CLINICAL ANALYSIS OF

OCCLUSION
 Terminology

Occlusion:

This words is used to describe the static contact

relationship between the incising or
masticating surfaces of the maxillary or
mandibular teeth or tooth
 Terminology

Articulation:

Refers to the static and dynamic contact

relationship of maxillary and mandibular
teeth as they move against each other during
function.
 Terminology

Balanced Occlusion:

It refers to the bilateral, simultaneous, anterior,

and posterior occlusal contact of teeth in
centric and eccentric position.
 Terminology

Free Mandibular Movement:

Any mandibular movement without

interference.
 Terminology

Occlusal Harmony:

A condition in centric and eccentric jaw relation

in which there are no interceptive or defective
contacts of occluding surfaces.
 Terminology

Occlusal Interference:

Any tooth contact that inhibits the remaining

occluding surfaces from achieving stable and
harmonious contacts.
 Terminology

Occlusal Pattern:

The form or design of the masticatory surfaces

of a tooth or teeth based on natural or
modified anatomic or non anatomic teeth
 Terminology

Maximal Intercuspal Position:

The complete intercuspation of the opposing

teeth independent of the condylar position.
Introduction

Occlusion in complete denture must be

developed to function effeciently and with
the least amount of trauma to the supporting
tissues.
Objectives

Preservation of the remaining tissues

Proper masticatory efficiency
Enhancement of denture stability, retention
and support
Enhancement of phonetics and esthetics
Difference Between Natural
and Artificial Occlusion
1. The teeth in natural dentitions are retained
by periodical tissues that are uniquely
innervated and structured. 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.
Difference Between Natural
and Artificial Occlusion
3. Malocclusion of natural teeth may be
uneventful for years.
4. Non vertical forces on natural teeth during
function affect only the teeth involved and
are usually well tolerated, whereas in artificial
teeth the effect involved all of the teeth on
the bases. It is usually traumatic to the
supporting structures.
Difference Between Natural
and Artificial Occlusion
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.
7. In natural teeth bilateral balance is rarely
found; If present it is considered balancing
side interference.
Difference Between Natural
and Artificial Occlusion
8. In natural teeth proprioception gives the
neuromuscular system control during
function.
Requirement of Complete
Denture Occlusion
1. Stability of occlusion in centric relation.
2. Balanced for all eccentric contacts bilaterally for
all eccentric mandibular movements.
3. Unlocking the cusp mesiodistally to allow for
gradual but inevitable settling of the bases due
to tissue deformation and bone resorption.
4. Control of horizontal forces by buccoligual cusp
height reduction according to the residual ridge
resistance and interridge space.
Requirement of Complete
Denture Occlusion
Requirement of Complete
Denture Occlusion
5. Functional lever balance by favorable tooth
to ridge crest position
Requirement of Complete
Denture Occlusion
6. Cutting and shearing effeciancy of the
occlusal surface (sharp cusps or ridges)
7. Anterior clearance of teeth during
mastication. Minimum occlusal
contact between the upper and
lower teeth to reduce pressure
during function
(linguilized occlusion)
Requirements for Incising
Units
These units should be sharp in order to cut
effeciently. They should not contact during
mastication.

They should have as flat an incisal guidance as

possible considering esthetics and phonetics.
They should have horizontal overlap to allow
for base settling without interference. They
should contact only during prostrusive
incising function.
Requirements for the Working
Occlusal Units
They should be effecient in cutting and
grinding. They should have decreased buccal-
lingual width to minimize the work force
directed to the denture foundation.

They should function as a group with

simultaneous harmoniuos contacts at the end
of the chewing cycle and during eccentric
excursions.
Requirements for the Working
Occlusal Units
They should be over the ridge crest in the
masticating area for lever balance. They
should center the work load near the
anteroposterior center of the denture.

They should present a plane of occlusion as

parallel as possible to the mean foundation
plane.
Fundamentals for Artificial
occlusion
The smaller the area of the occlusal surface
acting on food, the smaller will be the
crushing force on food transmitted to the
supporting structures.

Vertical force applied to an inclined occlusal

surface causes non vertical force on the
denture base.
Fundamentals for Artificial
occlusion
Vertical force applied to a denture base
supported by yielding tissue causes the base
to slide when the force is not centered on the
base.

