BALANCED OCCLUSION. pptx

BALANCED OCCLUSION

1. BALANCED OCCLUSION GUIDED BY: DR TUSHAR TANWANI(HOD AND PROFESSOR) DR GAURAV TRIPATHI (PROFESSOR) DR GAURAV AGRAWAL(READER) DR SUDEEPTI SONI(READER)

2. CONTENTS INTRODUCTION 1 NATURE OF SUPPORTING STRUCTURES 2 REACTION OF BONE TO PRESSURE AND TENSION 3 NATURAL VS ARTIFICIAL TEETH 4 DEFINITION 5 REQUIREMENTS OF COMPLETE DENTURE OCCLUSION 6 THREE DISTICT UNITS 7 SEARS AXIOMS OF ARTIFICIAL OCCLUSION 8 TYPES OF OCCLUSION ACCORDING TO POSTERIOR TOOTH FORM 9

3. Introduction Occlusion is the term generally accepted to describe the contact relationship between upper and lower teeth There are various concepts, techniques and philosophies concerning complete denture occlusion. 3/27/2023 presentation title 3

4. Nature of supporting structures Hard tissues Soft tissues 3/27/2023 SHELDON WINKLER- COMPLETE DENTURE PROSTHODONTICS 3 RD EDITION 4

5. Reaction Of Bone To Pressure And Tension Force is on line with the long axis of tooth- apposition Perpendicular or tangential to the long axis of tooth- bone resorption , tooth migration, and mobility 3/27/2023 SHELDON WINKLER- COMPLETE DENTURE PROSTHODONTICS 3 RD EDITION 5

6. Difference between Natural and Artificial teeth presentation title 6 Natural occlusion. Artificial occlusion Fixed in bone Rest on residual ridge Supported by periodontal ligament Not fixed to soft tissue Tooth move into socket during mastication because of elasticity of ligament Denture move toward tissue because of resiliency of muscosa . Incising with natural teeth does not affect posterior teeth Incising affects the posterior teeth Second molar is the preffered area for mastication Mastication with second molar will tilt the base and shift it Bilateral balance is rarely found Bilateral balance is considered necessary When tooth move one side during mastication other side is not affected When teeth move on other side the denture loses stability 3/27/2023

7. DEFINITIONS

8. OCCLUSION presentation title 8 It is defined as static relationship between the incising and masticating surfaces of the maxillary and mandibular teeth or tooth analogue (GPT 9) 3/27/2023

9. ARTICULATION The static and dynamic contact relationship between the occlusal surface of teeth during function. 3/27/2023 presentation title 9

10. Excursive movement 3/27/2023 presentation title 10 Movement occurring when mandible moves away from maximal intercuspation position

11. Balancing side/ non- working side the side of the mandible moves towards median line in lateral excursion. 3/27/2023 presentation title 11

12. Balanced occlusion The bilateral simultaneous occlusal contact of anterior and posterior teeth in excursive movement presentation title 12 3/27/2023

13. Centric Occlusion The occlusion of opposing teeth when mandible is in centric relation. This may or may not coincide with the maximal intercuspal position (GPT9) 3/27/2023 presentation title 13

14. Maximum intercuspal position Complete intercuspation of the opposing teeth independent of condylar position, sometimes referred to as the best fit of the teeth regardless of the condylar position 3/27/2023 presentation title 14

15. B ALANCED OCCLUSION Balanced occlusion is defined as the simultaneous contact between maxillary and mandibular teeth on their right and left and in anterior and posterior occlusal areas when the jaws are in either centric or eccentric positions, developed to lessen or limit tipping or rotating of the denture bases in relation to the supporting structures.

16. Requirement of complete denture occlusion Stability of occlusion in centric relation and areas forward and lateral to it. Balanced for all eccentric contacts bilaterally for all eccentric mandibular movements. Unlocking the cusp mesiodistally to allow for gradual but inevitable settling of the bases due to tissue deformation and bone resorption. 3/27/2023 Winkler 2 nd edition: complete denture prosthodontics 16

17. 3/27/2023 presentation title 17 4.Control of horizontal forces by buccolingual cusp height reduction according to the residual ridge resistance and interridge space. Requirement of complete denture occlusion

18. 3/27/2023 presentation title 18 5.Functional lever balance by favourable tooth to ridge crest position Requirement of complete denture occlusion

19. 3/27/2023 presentation title 19 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 in comminuting food. Requirement of complete denture occlusion

