Seminar - I Balanced Occlusion

CONTENTS

 INTRODUCTION
 DEFINITION
 DIFFERENCE BETWEEN NATURAL AND ARTIFICIAL
OCCLUSION
 CONCEPTS OF COMPLETE DENTURE OCCLUSION
 SEAR’S AXIOMS
 IDEAL REQUIREMENTS
 OCCLUSAL SCHEMES REQUISITES FOR
- Incisive unit
- Working unit
- Balancing unit
 TYPES OF COMPLETE DENTURE OCCLUSION
 BALANCED OCCLUSION
- Requirements
- Controversies
- General considerations/ principles
- Advantage
- Disadvantage
- Types
 LAW’S OF PROTRUSIVE BALANCE
 LAWS OF LATERAL BALANCE
 VARIOUS CONCEPTS PROPOSED TO ATTAIN BALANCED
OCCLUSION
 FACTORS INFLUENCING BALANCED OCCLUSION
 IMPACT OF SELECTED VARIABLES ON OCCLUSION FOR
RESTORATION
 MONOPLANE/ NON-BALANCED OCCLUSION
 ARRANGEMENT OF TEETH IN BALANCED OCCLUSION
 SUMMARY
 REFERENCES

DEPT. OF PROSTHODONTICS 0
Seminar - I Balanced Occlusion

BALANCED OCCLUSION

INTRODUCTION

Balance in complete denture is unique and man made. It

does not occur in natural teeth and indeed is not needed, as each

tooth is supported independently. Bilateral occlusal balance in

natural teeth is considered as a premature contact on the non-

working side (balancing side) and hence is considered pathologic.

The concept of centralizing the working occlusal surfaces

requires bringing the occlusal surfaces towards the center of the

denture foundation to their ideal positions, for favorable leverages.

In anteroposterior direction the center of basal seat is in the

area of premolar and first molar. This is the area where food is

masticated.

In centric occlusion only the working occlusal units are in

contact. The canine and incisors have at lest 1mm clearance when

the teeth are in centric occlusion. The upper and lower incisal units

meet only when the mandible is protruded, and the protrusive

balancing unit functions only when the upper and lower incisal

units contacts.

DEFINITIONS
Watt & McCrager; Occlusion is defined as static closed
relationship of cusps/ masticating surfaces of upper and lower
teeth”.
Or
“The act of closure or state of being closed”.

DEPT. OF PROSTHODONTICS 1
Seminar - I Balanced Occlusion

According to Dorlands Dictionary – “Occlusion is the relation

of the maxillary and mandibular teeth when in functional contact

during activity of the mandible”.

Articulation:

Is the dynamic sliding contact of cusps of upper and lower

teeth that takes place during closed grinding movements of the

mandible.

Articulation is the continuous change from one occlusal

position to next.

BALANCED OCCLUSION:

Has been defined in more than one manner.

“Balanced occlusion is the simultaneous contacting of the

maxillary and mandibular teeth on the right and left and in the

posterior and anterior occlusal areas when jaws are in either

centric or eccentric relation”. (Heartwell)

“A balanced occlusion is one in which simultaneous and

equal contacts are maintained among opposing tooth surfaces

throughout the entire arch and through the entire excursion”

(Mohi)

“Balanced occlusion in complete denture can be defined as

stable simultaneous contact of the opposing upper and lower tooth

in centric relation position and a continuous smooth bilateral

gliding from this position to any eccentric position within normal

range of mandibular function”. (Winkler)

DEPT. OF PROSTHODONTICS 2
Seminar - I Balanced Occlusion

“It is defined as an occlusion of teeth which presents a

harmonious relation of the occluding surfaces in all the centric and

eccentric positions within the functional range of mastication and

swallowing”.

“Bilateral simultaneous, anterior, and posterior occlusal

contact of teeth in centric and eccentric positions”. (According to

Glossary of Prosthodontics)

Balanced Articulation:

Is a continuing sliding contact of upper and lower cusps all

around the dental arches during all closed grinding movements of

the mandible.

Free occlusion:

The inference here is that there are no cuspal interferences in

lateral and protrusive movements, but balancing tooth contact are

not necessarily present on the side opposite to the occluding side of

the denture.

