Occlusion

Occlusion: is the relationship between the occlusal

surfaces of the maxillary and the mandibular teeth
when they are in contact .
There are several theories of occlusion but all of
them share in achievement of masticatory efficiency,
maximum stability & preservation of the underlying
oral tissue.
Centric occlusion: is the relation of opposing
occlusal surfaces of the teeth that provides the
maximum intercuspation (tooth to tooth relation) .

Eccentric occlusion: is the contacting of

opposing occluding surfaces of the teeth when the
jaws are in any other relation than centric relation.
Balanced occlusion: is described as the occlusal
contacts of maxillary & mandibular teeth when the
jaws are in either centric or eccentric relation.
Working or function occlusion side:in which buccal cusps of
upper teeth meet buccal cusps of lower teeth & palatal cusps of
upper teeth meet lingual cusps of lower teeth in lateral movement
during mastication.
Working side
Balancing occlusion side : in this side, palatal cusp
of upper teeth contact buccal cusps of lower teeth ,
such a contact during function help to maintain the
denture in position during lateral movements. As
example, during left lateral movement, the left side
of the dental arch becomes the working side and the
right side becomes the balancing side.
Protrusive balancing occlusion: contacts in
protrusive movements permit the posterior teeth
touch when the anterior teeth are in contact. This
helps maintain denture stability. The distal inclines of
the maxillary facial cusps contact the mesial inclines
of the lower facial cusps. Protrusive balancing
contacts may also occur on the lingual cusps.
Balancing Working

Protrusive
 Concepts of occlusion for complete
denture

We should consider the concept of occlusion which

we are going to adapt it during the arrangement of
teeth.
1- Neutro- centric or monoplane occlusion
or flat plane concept
using simple articulator & non-cusp form posterior
teeth arranged in a flat plane without any curvature
like the compensating curve and the occlusal plane is
parallel to the residual ridges.
*Advantages: It provides freedom in centric
occlusion & more stability of the dentures, it is used
in class II & III occlusion.
*Disadvantages: the decreased chewing efficiency
because of the absence of the cusps, decreased
esthetic in premolar area because of the missing cusp
& in anterior teeth region since they are set in edge
to edge relation with out overbite or overjet.
2- Balanced occlusion concept: this is the ideal occlusion
for complete denture , it can be defined as an occlusion
which gives a harmonious and simultaneous contact
between the teeth in centric and eccentric relation & in all
mandibular movement to achieve stability of the denture
within the functional limit.
In our school we use this concept. It needs the use of cusp
form posterior teeth (anatomic or semi anatomic teeth) &
adjustable articulator.
3- Lingualized occlusion concept:
This can combine components of both
of the previous occlusal schemes like
using of cusp form upper teeth & non-
cusp form lower posterior teeth to get
the advantages of both types of teeth &
concepts .
The upper posterior teeth are set with
buccal inclination so that the buccal
cusp is out of occlusion in centric &
lateral movements while their lingual
cusps make in contact with the middle
of the lower wide shallow fossa of non
cusp form lower teeth .
*Advantages: freedom in centric
relation, better stability because less
cusps are involved in lateral &
protrusive movements, better chewing
efficiency because of the sharp upper
lingual cusps.
Indication of each type of the previous concepts:
1. age of the patient: old age & geriatric patients need
monoplane or lingualized concept because of their poor
muscle tonicity while we can use balanced occlusion in
young patients.
2. condition of oral health: patient with resorbed ridges
or bad soft tissue condition like flabby ridge need
monoplane or lingualized concept & we can use balanced
concept in adverse conditions.
3. demand of the patient: esthetic & function demand
need balanced or lingualized occlusion.
4. skill of the dentist & the technician: balanced
occlusion need an experienced dentist & technician in
using of the adjustable articulator & teeth setting.
Factors of occlusion: There are five factors of occlusion
which influence the arrangement of posterior teeth or
governing articulation, these factors are:-
1- Condylar guidance : is the part of an articulator that
intended to produce similar guidances in articulator movement
as that produced by the paths of the condyles in the
temporomandibular joints. The condylar guidance inclination
is the only factor totally controlled by the patient and the
dentist can’t change or modify it to fit a particular occlusion
unlike the other factors which is entirely under the control of
the dentist.
2- Incisal guidance : is the part of an articulator that
maintains the incisal guide angle. The last is the angle
formed with the horizontal plane by drawing a line in
the sagittal plane between the incisal edges of the
maxillary and mandibular central incisors when the
teeth are in centric occlusion.
For the patient, the incisal guide is influenced by the
amount of horizontal & vertical overlaps of anterior
upper & lower teeth developed during teeth
arrangement . the greater the horizontal
overlap and the less the vertical
overlap result in a less incisal guide
angle and a more stable dentures
because of the reduction of lateral inclines.
3- Occlusal plane: is an imaginary surface
that is related anatomically to the cranium
and that theoretically touches the incisal
edges of the incisors and the tips of the
occluding surfaces of posterior teeth.
The soft tissue guides used by the dentist
in locating the plane are the retromolar
pads (junction of middle and upper third of
each pad) and the corners of the mouth
bilaterally. The orientation of the plane is
selected to be in harmony with the lateral
borders of the patient’s tongue & medial
roll of buccinator muscle so that food can
be held between the teeth for proper
chewing
4- Cusp height : is defined as the
shortest distance between the deepest
part of the central fossa of a posterior
tooth and a line connecting the tips of
the cusps of the tooth. Cusp inclines
disturb the stability of dentures &
should be reduced to a minimum to
eliminate lateral forces on teeth &
denture.
5- Compensating curve & Manson’s curve: is the
anterio-posterior curvature of the occlusal surface of
a complete denture teeth; it provides for a balanced
occlusion. It corresponds to the curve of spee which
is an anatomical curve in the sagittal plane present in
the natural dentition. The compensatory curve may be
increased or decreased in an artificial dentition to
help achieve balanced occlusion.
Another curve in the frontal plane in the natural
dentition which we call it Manson's curve or
Willson's curve which is passed between upper molar
cusps of right & left side of the upper arch.
 The try –in
appointment
It is the fourth clinical step or appointment in complete
denture construction. After the primary arrangement of
the teeth on the bite rims, it is essential that the
accuracy of the jaws relation records made with the
bite rims be tested for the following:
• Check vertical dimension of occlusion and rest
• Prove centric relation record
• Evaluate esthetics and phonetics
• Posterior palatal seal
• Teeth position
1. Vertical dimension: Vertical dimension
of rest(V.D.R) is measured first with out
trial dentures in patient mouth between a
prominent points in patient chin & nose by
a gauge or roller.