20. Incising unit Working unit 3/27/2023 presentation title 20 Three distinct units Balancing unit

21. Incising unit 3/27/2023 presentation title 21

22. Efficient in cutting and grinding Decreased buccolingual width Function as group Be over the ridge crest- Lever Balance Transmit force vertically Center the work load near the anteroposterior center of denture Plane of occlusion-parallel to mean foundation plane. 3/27/2023 presentation title 22 Occlusal Working Unit

23. Contact on 2 nd molar-when incising unit contact in function Contact at the end of chewing cycle- when working unit contact Smooth gliding contacts for lateral and protrusive excursions 3/27/2023 presentation title 23 Balancing Occlusal Unit

24. SEAR’S AXIOMS OF ARTIFICIAL OCCLUSION 3/27/2023 presentation title 24

25. FORCES OF MASTICATION Natural teeth- 5 to 175 pounds 100 dentures: 26 to 83 years Molar and bicuspid-28 to 24 pounds Incisor 9 pounds Avg closing force during mastication-11.7 pounds sheppard test Second PM has heaviest load Then 1 st molar and 1 st PM

26. Penetration of bolus Carnivorous Herbivorous Omnivorous or human teeth

27. Types of occlusion according to posterior tooth form 3/27/2023 presentation title 27 ANATOMIC TEETH SEMI-ANATOMIC TEETH NON-ANATOMIC TEETH

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29. CONCEPT OF COMPLETE DENTURE OCCLUSION 3/27/2023 presentation title 29

30. OCCLUSAL CONCEPTS occlusal rehabilitation of complete denture falls into 4 occlusal concepts Unbalanced occlusion Balanced occlusion Monoplane occlusion Lingualized occlusion 3/27/2023 presentation title 30

31. BALANCED OCCLUSION 3/27/2023 presentation title 31

32. CONTENTS OBJECTIVES 1 TYPES OF BALANCED OCCLUSION 2 GENERAL CONSIDERATIONS FOR BALANCED OCCLUSION 3 CONCEPTS TO ATTAIN BALANCED OCCLUSION 4 FACTORS AFFECTING BALANCED OCCLUSION 5

33. OBJECTIVES 3/27/2023 presentation title 33

34. Types of Balanced Occlusion 3/27/2023 presentation title 34

35. Unilateral Lever Balance 3/27/2023 presentation title 35

36. Unilateral Occlusal balance 3/27/2023 presentation title 36

37. Bilateral Occlusal Balance 3/27/2023 presentation title 37

38. Protrusive Occlusal Balance 3/27/2023 presentation title 38

39. General considerations for Balanced Occlusion wider and larger the ridge and tooth closer to the ridge greater the lever balance. Narrower teeth buccolingually greater the balance More lingual to the ridge crest teeth are placed greater the balance More centered the force of occlusion anteroposteriorly greater the stability of base 3/27/2023 presentation title 39

40. Concepts to attain Balance Occlusion Gysi concept French concept Sears concept Pleasure concept Frush concept Hanau’s squint Trapozzano concept Boucher concept The lott concept Bernard levin’s concept 3/27/2023 CONCEPTS OF OCCLUSION IN PROSTHODONTICS :A LITERATURE REVIEW PART 1 JOURNAL OF INDIAN PROSTHODONTIST SOCIETY JULY SEP2015;VOL 15 40

41. Gysi Concept 33° inclination of cusp and 33° condylar inclination 3/27/2023 presentation title 41 Centric occlusion Lateral movements Extreme working lateral position Forces towards ridges Cusp contact bilaterally Forces directed outward the ridge

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43. French Concept Mandibular posterior teeth- occlusal surface reduced to increase the stability of denture Maxillary posterior teeth- slight lingual occlusal inclines 5° for 1 st premolar 10° for 2 nd premolar 15° for 1 st and 2 nd molar 3/27/2023 presentation title 43

44. 3/27/2023 presentation title 44 Centric occlusion Working side Balancing side Buccal direction to mandibular residual ridge Towards ridge Away from ridge

45. Sear’s Concept -Non-Anatomic teeth Curved occlusal plane anteroposterior and laterally Use of 2 nd molar ramp 3/27/2023 presentation title 45

46. Centric occlusion Working side Balancing side Towards residual ridge Towards ridge Buccal side of ridge 3/27/2023 presentation title 46

47. Pleasure Concept 1937, Dr Max Pleasure-Pleasure Curve Reverse cureve - Bicuspid area Flat scheme – 1 st molar Spherical - 2 nd molar 3/27/2023 presentation title 47

48. Centric occlusion Working side Balancing side Towards residual ridge Towards lingual side of lower ridge Buccal side of ridge 3/27/2023 presentation title 48

