maxillary Premolar: The most efficient method for setting the maxillary teeth is to first set them for proper position and static cusp contact in centric relation. Once set and luted in place, they should be checked and refined for dynamic cusp contact in working, balancing, and protrusive movements. Place the first maxillary premolar in position next to the canine and then gently close the articulator to its proper vertical and centric position. Guide the tooth so that the lingual cusp fits into the lower common central fossa at the midpoint of the distal marginal ridge of the first mandibular premolar. This is the first premolar holding cusp contact for centric occlusion, that is, the upper lingual cusp in the lower central fossa on the lower marginal ridges. It should be a solid and stable contact. The buccal cusp is raised slightly out of contact. Place the second premolar into the heated wax and guide the lingual cusp into contact with the central fossa at the midpoint of the distal marginal ridge of the mandibular second premolar and mesial marginal ridge of the mandibular first molar. The tooth is kept vertical from the lateral aspect and has a slight buccal tilt to raise the buccal cusp out of contact slightly more than the first premolar.

When the teeth are set and luted, the wax should be allowed to cool to room temperature. Visually check the static cusp contacts of centric occlusion. This best done by looking for the rear aspect of the articulator into the area normally occupied by the tongue. From this point the lingual cusps are easily seen. Next, evaluate the functional occlusion from the same vantage point. The side toward which the mandible moves is the working side. Thus, in a left lateral excursion, the mandible swings to the left, the left condyle pivots, and the right condyle translates. When using the articulator, the maxilla is moved in the opposite direction to effect a lateral excursion, so that a left lateral excursion is performed on the articulator by moving the maxillary member to the right. The upper lingual cusps are the functional cusps in a simulated working side contact the upper lingual cusps should ride smoothly up the buccalfacing inclines of the lower lingual cusps and in a balancing side contact they should ride smoothly up the lingual-facing inclines of the lower buccal cusps. There should be no maxillary buccal cusp contacts in lateral excursions. The only contacting maxillary cusps are the lingual cusps. Buccal cusp contacts are eliminated by the increasing buccal cusp rise from first premolar to second molar.

Maxillary Molars: The maxillary first molar is set with slightly more buccal tilt than the maxillary second premolar. The tooth will have a mesial inclination dictated by the amount of compensating curve established by the mandibular molars. The mesiolingual cusp sets into the central fossa of the mandibular first molar and the distolingual cusp contacts the centers of the distal marginal ridge of the mandibular first molar and the mesial marginal ridge of the second molar in centric occlusion. The maxillary second molar should be set with slightly more buccal tilt and its mesiolingual cusp contacts the central fossa of the lower second molar. All of the upper lingual cusps should occlude in the common central fossa of the modified lower teeth. Without this as a starting point, a stable static centric occlusion is not possible. It also compromises a balanced occlusion for lateral excursions. The right and left lateral excursions for the completed unilateral setup are then checked. There should be working and balancing contacts that are in harmony with the guidance of the condylar inclination and incisal guidance. Ideally, in this occlusal scheme there should be five working cusp contacts, five balancing cusp contacts and no upper buccal cusp contacts.

When functioning as balancing contacts, upper lingual cusps ride lower buccal (lingual-facing inclines) cusp inclines diagonally. When acting as working cusps, upper lingual cusps pass between modified triangular ridges of the lower lingual cusps that run either to the marginal ridge or to the groove between the cusps of the lower molars. Complete the upper posterior setup on the opposite side in the same way. There should be simultaneous working and balancing contacts bilaterally. In protrusive excursion the lingual cusps of the upper right and left second molars should glide up the distal inclines of the lower second molars. There should be no cuspal collisions of other posterior teeth to have and a smooth excursion. As the protrusive excursion brings the upper and lower anterior teeth in apposition, they should just glide by each other under the guiding factors of the compensating curve and the condylar inclination. The initial balance achieved during the setup of the upper posteriors must be further refined by selective grinding.

Final Balancing of Occlusion: The objective of balancing a denture occlusion is to create simultaneous bilateral contacts from the centric relation position to all eccentric occlusal positions that are free of interferences. These multiple contacts should be smooth, uniform and in harmony with the temperomandibular joint and neuromuscular activity.