Then Vertical dimension of

occlusion(V.D.O) is measured , maxillary
& mandibular trial dentures are placed in
the mouth, the mandible is guided to close
into centric relation by the dentist’s thumb
placed directly on the anteroinferior
portion of the patient’s chin and the index
fingers bilaterally on the buccal flanges of
the lower trial denture while the patient
pulls his lower jaw back as far as it will go
and closes just until the back teeth make a
feather touch with each other.
V.D.O must be less than V.D.R by 2-4mm(free way
space), if the difference is less than 2mm, this mean
there is increased V.D.O but if the difference is more
than 4mm this mean there is decreased V.D.O so it
must be corrected .
2. Centric jaws relation(CR) : test for accuracy of CR record
involves the observation of intercuspation when the mandible is
pulled back by the patient with the aid of the dentist as said
before . All the teeth that occluded uniformly on the articulator
must have equally uniform contacts in the mouth, if not this
mean the CR record is incorrect (centric-off).
Factors that contribute to maxillomandibular relation recording
inaccuracy (centric –off) are may be caused by biological
difficulties arising from lack of patient muscle coordination
&control or psychological difficulties because patient &/or
dentist are tired or nervous that is difficult to get a relaxed
position of the mandible. mechanical difficulties due to
unstable & poorly fitting record bases & displaceability of
denture bearing tissues. Also, materials consistency &
equipments used in record making must not be too hard like
impression plaster, Z.O.E paste & not well-softened wax .Type
of the articulator that used & finally incorrect recording
technique or mounting used by the dentist & lack of dentist
skill especially with difficult cases.
3. Establishing the posterior palatal seal(p.p.s)of
upper denture: posterior palatal seal: defined as
“the soft tissues along the junction of the hard and
soft palates on which pressure within the
physiological limits of the tissues can be applied by a
denture to aid in the retention of the denture.
Recording of posterior palatal seal is very important in retention
to provide a peripheral seal. The denture posterior border
which should rest on soft and resilient tissues, which can
move along with the denture during function and prevent
loss of peripheral seal refered as post dam or vibrating line.
posterior border of upper denture is determined in the mouth &
transferred onto the cast. The vibrating line of the soft palate is
used as a guide to p.p.s , usually is located slightly anterior to
fovea palatinae or on it, the dentist observes closely vibrating
line when the patient say (ah) & marks it with an indelible
pencile from one hamular notch to the other, the trial denture
base is now inserted so that this line is transferred to it & the
excess of the record base is reduced by a prosthetic handpiece to
this line. Then is recorded & drawn on the cast & carved as a V-
shaped groove with 1.5mm width at its base & sharp at its apex
& 1-1.5mm deep. The groove will form a bead on the denture
that provide p.p.s. Two wide p.p.s can push the denture
downward gradually & break the seal. Too high p.p.s can make
tissue soreness.
4. Phonetic & esthetic: the appearance of the entire lower half
of the face & its anatomical landmarks depends on the dentures.
The appearance of the patient premature aging may be caused
by the lack of support for the lips & cheeks due to improper
setting of teeth or decreased V.D.O. Over support of lips &
cheeks by teeth or thick denture flanges or increased V.D.O also
affects esthetic.
The teeth color, size, shape also must be checked with patient
gender, age, personality & skin color with taking patient’s
desire, acceptance & attitude into consideration.
Phonetic must be checked by the dentist which is affected by
the V.D.O, overbite & overjet of anterior teeth , teeth position &
tongue space.
*(s) sound is the most interesting sound from a dental point of
view as is mainly influenced by the teeth & palatal part of the
prosthesis & it is common in nearly all languages of the world.
(s) sound is produced by a small space formed between the
tongue tip & rugae area during its pronounceation , the size &
the shape of this space determine the quality of the sound.
5. Teeth position: finally the dentist must check that
the anterior & posterior artificial teeth are arranged
in their correct position in the articulator so that they
will not cause cheek or tongue bite, or instability of
the dentures. In addition, the five factors of occlusion
must be checked with teeth setting like vertical &
horizontal overlap, height of occlusal plane of lower
trial denture, compensating curves . Also ,
orientation of occlusal plane of upper trial denture
must be checked with the fox bite.
Thank You
Q/ Define the incisal guidance angle.