Vertical force applied outside (lateral to) the

ridge crest creates tipping force on the base.
Balance occlusion

Balance as related to complete denture

occlusion:
Balance 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 within the normal range of
mandibular function.
Balance occlusion

Balance in complete dentures is unique and

man made. 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:
Balance occlusion

1. The wider and larger the ridge and the closer

the teeth are to the ridge, the greater the level
balance.
2. Conversely, the smaller and narrower the ridge
and the farther the teeth from the ridge, the
poorer the level balance.
3. The wider the ridge and the narrower the teeth
buccolingually, the greater the balance
4. The more lingual (inside) the teeth are place in
relation to the ridge crest, the greater the
balance
Balance occlusion

5. The more centered the force of the occlusion

anteroposteriorly, the greater the stability of
the base.
Types of Balance

(a) 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 exist
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.
Types of Balance

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.
Types of Balance

(b) Occlusal Balance

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.
Types of Balance

c)Protrusive occlusal balance this is

present when the mandible moves essentially
forward and the occlusal contacts are smooth
and simultaneous in the posterior both
anterior teeth. It is slightly different from
bilateral balance in that it requires a
minimum of three contacts, one on each side
and one anterior, and is dependently on the
interaction of the same factors.
Types of 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. Occlussal balance with stable contacts at the
retruded border position and in an area
(long centric)
Types of Balance

N.B. In both natural and artificial dentition,

when centric relation and centric occlusion do
not coincide, it is desirable to create an area
within the fossae that will allow freedom of
tooth movement from centric relation to
centric occlusion (this is called long centric or
freedom in centric)
Types of Balance

4. Right and left eccentric 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 excursion to the
right, left and protrusive.
Advantages of Balanced
Occlusion
1. Distribution of load
2. Stability
3. Reduced trauma
4. Functional movement
5. Efficiency
6. Comfort
Factors Affecting the
balanced occlusion (Laws of
Articulation Hanau quint)
There are five factors involved in eccentric
occlusal balance in complete dentures.
Condylar guidance
Incisal guidance
The occlusal plane
The compensatory curves
Cusp angulation
1. Condylar guidance it is definite anatomic feature
that depends on the inclination of the floor of the
glenoid fossa. It should be determined on the
patient and set on the articulator by eccentric
records so that the patients TMJ is in harmony with
the occlusion programmed on the articulator. If the
condylar angle (angle between the path of condyle
and the Franfort horizontal plane) is steep, its
difficult to produce balance occlusion because
when the condyle travel downward and forward
large space is created posteriorly when the anterior
teeth are edge to edge. So compensation should be
made by altering the other factors to otain the
desired balanc.
2. Incisal guidance Incisal guidance is the effect of
the contact of the upper and lower anterior teeth
on the movement of the mandible. It is usually
expressed in degrees of agulation 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. If
the incisal guidance is steep, it requires steep
cusp, a steep occlusal plane, or a steep
compensating curve to effect an occlusal
balance.
 Factors affecting the incisal guidance
angle.
1. Vertical overlap (over bite): the vertical
overlap is directly proportional with the
incisal angle. For complete dentures the
incisal guidance should be as flat as esthetic
and phonetics will permit.
 For the following reasons:
1. To guard against loss of posterior teeth
contact during prostrusive movement.
2. To allow the use of posterior teeth with
reduced cusp angle and this will reduce the
lateral stresses transmitted to the ridge.
3. To reduce the downward movement of the
mandible during edge to edge position.
The incisal guidance is reduce by:
Setting the upper anterior teeth outside the
ridge
Setting the lower anterior teeth inside the
ridge without encroaching on the tongue
space
Shorten the upper and lower anterior, if
esthetics and phonetics allows.
When the arrangement of the anterior teeth
necessitates a vertical overlap, a
compensating horizontal overlap should be
set to prevent anterior interference.
3. Plane of Occlusion the occlusal plane is
established in the anterior by the height of
the lower cuspid, which is nearly coincident
with the commissure of the mouth, and in the
posterior, by the height of the retromolar
pad. It is also related to the related to the ala-
tragus line. Its role is not as important as are
the other determinants.
4. Compensating curves -- Compensating curve is
one of the more important factors in establishing
a balanced occlusion 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 compensating
curve for occlusal balance. A lesser
compensating curve for the same condylar
guidance would result in a steeper incisal
guidance (anterior interference), which would
cause loss of molar balancing contacts.
Height of cusps on teeth or inclination of cusp less
teeth.