There are four specific conditions that must be met by the mandibular posterior teeth in order to achieve a balanced occlusion:

1.The mandibular posterior teeth must be set so that the occlusal surfaces are horizontal. 2.The plane of occlusion must have a proper orientation. 3.A compensating curve must be set. 4.The teeth must be modified so that there are no interlocking transverse ridges.

The maxillary teeth must be

1.Modified to eliminate buccal cusp contact. 2.Set so that the upper lingual cusps have a positive but static centric occlusal contact. 3.Have no buccal cusp contacts in lateral excursions.

Selective grinding for static centric contacts: Once the initial balance is achieved during the setup of the maxillary posteriors, the complete occlusion must be refined by selective grinding. First remove the incisal guide pin so that only the teeth are holding the proper occluding vertical dimension. A length of thin articulating paper is placed on the posterior teeth, and the articulator is gently tapped several times in centric occlusion. There should be marks on each of the areas. If marks show on lower cusp inclines, gently grind the inclines to eliminate deflective contacts. If there are any upper lingual cusps out of contact, the nonoccluding maxillary teeth are repositioned by moving the lingual cusps down into contact. It is also possible to selectively grind the teeth into a stable centric occlusion. Only the lower central fossae or marginal ridges should be ground, not the upper lingual cusps. If any significant grinding is done on the lower teeth, the occlusal vertical dimension will be reduced and anterior interference will occur. If any upper buccal cusps or inclines are in contact, they should be ground out of contact. Only the upper lingual cusp, that is, the pestle of the mortar-and-pestle-type lingual contact occlusion, should articulate with the lower posteriors.

NONANATOMIC (ZERO DEGREE) POSTERIOR SETUP: The presence of cusps, however, does introduce horizontal thrusts. Many severely resorbed or generally debilitated ridges may not stand these potentially destructive forces. Nonanatomic posterior teeth were designed to favor these types of ridges by minimizing the horizontal component of force during mastication and during parafunctional movemetns. The indications for the use of flat teeth are as follows: 1) flat ridges, 2) knife-edge ridges (narrow, well-sluiced forms needed), 3) large interridge space, 4) milling type of chewing pattern with broad excursions, and 5) where debilitation has reduced the patients coordiantion needed to handle a cusped type of occlusion.

The problem arises because flat teeth occlude in two dimensions (length and width), but the mandible, because of the incline of the condylar path, moves in a threedimensional path. The loss of the vertical component (cuspal rise) in flat teeth alters the protrusive and bilateral balance that is possible with cusped teeth. The traditional amount of anterior vertical overlap must be also be eliminated or modified in order to avoid anterior interference in lateral and protrusive excursions. Various approaches have been described, such as the balancing ramp, the inclined occlusal plane, the reverse curve, and the pleasure curve, to enhance the occlusal balance and compensate for the loss of cuspal rise. The uppers should be set on the lowers flat-on-flat rather than with a buccal cusp rise as in the cusp setup. Buccal overjet of approximately one half the width of the tooth should be set to prevent cheek biting. Be sure that the lingual portion of the upper teeth is in contact with the center area of the lower teeth.

Selective grinding for static centric contacts: Initially, there will be a few dominant contacts when the teeth are tapped together in centric occlusion. These contacts should be judiciously ground until there are linear contacts from the first premolar to the second molar. Selective Contacts: Grinding for working and Balancing

There is no working or balancing cusp contacts as in the modified anatomic tooth setup. Rather, there are simultaneous working and balancing sides. The left lateral excursion should be a smooth milling type of occlusion that is free of tripping both on the working side and balancing side during the entire excursion.

Selective grinding for protrusive balance: The protrusive contacts must be simultaneous on the left and right sides. The primary protrusive balancing contacts are the upper second molars riding up the distal inclines of the lower second molars created by the compensating curve.

VALUE OF BALACED OCCLUSION The question often arises as to the value of balanced occlusion when a bolus of food on the working side separates the teeth so far that there is no contact on the balancing side. The reply to this question is simply that the average patient masticates food for only 10 or 15 minutes, two or three times daily. However, during the remainder of the day, the teeth are in occlusal contact many times in centric and eccentric positions with no food between them, and even during the process of chewing food, the teeth will cut through the bolus frequently, and contact will be made on the balancing side. The most important reason for providing balanced occlusion is the added retention which it affords to a denture at times when the stability is threatened.

