balancedocclusion in prosthodontics dentistry

Department of prosthodontics
Presented by,
Shiji margaret
CRRI

• Introduction
• Definition
•Concepts of balanced occlusion
•Factors affecting balanced occlusion (hanau’s quint)
•Pre-requisites
•Types of balanced occlusion
•Selection of posterior teeth
•Teeth arrangement in various condition
•Conclusion
•Reference

INTRODUCTION
Relationship between the occlusal surface of the maxillary and mandibular
teeth when they are in contact.
TYPES OF OCCLUSION
SLIDING OCCLUSION
CENTRIC OCCLUSION
ECCENTRIC OCCLUSION
BALANCED OCCLUSION
BALANCED SLIDING OCCLUSION
Syllabus of complete denture-Heartwell -4th
edition 231&232
OCCLUSION

BALANCED OCCLUSION = BALANCE+OCCLUSION
BALANCE = When forces act on a body in such a way that
no motion results,-there is balance or
equilibrium
OCCLUSION =
Relationship between the occlusal surface
of the maxillary and mandibular teeth
when they are in contact.

 DEFINITION:
Balanced occlusion is defined as
“The simultaneous contact of the opposing upper and lower teeth
in centric relation position and a continuous smooth bilateral
gliding from the position to any eccentric positions with the
normal range of mandibular function. Sheldon winkler 2nd
edition page 240
“The simultaneous contacting of the maxillary and mandibular teeth on the
right and left and in the posterior and anterior occlusal areas in centric and
eccentric positions, developed to lessen or limit tipping or rotating of the
denture bases in relation to the supporting structures” –GPT

1) Gysi’s concept
2) French’s concept
3) Sears’s concept
4) Pleasure’s concept
5 )Frush’s concept
6) Hanau’s Quint
7) Trapozzano’s concept
8) Boucher’s concept
9) Lott’s concept
10) Levin’s concept

Sheldon winkler 2nd
edition page 242
These five factors are now called as hanau’s quint
The five basic factors that determine the balance of an occlusion are:
1) Inclination of condylar guidance.
2) Inclination of Incisal guidance
3) plane of occlusion
4) Compensating curves 5) Cusp inclination

(Incisal guidance)(condylar guidance) (cusp) (plane) (curve)
I x CG = CS x P x CV
I = CS x P x CV
CG
BALANCED OCCLUSION

C -BALANCED OCCLUSION
C = CONDYLAR INCLINATION× INCISALGUIDANCE
OCCLUSAL PLANE ×CUSPAL INCLINATION ×
COMPENSATORY CURVE
edition

Hanau’s quint
(Incisal guidance)(condylar guidance) (cusp) (plane) (curve)

CONDYLAR GUIDANCE
 Mandibular guidance generated by condyle and articular disc traversing contour
of glenoid fossa
 Condylar guidance is due to path followed by condyle in temporomandibular
joint
 Obtained by protrusive registration record
Sheldon winkler 2nd
edition page 242,243

•“The influence of the contacting surfaces of the mandibular and maxillary
anterior teeth on mandibular movements”- GPT.
•For complete dentures the incisal guidance should be as flat as esthetics and
phonetics will permit.
Incisal guidance
Sheldon winkler 2nd
edition page 243
•When the arrangement of the anterior teeth necessitates vertical overlap, a
compensating horizontal overlap should be set to prevent dominant incisal
guidance, from upsetting the occlusal balance on the posterior teeth

PLANE OF OCCLUSION OR
OCCLUSAL PLANE
DEFINITION:
“An imaginary surface which is related anatomically to the
cranium and which theoretically touches the incisal edges of the
incisors and the tips of the occluding surfaces of the posterior teeth.
It is not a plane in the true sense of the word but represents the
mean curvature of the surface”- GPT.
•It represents the mean curvature of the surface. Established
anteriorly by height of lower cuspid and posteriorly by height of
retromolar pad.