The difference between free occlusion and balanced occlusion

can be easily distinguished by asking the patient to grind his teeth

firmly and then open the mouth, the denture with free occlusion

will loosen but the denture with balanced occlusion will become

firmer than ever.

Benett Angle:

The angle formed between the sagittal plane and the average

path of advancing condyle as viewed in horizontal plane during

mandibular movement.

DEPT. OF PROSTHODONTICS 3
Seminar - I Balanced Occlusion

Border movement:

Mandibular movements at the limits dictated by anatomic

structures as viewed in given plane.

Compensating curve:

The anteroposterior curvature (in the median plane) and the

mediolateral curvature (in the frontal plane) in the alignment of the

occluding surfaces and incisal edges of artificial teeth that are used

to develop balanced occlusion.

Anteroposterior curve: (GPT)

The anatomic curve established by the occlusal alignment of

the teeth, as projected onto the median plane, beginning with the

cusp tip of the mandibular canine and following the buccal cusp

tips of the premolar and molar teeth, continuing through the

anterior border of the mandibular ramus, ending with the anterior

most portion of the mandibular condyle.

Curve of monsoon:

Eponym for a proposed ideal curve of occlusion in which each

cusp and incisal edges touches or conforms to a segment of the

sphere 8 inches in diameter with its center in glabella.

Curve of pleasure-/Antimonsoon curve/ frequency curve /

probability curve/ reverse curve:

In excessive wear of the teeth, the abliteration of the cusps

and formation of either flat/ cupped out occlusal surfaces,

associated with the reverse of the occlusal plane of premolar, first

DEPT. OF PROSTHODONTICS 4
Seminar - I Balanced Occlusion

and second molar teeth, whereby occlusal surfaces of the

mandibular teeth slope facially instead of lingually and those of

maxillary teeth incline lingually.

Fischer’s angle:

Angle formed by the intersection of the protrusive and non-

working side condylar paths as viewed in the sagittal plane.

Face bow:

A caliper like instrument used to record the spatial

relationship of the maxillary arch to some anatomic reference

point/ points and then transfer this relationship to an articulator.

It orients the dental cast in the same relationship to the

opening axis of the articulator.

OCCLUSION

Occlusion is defined as, “Any contact between the incising or

masticating surfaces of the maxillary and mandibular teeth” – GPT.

Another term, which deals with the relationship of the

maxillary and mandibular teeth is Dental articulation.

Dental articulation is defined as, “The static and dynamic

contact relationship between the occlusal surfaces of the teeth

during function” – GPT

It is generally considered that occlusion deals with the static

relationship of opposing teeth and articulation deals with the

dynamic (during movement) relationship of the opposing teeth. In

this chapter, we have grouped for convenience occlusion and

articulation as a single phenomenon.

DEPT. OF PROSTHODONTICS 5
Seminar - I Balanced Occlusion

Occlusion is an important factor, which governs the retention

and stability of the complete denture in vivo. It is important for one
to know the principles of occlusion before arranging artificial teeth.

DIFFERENCES BETWEEN NATURAL AND ARTIFICIAL

OCCLUSION

Occlusion of natural and artificial teeth vary to a great extent.

It is important for one to know about these differences in order to
understand the need of balanced occlusion in a complete denture
which is discussed later.

Natural teeth Artificial teeth

 Natural teeth function  Artificial teeth function as a

independently and each group and the occlusal loads are
individual tooth disperses the not individually managed.
occlusal load.

 Malocclusion can be non-  Malocclusions problems

problematic for a long time

 Non-vertical forces are well  Non-vertical forces damage

tolerated the supporting tissues

 Incising does not affect the  Incising will lift the posterior
posterior teeth. part of the denture.

 The second molar is the  Heavy mastication over the

favoured area for heavy second molar can tilt or shift the
mastication for better leverage denture base.
and power.

 Bilateral balance is not  Bilateral balance is

necessary and is usually mandatory to produce stability
considered a hindrance of the denture.

 Proprioceptive impulses give  There is no feedback and the

feedback to avoid occlusal denture rests in centric relation.
prematurities. This helps the Any prematurities in this
patient to have a habitual position can shift the base.
occlusion away from centric
relation.