49. Frush concept Linear occlusal concept Arbitary articular balance intraoral corrections Single mesiodistal ridge on lower posterior teeth Flat occlusal surface of upper posterior teeth set at an angle of horizontal. 3/27/2023 presentation title 49

50. Centric occlusion Working side Balancing side Towards residual ridge Towards ridge Buccal side of ridge 3/27/2023 presentation title 50

51. Hanau’s Quint 1925, Rudolph L. Hanau presented a discussion paper entitled, “Articulation: Defined, analyzed, and formulated” He believed articulation of artificial teeth was related to nine factors: Horizontal condylar inclination Compensating curve Protrusive incisal guidance Plane of orientation Buccolingual inclination of tooth axes Sagittal condylar pathway Sagittal incisal guidance Tooth alignment Relative cusp height 3/27/2023 presentation title 51

52. 3/27/2023 presentation title 52

53. . Hanau combined the original nine factors and reduced them to five. Thielemann subsequently simplified Hanau’s factors in a formula for balanced articulation. [K × I]/[OP × C × OK] 3/27/2023 presentation title 53

54. Where, K = Condyle guidance. I = Incisal guidance. C = Cusp height inclinations. OP = Inclination of the occlusal plane. OK = Curvature of the occlusal surfaces 3/27/2023 presentation title 54

55. Trapozzano Concept 3/27/2023 A reevaluation of Hanau's Laws of Articulation and the Hanau Quint Bernard Levin, D.D.S., M.Ed.* University of Southern California, School of Dentistry, Los Angeles, Calif. 55

56. Decided that only three factors were actually concerned in obtaining balanced occlusion. Also suggested the occlusal plane can be located at various heights to favor a weaker ridge. 3/27/2023 presentation title 56

57. Boucher’s Concept There are three fixed factors: The orientation of the occlusal plane, the incisal guidance, and the condylar guidance The angulation of the cusp is more important than the height of the cusp The compensating curve enables one to increase the effective height of the cusps without changing the form of the teeth. 3/27/2023 presentation title 57

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59. Lott Concept : laws 3/27/2023 presentation title 59

60. Bernard Levin’s Concept 3/27/2023 presentation title 60

61. Discussion 3/27/2023 presentation title 61

62. FACTORS affecting balanced occlusion 5 factors /HANAU’S QUINT 3/27/2023 presentation title 62 Inclination of condylar guidance Inclination of incisal guidance Plane of occlusion Compensatory curves Cuspal inclination

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64. 1.Condylar Guidance Mandibular guidance generated by condyle and articular disc traversing the contour of articular eminence (GPT 9) The mechanical form located in posterior region of and articulator that controls the movement of its mobile member (GPT 9) 3/27/2023 presentation title 64

65. Condylar guide angle The angle formed by the the inclination of condylar guide control surface of an articulatorand a specified refrence point. 3/27/2023 presentation title 65

66. Hanau-primary dictator of occlusion Kurth - not same for varying incisal guidance Weinberg-condylar path varies owing to variable pressure during function Only factor obtained from patient 3/27/2023 presentation title 66

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68. Significance 3/27/2023 presentation title 68 Shallow CG causes lesser posterior tooth separation on protrusion Steep CG causes greater tooth separation on protrusion

69. 3/27/2023 presentation title 69 Steep CG requires teeth with longer cusp and deeper fossa

70. INCISAL GUIDANCE The influence of contacting surface of mandibular and maxillary anterior teeth on the mandibular movement (GPT9) The influence of contacting surfaces of guide pin and guide table on articulator movement 3/27/2023 presentation title 70

71. Incisal Guidance Angle The angle formed between the horizontal plane of occlusion and a line drawn in sagittal plane between the incisal edge of maxillary and mandibular central incisors when teeth are in maximum intercuspation 3/27/2023 presentation title 71

72. 3/27/2023 presentation title 72 if steep overbite is required for esthetics, a corresponding increase in overjet will help to decrease the incisal guidance.

73. For complete denture incisal guidanace should be as flat as esthetics and phonetics permit 3/27/2023 presentation title 73

74. Plane of occlusion Anteriorly- by height of lower cuspid Posteriorly – by height of retromolar pad Nearly coincides with commissure of mouth 3/27/2023 presentation title 74

75. Also related to ala tragus line or camper’s line Its position can be altered slightly without creating serious functional problems 3/27/2023 presentation title 75

76. 3/27/2023 presentation title 76 Plane of occlusion is can be altered to a maximum of 10°

77. Compensating curves Anteroposterior curvature (in median plane) and mesiodistal curvature (in frontal plane) in the alignment of occluding surfaces and incisal edges of the artificial teeth that are used to develop balanced articulation. ~Glossary of prosthodontic terms-9 Most important determinants of occlusal balance 3/27/2023 presentation title 77