• These landmarks also creates an occlusal plane essentially parallel
to the ala-tragus line( Camper`s plane).
Sheldon winkler 2nd
edition page 243

 DEFINITION:
“The anteroposterior and lateral curvatures in the alignment of the occluding surfaces and
incisal edges of artificial teeth which are used to develop balanced occlusion”-GPT.
Sheldon winkler 2nd
edition page 243
COMPENSATING CURVE
• Determined by inclination of posterior teeth and their vertical relationship to occlusal plane.
• Steep condylar path requires steep compensating curve to produce balanced occlusion

Cuspal Inclination
 DEFINITION:
“The angle made by the average slope of a cusp with the cusp plane
measured mesiodistally or buccolingually”-GPT.
 angle made by average slope of cusp with cusp plane measured
mesiodistally or bucco lingually
 It is an important factor that modify the effect of plane of occlusion & the
compensating curves.
Sheldon winkler 2nd
edition page 243

•The angulation of the cusp is more important than the height of the cusps.
•The mesiodistal cusp heights that interdigitate lock the occlusion so that
reposition of the teeth due to setting of the base cannot take place.
•To prevent this problem, it is advocated that all mesiodistal cusp heights be
eliminated in anatomic type teeth.
•With the teeth so modified, only the buccolingual inclines need be considered
as determinants of balanced occlusion.
Sheldon winkler 2nd
edition page 243

The MANDIBULAR posterior teeth must be set
1) With horizontal occlusal surfaces
2) the plane of occlusion must have proper orientation
3) a compensating curve must be set
4) no interlocking transverse ridges
The MAXILLARY teeth must be
1) no buccal cusp contact
2) static centric occlusal contact
3)no buccal cusp contacts in lateral excursions
Sheldon winkler 2nd
edition page 261,262

UNILATERAL balance occlusion
BILATERAL balance occlusion
PROTRUSIVE balance occlusion
Sheldon winkler 2nd
edition page 241

 This is present when there is equilibrium of the base on supporting
structures when a bolus of food is interposed between the teeth on one
side and a space exits between the teeth on the opposite side.
Sheldon winkler 2nd
edition page 241
a) Teeth placement should be such that to direct the
resultant force on the functioning side over the
ridge or slightly lingual to it.
b) Having the denture base cover as wide an area on
the ridge as possible.
c) Placing the teeth as close to the ridge as other factors
will permit.
d) Using as narrow a buccolingual width occlusal food
table as practical

 This is present when the occlusal surface of teeth on one side articulate
simultaneously as a group with a smooth uninterrupted glide
Sheldon winkler 2nd
edition page 241
 This is present when there is equbilibrium on both sides of the denture due
to simultaneous contact of teeth in centric and eccentric occlusion
 It requires a minimum of three contacts for establishing an equilibrium.
 This type of balance is dependent on interaction of the incisal guidance,
the plane of occlusion, the angulation of teeth, cusp height, compensating
curve and inclination of condylar path.

 This is present when mandible moves essentially forward and
occlusal contact are smooth and simultaneous in the posterior both on right
and left side and on anterior teeth.
Sheldon winkler 2nd
edition page 241
Posterior contact during
protrusion to maintain
balance

 Selection of posterior teeth: Artificial teeth are the important part of the denture to
establish occlusion.
These teeth can be divided into 3 main groups-
- Anatomic teeth
- Semi - anatomic
- Non-anatomic teeth.
edition

 An anatomic tooth is one that is designed to simulate the natural tooth form.
 It has cusp heights of varying degrees of inclination that will intercuspate
with an opposing tooth of anatomic form.
 The standard anatomic tooth has inclines of approximately 33 degrees or
more and somewhat resembles natural teeth
edition
CUSPAL ANGLE > 30°
( CUSPED TEETH )
GOOD RIDGE

 When the cusp incline is less steep than the conventional anatomic tooth
form of 33 degree, it can be classified as a modified or semi-anatomic
tooth.
CUSPAL ANGLE < 30°
(SEMI-ANATOMIC TEETH)
MODERATE RIDGE
edition