DEPT. OF PROSTHODONTICS 6
Seminar - I Balanced Occlusion

GENERAL CONCEPTS OF COMPLETE DENTURE OCCLUSION

Unlike natural teeth, the artificial teeth act as a single unit.

Hence, there should be a minimum of three contact points (usually

one anterior and two posterior) between the upper and lower teeth

at any position of the mandible for even force distribution and

stabilization of the denture.

Complete denture occlusion varies with the type of teeth

selected. In posterior teeth selection we discussed anatomic and

non-anatomic teeth. Anatomic teeth should be arranged using

balanced occlusion and non-anatomic teeth are usually arranged

using monoplane occlusion.

All occlusal forms should at least have a tripod contact in

centric relation. Balanced occlusion should have tripod contact

even in eccentric relation. Before we go in detail about each type of

occlusion, let us look at the different concepts of occlusion.

1. Balanced occlusion

2. Lingualised occlusion (Gysi, Payne, Pound and Murrel)

3. Spherical concept of occlusion (monsoon)

4. Organic concept of occlusion

5. Neutrocentric concept of occlusion (De-Van)

6. Monoplane occlusion

7. Linear occlusion

8. Leneal occlusion

9. Physiologically generated occlusion

DEPT. OF PROSTHODONTICS 7
Seminar - I Balanced Occlusion

Spherical Concept of Occlusion: (Monson)

According to this concept, the anteroposterior and

mesiodistal inclines of the artificial teeth should be arranged in

harmony with a spherical surface. (Refer spherical theory in

articulators).

Organic Concept of Occlusion:

Here, the shapes of the teeth are altered to have cusps

suitable for the patient. The movement of the condyle determines

the direction of the ridges and grooves of the teeth and the

mandibular movements determine other factors like cusp height,

fossa, depth of the fissure, and concavity of the lingual surfaces.

In organic or organized occlusion, the aim is to relate the

occlusal surfaces of teeth so that the teeth are in harmony with the

muscles and joints during function. The muscles and joints

determine the mandibular position of occlusion without any tooth

guidance. In function, the teeth are supposed to have a passive role

and do not influence or determine the path of mandibular

movement. (In normal occlusion, tooth factors determine

mandibular movements e.g. incisal guidance).

Neutrocentric Concept of Occlusion:

According to this concept, the plane of occlusion should be

flat and parallel to the residual alveolar ridge. This concept is

similar to the monoplane occlusion used to set non-anatomic teeth.

The term neutrocentric denotes an occlusion that eliminates the

anteroposterior and buccolingual inclines in order to direct the

forces to the posterior teeth.

DEPT. OF PROSTHODONTICS 8
Seminar - I Balanced Occlusion

SEARS AXIOMS OF COMPLETE DENTURE OCCLUSION

Sears published the following factors to be considered that

helps to plan a complete denture occlusion.

 Smaller the area of the occlusal surface, the lesser is the

amount of occlusal load transmitted to the supporting

structures.

 Vertical force on a tilted occlusion surface will produce a non-

vertical force on the denture.

 Vertical forces acting on a tilted tissue support will produce a

non-vertical force on the denture base.

 Vertical force on the denture base lying over the resilient

tissues will produce lever forces on the denture.

 Vertical forces acting outside the ridge crest will produce

tipping of the denture.

IDEAL REQUIREMENTS OF COMPLETE DENTURE OCCLUSION:

Complete denture occlusion should fulfill the following

characteristics:

 Stability of the denture and its occlusion when the mandible

is in both centric and eccentric relations.

 Balanced occlusal contacts (tripod contact) during all

eccentric movements.

 Unlocking (removing interferences) the cusps mesiodistally so

that the denture can settle when there is ridge resorption.

 The cuspal height should be reduced to control the horizontal

forces.

DEPT. OF PROSTHODONTICS 9
Seminar - I Balanced Occlusion

 Functional lever balance should be obtained by vertical tooth

to ridge crest relationship. (Lever balance is balance against

leverage forces acting on the denture. Presence of positive

contact on the opposing side provides lever balance. It differs

from bilateral balance in that it does not necessarily require

three-point contact).