REVIEW OF LITERATURE Robert B. Sloane, and Jackcook (1953) found there is apparent relationship between both the skull and the edentulous upper cast. This relationship is sufficiently constant to allow the projection of the plane of occlusion when certain fundamental individual adjustment are incorporated into a mechanical device that correlates these basic relationships. Colonel George J. (1953) described that a. all lower teeth are set up first according to existing anatomy of the lower arch. b. A thorough knowledge of the influence of inclined planes and leverages should be understood for correction and control of these unstabilizing factors. c. Orientation of the mounting in 3 dimensions is necessary to properly evaluate the edentulous areas. d. Predetermine the location of the lower teeth by measurement and thus maintain equidistance from the midline. e. 960 dentures were constructed during a five year period using this technique with only 71 failures.

M.A. Pleasure (1953) said teeth for dentures differ so radically from natural teeth in the firmness of their attachment to the jaw that special designs are required to help stabilize them during chewing. These functional designs will minimize the displacement of denture basis which is traumatic to the alveolar mucosa during mastication.

Robert Rapp: (1954) Did a study on the occlusion and occlusal patterns of artificial posterior teeth and he summarized: a. Mandibular movements may be separated into masticatory and non masticatory components. Tooth form and arrangement must conform to these movements, the non anatomic teeth being the more suitable. b. Pressures on teeth may create resultant or horizontal stresses which must be controlled. Flat teeth arranged so that force is directed lingual to lower ridge crest give better control of stress. c. The anti-monson arranged, combined with non anatomic teeth is preferable. d. Non anatomic teeth, due to lack of cuspal locking, permit the mandible to assume its new position of occlusion with less displacement of the dentures as resorption changes the vertical dimension. e. There is less resorption of the ridge tissue when flat cusped teeth are used. f. Esthetics is reduced in the use of non anatomic teeth, but the comfort is increased. g. Non anatomic teeth are indicated for high, well developed ridges as well as the low flat ridges.

L.E. Kurth (1955) according to his critical study on the view of balanced occlusion he explained that graphic tracings of the directions of the condyle path and different conditions (flat, concave and converse plate, tooth to tooth contact) demonstrate the constancy and immutability of the condyle path, provided they be obtained under unobjectionable conditions. Graphic tracings of the extreme movements of the incisor point under different conditions (Flat, concave and convex plate, tooth to tooth contact) yield different curves.

Victor E (1956) said both artificial cusp and flat cuspless occlusal forms present disadvantages when they are used for C.D. Cuspless occlusal pattern is characterised by a curved 3dimensional occlusal surface rather than a flat, two dimensional occlusal surface. It is biomechanical and meets with the biologic and mechanical requirements of occlusion in complete denture construction. Clare. W Sauser (1957) proposed that anatomic occlusion be utilized only for those patients who have an ideal ridge relationship. A non anatomic, cuspless occlusion with variations of technique is the scheme of choice for patients who have abnormal ridge relations, congenital or acquired bony defects, who are at an advanced age or chronically ill and for those for whom immediate dentures are to be made.

Finn Tenqs Christensen (1958) according to him, in order to attain complete antagonistic contact along the entire length of the mandibular protrusion facets during a sagittal gliding (protrusive) movement of the jaw, coincidentally with a minimum of horizontal stresses, the sagital cusp angle must be in relation to the inclination of the condylar guidance. The calculation of the cusp angulation is based on the christensen phenomenon. By means of the christensen distance, it is possible to calculate the cusp height and the sagittal cusp angulation for the different buccal cusps.

Finn Tengs Christensen (1959) according to his study on the effect of Bonwills triangle on complete denture, the degree of the cusp angulation for complete dentures is inversely proportional to the hight of the Bonwills triangle.

Finn Tengs Christensen (1960) according to his study by means of the compensating curve, complete antagonistic contact during protrusive movements can be obtained with lower cusp angulation. Finn Tengs Christensen (1960) discussed the effect of the size of Balkwills angle on the Christensen angle and on cusp angulation, and on the basis of the findings a simplified formula for Christensen angle was suggested. Sine = p/a sine , where is the Christensen angle, is the inclination of condylar guidance, p is the length of protrusion and a is the height in Bonwills triangle.