 A nonanatomic tooth is essentially flat and has no cusp heights to interdigitate with
an opposing tooth.
 Non anatomic teeth articulate on an essentially flat surface in only two dimensions.
CUSPAL ANGLE 0°- 5°
( FLAT TEETH )
POOR RIDGE
edition

Teeth arrangement in
various condition

•Mesio buccal cusp of the lower 1st
molar occludes in
the fossa between upper 2nd
premolar and 1st
molar.
•Mesio buccal cusp of the lower 2nd
molar occludes
in the fossa between upper 1st
and 2nd
molars.
Class 1
Sheldon winkler 2nd
edition

Molar relation class I
Maxillary anterior teeth larger
Mandibular 1st
premolar is eliminated
class II
Sheldon winkler 2nd
edition

•Molar relation class I
•Mandibular anterior teeth larger
•Maxillary 1st premolar eliminated
•Anterior edge to edge
Class III
Sheldon winkler 2nd
edition

Pre treatment frontal view of the
patient
Resorbed maxillary and
mandibular ridge
Impression using
Mc.cord’s technique
Prosthodontic management of resorbed mandibular ridges-journal of dental
science and oral rehabilitation 2013-; jan-march
RESORBED RIDGE

Custom tray with spacer
Primary impression with putty
Primary cast with special tray

Max and Mand impressions
with light bodied impression
material
Rims cut from three regions

Record bases with vertical stops
and retentive loops
Record bases delivered in
pt’s mouth
Neutral zone is recorded

Record bases with plaster indices
Wax flowed into plaster indices
Try in done

Flabby Ridge
Intraoral view of maxillary arch.
Intraoral view of mandibular arch.
1 mm thick sheet placed on
the invested master cast prior
to packing.
1 mm thick sheet being
removed from the processed
denture at recall appointment.
Management of flabby ridges using
liquid supported denture: a case report DOI:10.4047/jap.2011.3.1.43

Primary impressions were made with alginate
Border molding was performed by
using low fusing impression compound
The flabby tissue was marked in the mouth and transferred on the tray.
Vaccum heat pressed polyethylene sheet of 1 mm thickness
was adapted on the master cast. The sheet was made 2 mm short
of the sulcus and was not extended in the PPS area. This sheet
was incorporated in the denture at the time of packing.
At recall appointment, the 1 mm thick sheet which was used
as a spacer was removed from the denture

The polyethylene sheet was cut using the putty index as
guide. The borders of the 0.5 mm thick sheet were placed in
the crevice formed due to removal of 1mm thick sheet.
The space created due to the replacement of a 1 mm thick
sheet with a 0.5 mm thick sheet was filled with glycerine.
Finally the upper liquid supported denture was delivered
Denture care instructions were given to the patient.
Patient was told to clean the tissue surface using soft cloth. Recall
appointments were scheduled at 1 day, 1 week, 1 month and 3 months. At 1 week
appointment, patient complained of
floating feeling. But, at 3 months recall appointment, patient
was comfortably using the denture. The denture was well maintained.

Stone cast poured from the putty impression
to mark the exact junction of polyethylene
sheet.
Intra oral view with upper and lower
dentures.
Upper liquid supported complete denture and
lower cast partial denture.
Schematic representation of the cross
sectional view of the upper denture with
polyethylene sheet and glycerin.

Thus A Dentist Should Have A Thorough Knowledge On Occlusion.
To Provide A Balanced Occlusion For Patients
The responsibility for complete understanding of all of the basic
principles of occlusion is inherent in the professional license
 Sheldon Winkler: Essentials Of Complete Denture Prosthodontics.

 Sheldon Winkler: Essentials Of Complete Denture Prosthodontics.
 Charles M.Heartwell . Jr. , Artur O.Rahn : Syllabus Of Complete Dentures
 Zarb-bolender : Prosthodontic Treratment For Edentulous Patients
 Beck H.O. (1972): Occlusion As Related To Complete Removable Prosthodontics. Journal
Of
 Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral
rehabilitation 2013-; jan-march
REFERENCES

balancedocclusion in prosthodontics dentistry

balancedocclusion in prosthodontics dentistry

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