78. Determinants by the inclination of the posterior teeth and their vertical relationship to the occlusal plane So that the occlusal plane results in a curve 3/27/2023 presentation title 78

79. In natural dentition Curve of spee Curve of Wilson Pleasure curve 3/27/2023 presentation title 79

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81. Compensating curves Anteroposterior curve Mesiodistal curve Curve of monson Reverse curve 3/27/2023 presentation title 81

82. Anteroposterior curve/ curve of Spee Raising the distal portion of 1 st and 2 nd molar to confirm the curve Significance Without this entire occlusal plane would have to be tilted to achieve the balanced occlusion 3/27/2023 presentation title 82

83. Mesiodistal curve – curve of wilson Compensates for the wedge like opening formed when the mandible is moved laterally to the opposite side. 3/27/2023 presentation title 83

84. Curve of monsoon- George. S. Monsoon Eponym for the proposed ideal curve of occlusion in which each cusp and incisal edge touches or conforms to a segment of a surface of a sphere 8 inches in diameter with its center in the region of glabella 3/27/2023 presentation title 84

85. CUSPAL HEIGHT OR INCLINATION 3/27/2023 presentation title 85 Cusp inclinations: the angle made by the average slope of a cusp with the cusp plane measured mesiodistal or buccolingual

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87. CONDYLAR GUIDANCE INCISAL GUIDANCE OCCLUSAL PLANE COMPENSATING CURVE CUSP INCLINATION Only factor which is recorded from patient Can be modified by dentist to certain limit Anteriorly commissure of mouth Curve of spee Not too steep Lateral force Cannot be modified Overjet Incisal guidance decrease Posteriorly height of retromolar pad Curve of wilson Compensated by compensating curves Steeper the condylar guidance Overbite Incisal guidance increase Parellel to ala tragus line or campers plane Curve of monsoon Decrease the incisal guidance Steeper the incisal guidance Steeper cusp/steep occlusal plane/ steep CC Cannot tilt plane > 10° Pleasure curve 3/27/2023 presentation title 87

88. THEILMANN’S FORMULA BALNCED OCCLUSION Where; CG= condylar guidance IG=incisal guidance CH= cuspal height CC=compensatory curves OP=plane of occlusion   3/27/2023 presentation title 88

89. Advantages of balanced occlusion Sheppard- enter bolus exit balance Winkler – balancing the occlusion of CD is like stumbling prose into poetry 3/27/2023 presentation title 89

90. Pros of balanced occlusion 3/27/2023 presentation title 90

91. Cons of balanced occlusion 3/27/2023 presentation title 91

92. Procedure 1. Anterior balancing- Protrusive 3/27/2023 presentation title 92

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94. Lateral incisal balancing 3/27/2023 presentation title 94

95. Posterior Balancing 3/27/2023 presentation title 95

96. Characterstics of balanced occlusion in complete denture CROSS ARCH AND CROSS TOOTH Anterior teeth- No contact Posterior teeth- Multiple uniform occlusal contacts 3/27/2023 presentation title 96

97. IN PROTRUSIVE Anterior teeth- maxillary and mandibular teeth contact Posterior teeth- Semi anatomic / anatomic –multiple posterior buccal cusp to buccal cusp and lingual cusp to lingual cusp contact between maxillary and mandibular teeth (CUSP TO CUSP) Flat / neutocentric / monoplane- 2 nd molar contact if increase in compensating curve Balancing ramp contact if true flat plane If no curve or ramp and have overbite cant balance in protrusion. 3/27/2023 presentation title 97

98. Cusp to Cusp 3/27/2023 presentation title 98

99. I n lateral excursion- working side Anterior teeth: maxillary and mandibular anterior teeth contact Posterior teeth: the lingual inclines of buccal cusp of maxillary posterior teeth should contact the buccal inclines of buccal cusp of mandibular posterior teeth(LBBB) 3/27/2023 presentation title 99

100. In lateral excursion- balancing side Anterior teeth-maxillary and mandibular anterior teeth contact Posterior teeth- buccal inclines of palatal cusp of maxillary posterior teeth should contact the lingual inclines of buccal cusp of mandibular posterior teeth (BPLB) With monoplane balanced occlusion usually only 2 nd molar are in contact or the balancing ramp With cusped teeth multiple contacts of posterior teeth are possible 3/27/2023 presentation title 100

101. BPLB 3/27/2023 presentation title 101

102. Indications Steep incisal guidance Requirement of anatomic or semianatomic for esthetic or other reason 3/27/2023 presentation title 102