Peter S. Mjor (1965) He did a study on the effect of the end controlling guides on cusp inclination on the working side and on the balancing side (were studied) both with and without the influence of a 15 degree lateral condylar guidance. He concluded in the protrusive position cusp inclinations increased toward the steeper of the end controlling guides. The same was true for cusp inclinations on the balancing side during lateral movements, cusp inclinations on the working side were controlled mainly by the lateral incisal guidance. The degree of cusp inclination on the working side, as compared with the inclination of the lateral incisal guidance, increased or decreased posteriorly depending on the inclination of the condylar pathway on the balancing side.

Donald O. Lundquest, Colonel DC (1970) found close relationship between the plane of occlusion and the retromolar pad, the parotid papilla, the buccinator grooves and the commissure of the lips in subjects with ideal occlusions of natural teeth and suggested vestibular impression technique for determining the location of the occlusal plane in complete edentulous patients. Bernard Levin (1977) found lingual bladed teeth are on improvement over conventional designs.

Curtis M. Becker, Charles C. Swoope (1977) did a study on lingualized occlusion for removable prosthodontics and concluded lingualized occlusion provides a useful combination of several occlusal concepts. Many advantages anatomic and nonanatomic occlusions are retained. Adjustment to compensate for minor changes in vertical and centric relation is readily accomplished. Satisfactory occlusion is easily obtained, and balanced occlusion can be accomplished. Levin (1977) reviewed on artificial posterior teeth and concluded lingual bladed teeth are in improvement over conventional designs. Harold R Ortwan and Ding H. Tsad (1979) Studied the relationship of incisive papilla to the maxillary central incisors and concluded Biting force during maximum clenching was the greatest when the occlusal plane was made parallel to the alatragus line. It is decreased when the occlusal plane was inclined about 5 degrees anteriorly or posteriorly.

Brien R Lang and Michael E Razzoog (1982) suggested a practical approach for restoring the edentulous patients. It requires the dentist to establish a philosophy of occlusion, select an occlusal concept to be used with the philosphy, and then choose an occlusal scheme to satisfy the concept and fulfill the philosophy. Harold E Claugh, Stephen H. Leeper (1983) compared lingualised occlusion and monoplane occlusion in complete dentures. Two sets of dentues, one with lingualized occlusion and the other with monoplane occlusion were made for each of 30 edentulous patients. Sixty seven percent of those people preffered the lingualized occlusal scheme because of improved masticatory ability, comfort and esthetics.

D.C. Berry, B.P. Singh (1983) studied the location and severity of occlusal contacts in the morning and the evening on 3 seperate days for 10 women. The findings suggest that occlusion and occlusal contacts change throughout the day and depend on the physical state of the masticatory muscles and mental state of the patient. Foley P.F and Latta (1985) studied the position of the paroted papilla relative to the occlusal plane and show parotid papilla was on the average 3.3 mm above the occlusal plane and that it should be considered and used as a guide for establishing the height of the occlusal plane.

Hiroko Ito, Kimic Okimoto (1997) said the occlusal curvature should be hormolized with stomatoguathic function, but excessive occlusal curvatures are found in some craniomandibular disorder patients. They did a study on 40 healthy patients and 95 patients with craniomandibular disorders and they concluded the clicking and locking groups had significantly larger anteroposterior and lateral occlusal curvatures.

SUMMARY AND CONCLUSION Complete dentures are constructed to function in the mouth as in integral part of the masticatory apparatus, and, therefore, they should be designed to conform to the patients physiologic jaw relations. The dentures should also conform to the functional occlusal movements of swallowing, the nonfunctional lateral and the protrusive movements of bruxism, and the deformation of the dentures which occurs during swallowing. Teeth which are not arranged in balanced occlusion are merely arranged for the opening and closing mandibular movements. Dentures with this type of oclusion generally destroy the efficient masticating movements habitual to the patient. This is true especially when teeth with high cusps are used on the dentures. Patients with dentures that have unbalanced occlusion lose all definite control of the jaw movements and, consequently, many find it quite difficult to use such dentures.

The nature of supporting structures for complete dentures and the forces directed to them by occlusion creates special biomechanical problem. Biological, physiological and mechanical principles used to be considered and carefully co-ordinated the artificial occlusion. When cusped teeth are used for balanced occlusion an adjustable articulator is needed. Non anatomic teeth do not need all these exacting jaw records and instrumentation, but only the common starting point for all artificial occlusion is the position of centric relation.

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