Cusp angle the angle made by the slopes of a cusp

with a perpendicular line bisecting the cusp,
measured mesio-distally or buccolingullay.
Cusp Height the shortest distance between the tip of
a cusp and its base plane. Altering the cusp height by
widening or narrowing a tooth alters the length of
the cusp incline but does not change the relationship
to the mean occlusal plane, i.e. cusp angle is not
affected by a change in cusp width.
 when we select a tooth with a certain xusp
height or angle, it doesnt mean anything
until the tooth is positioned in the denture.
For example, a particular tooth may be
manufactured with a 30 degree inclination.
However, by tilting the tooth in relation to
the mean occlusal plane, one may create an
effective inclination of greater or less than 30
degrees.
Interaction of the five
factor
Of the four that he can control two of them (the
incisal guidance and the plane 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
the inclinations or cusp on the occlusal
surfaces of the teeth.
Selection of Posterior Tooth
Forms
Factors affecting the selection of posterior teeth
forms:
1. The capacity of the ridge to receive and resist
forces of mastication.
2. Inter ridge distance.
3. Ridge relationship
4. Esthetics
5. Patients age and neuromuscular coordination
6. Previous denture wearing experience.
Posterior artificial teeth are classified according
to their oclusal form into anatomic, semi-
anatomic and non anatomic.
1. Anatomic Teeth the standard anatomic
tooth has inclines of approximately 33. The
cuspal inclination is measured by the angle
formed by the mesiobuccal cuspal incline to
the horizontal plane when the long axis of the
tooth is vertical.
2. Non Anatomic Teeth (0) Non
anatomicteeth have a flat occlusal surace
(without cusps) this type of teeth does not
function efficiently unless the occlusal surface
is provided with cutting ridges and spill ways
this types of teeth were designed to eliminate
the problems evolved with using anatomic
teeth.
Semi Anatomic Teeth Examples of the semi
anatomic teeth are twenty degree teeth.
Problems with Anatomic Tooth
Forms
In edentulous mouths, these same cusps can
cause trauma, discomfort, and instability to
the bases because of the horizontal
components they generate. The basic
problem initiallly is the coordination of their
cusps to harmonize with one another and the
mandibular movements.
The problem of unmodified, cusped teeth for
complete dentures can be summed up as
follows:
1. It is mandatory to use an adjustment
aritculator.
2. Eccentric records must be made for articulator
adjustments.
3. Mesiodistal interlocking will not permit settling
of the base without horizontal forces
developing. So reduction of cusp height and
performing long centre concept becomes
mandatory.
4. Harmonious balanced occlusion is lost when
settling occurs.
5. The base need prompt and frequent refitting
to keep the occlusal stable and balanced.
6. The presence of cusps generates more
horizontal force during function.
Problems with Non anatomic
Tooth Forms
1. Non anatomic (flat) teeth occlude in only two
dimensions (length and width), but the
mandible has an accurate three dimensional
movement due to its condylar behavior.
2. This form loses shearing efficiency.
3. Bilateral and protrusive balance are not
possible with a purely flat occlusaion. Non
anatomic teeth set on inclines for balance
require as much concern as anatomic teeth
for jaw movements.
the flat teeth do not function efficiently
unless the occlusion surface provides cutting
ridges and generous spillways.
Balanced Occlusion with Non
Anatomic or Flat Teeth
Balanced occlusion with cupless teeth can be
achieved by several ways:
1. Zero-degree teeth with inclination of the
lower second molar
2. Zero-degree teeth with balancing ramps
placed posterior to the most distal molar.
3. Zero-degree teeth set to steep
compensatory.
Occlusal Designs for
Balanced Occlusal
Lingualized Occlusion
This method of lingualizing the occlusaion was
suggested as a method to achieve bilateral
balanced occlusion.

The lingulaized occlusaion utilizies only the

upper lingual cusps on each side to act as cutters
operating in the central fossa of the lower teeth
this gives mortar and pestle type contact that
lingualizes the resultant force without moving
the teeth in relation to the ridges.
 Lingualized occlusion is indicated when
the patient places high priority on esthetics
but a non anatomic occlusal scheme is
indicated by oral conditions suchs as sever
alveolar resorption, class II jaw relation or
displaceable supporting tissues.
Advantages of lingualized
occlusion
a. Most of the advantages attributed to both
anatomic and non anatomic forms are
retained
b. Cusp form is more natural in appearance
c. Good penetration of the bolus is possible
d. Bilateral balanced occlusion is readily
obtained
Linear Occlusion concept
In this type of occlusion the teeth are
arranged so that the masticatory surfaces of
the mandibular posterior teeth have straight
long, very narrow occlusal form resembling
that of a line articulating with apposing
monoplane teeth.
Monoplane Teeth with Compensating Curve
The arrangement of monoplane teeth in a
compensating curve of occlusion is similar to
that for anatomic teeth.
Non-Balanced Occlusion
When the foundation tissues is compromised,
i.e. severely resorbed ridge, knife-edge, thin
wiry ridge or one that is covered with thick
movable flabby tissues, favorable control of
occlusal forces can be utilized by the use of
non-anatomic teeth arranged following the
monoplane occlusion concept.
Monoplane Occlusion Concept

The monoplane occlusion concept utilizing non-

anatomic teeth with flat occlusal surfaces set to
a flat occlusal plane. The posterior limit of the
extent of lower posterior teeth is the point at
which the mandibular ridge begins to curve
upward, with elimination of contact between the
upper and lower second molars, which are
considered as space fillers. The patients should
avoid incising with their anterior teeth, as the
purpose of the anterior teeth is to produce a
desired appearance. If they recognized this
limitations, no balancing contact will be
necessary for protrusive occlusion.