103. contraindications Patient lack of achieving repeatable centric relation 3/27/2023 presentation title 103

104. REVIEW OF LITERATURE 3/27/2023 presentation title 104

105. Lingualized occlusion for removable prosthodontics Curtis M. Becker, D.D.S., M.S.D., Charles C. Swoope , D.D.S., M.S.D., and Albert D. Guckes , D.D.S., M.S.D. J. Prosthet . Dent. December, 1977 LINGUALIZED OCCLUSION

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107. INDICATIONS FOR LINGUALIZED OCCLUSION 3/27/2023 presentation title 107

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110. CARBORUNDUM STONE IS USED TO RECONTOUR THE MANDIBULAR TEETH 3/27/2023 presentation title 110

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113. 3/27/2023 presentation title 113 OCCLUSION AS RELATED TO COMPLETE REMOVABLE PROSTHODONTICS H.O. BECK J. Prosthet . Dent. March. 1972

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123. Review of Literature Clinical performance of and patient satisfaction with conventional complete denture with different occlusal schemes: a systematic review – journal of prosthodontic society- 3 jan 2022

124. Purpose The purpose of this review was to assess the methodological quality and summarize the scientific evidence from secondary studies about the influence of occlusal schemes on the clinical performance of and patient satisfaction with complete dentures.

125. Results The present overview concluded that occlusal schemes might interfere with the clinical performance of and patient satisfaction with complete dentures. Lingualized, bilateral balanced, and canine guidance are preferred compared with monoplane occlusion, but lingualized occlusion tends to show better results in some reviews. However, the results should be carefully considered because of the low quality of the systematic reviews included.

126. Occlusal schemes for complete dentures: a systematic review Abduo J. Int J Prosthodont 2013;26:26-33 Results: A total of 565 articles were retrieved; however, only 12 articles met the inclusion criteria. The included studies evaluated the effects of posterior tooth morphology/arrangement and lateral occlusal guidance. In relation to morphology, the posterior teeth were either anatomical or flat. The posterior tooth arrangements showed conventional bilaterally balanced occlusion (CBBO), lingualized bilaterally balanced occlusion (LBBO), or monoplane occlusion (MO). The lateral occlusal guidance involved either balanced occlusion or anterior tooth-guided occlusion (ATGO).

127. Conclusions: Within the limitations of this review, it can be concluded that anatomical teeth arranged in CBBO or LBBO are preferable to flat teeth arranged in MO. This is primarily related to patient acceptance. ATGO can also be considered for complete dentures

128. Tests of balanced and nonbalanced occlusions Vincent R. Trapozzano Test denture bases with interchangeable inserts with “balanced” and “ nonbalanced ” types of occlusion were made for 12 patients. Both types of occlusion were constructed to the  same  centric relation record. Subjective observations of the 12 patients were recorded along with objective observations of chewing efficiency tests and a correlation with the ridge conditions.

129. There was slightly more complaint about the relative “looseness” of the dentures with the nonbalanced occlusion than there was with the balanced occlusion. For 9 patients, there was greater efficiency of chewing with the balanced occlusion. In 3, the chewing efficiency was greater with the nonbalanced occlusion. The balanced occlusion showed a greater efficiency based on fineness of chew when carrots were being chewed. When peanuts were chewed, the difference in efficiency between the balanced and nonbalanced occlusions was not so clearly defined. This indicates that the chewing efficiency of both forms of occlusion varies with the types of food.

130. Summary The nature of the supporting structures for the complete dentures and forces directed to them by occlusion creates a special biomechanical problems. Balanced occlusion is one of the most important factors which will favour the stability of the base; and help in preservation of the supporting structures by reducing the lateral forces. “thereby signifying its importance in complete denture fabrication”

131. Conclusion Regardless of ones belief about the superiority of the particular form of occlusion; the anatomical, mechanical, physiologic and esthetic limits presented by the patient should determine the choice of the occlusal schemes.

132. References Sheldon winkler - essentials of complete denture prosthodontics, 3 rd edition Charl M. Heartwell - syllabus of complete denture 4 th edition Rudd Morrow Rhoads- Dental Laboratory procedure – complete denture 4 th edition John J Sharry – complete denture prosthodontics 3 rd edition Concepts of occlusion in prosthodontics : a literature review part 1 j- Indian prosthodontic society 2015 July- sep;15(3):200-205 The glossary of prosthodontic term, 9 th edition Boucher’s – Prosthodont treatment for edentulous patient 9 th edition V. Rangarajan textbook of prosthodontics, 2 nd edition