 Cutting, penetrating and shearing efficiency of the occlusal

surface is equivalent to that of natural dentition.

 Incisal clearance during posterior functions like chewing.

 Minimal area of contact to reduce pressure while crushing

food (Lingualized occlusion).

 Sharp ridges, cusps and sluiceways to increase masticating

efficiency.

OCCLUSAL SCHEME REQUISITES TO FULFILL THE

REQUIREMENTS:

Each occlusal scheme has three characteristics, namely, the

incisal, working and balancing units. The incisal unit includes all

the four incisors. The working unit includes the canine and the

posterior teeth of the side towards which the mandible moves. The

balancing unit includes the canine and the posteriors opposite to

the working side.

The ideal requirement of a complete denture occlusion can be

fulfilled by creating or providing the following characteristics for

each unit.

DEPT. OF PROSTHODONTICS 10
Seminar - I Balanced Occlusion

Incisal Units:

 Sharp units for improved incising efficiency.

 The units should not contact during mastication. The units

should contact only during protrusion.

 Shallow incisal guidance.

 Increased horizontal overlap to avoid interference during

settling (the mandibular denture may slide anteriorly as it

settles).

Working Units:

 Cusps for good cutting and grinding efficiency

 Smaller buccolingual width to decrease the occlusal load

transferred to the tissues.

 Group function at the end of the chewing cycle in eccentric

positions. (During lateral movement if there is simultaneous

contact of the posterior teeth of the working side, it is called

group function. In the same situation if the canine alone

contacts then its called canine guided occlusion. Canine

guided occlusion and group function are usually described in

relation to the natural teeth).

 The occlusal load should be directed to the anteroposterior

centre of the denture.

 The plane of occlusion should be parallel to the mean

foundation plane of the ridge.

DEPT. OF PROSTHODONTICS 11
Seminar - I Balanced Occlusion

Balancing Units:

 The second molars should be in contact during protrusive

action (Protrusive balance).

 They should have contact along with the working side at the

end of the chewing cycle.

 Smooth gliding contacts should be available for uninterfered

lateral and protrusive movements.

TYPES OF COMPLETE DENTURE OCCLUSION:

Complete denture occlusion can be of three types:-

 Balanced occlusion

 Monoplane occlusion

 Lingualized occlusion

Each type has its own indications and contraindications,

advantages and disadvantages. The most important type of

occlusion employed in complete dentures is the balanced occlusion.

BALANCED OCCLUSION

It is defined as, “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.

Balanced occlusion can be described as the position of the

teeth such that they have simultaneous contact in centric relation

and provide a smooth sliding motion to any eccentric position. A

DEPT. OF PROSTHODONTICS 12
Seminar - I Balanced Occlusion

three-point contact (usually one anterior and two posterior) at

centric relation is not sufficient for balanced occlusion instead

there should be simultaneous contact of all the teeth. Remember,

balanced occlusion is absent in natural dentition.

Characteristic Requirements of Balanced Occlusion:

A balanced occlusion should have the following

characteristics:-

 All the teeth of the working side (central incisor to second

molar) should glide evenly against the opposing teeth.

 No single tooth should produce any interference or

disocclusion of the other teeth.

 There should be contacts in the balancing side, but they

should not interfere with the smooth gliding movements of

the working side.

 There should be simultaneous contact during protrusion.

Importance of Balanced Occlusion:

Balanced occlusion is one of the most important factors that

affect denture stability. Absence of occlusal balance will result in

leverage of the denture during mandibular movement.

Sheppard stated that, “Enter bolus, Exit balance”. According

to this statement, the balancing contact is absent when food enters

the oral cavity. This makes us think that balanced occlusion has

not function during mastication; hence, it is not essential in a

complete denture. But this is not true. Brewer reported the

DEPT. OF PROSTHODONTICS 13
Seminar - I Balanced Occlusion

importance of balanced occlusion. He stated that on an average, a

normal individual makes masticatory tooth contact only for 10

minutes in one full day compared to 4 hours of total tooth contact

during other functions. So, for these 4 hours of tooth contact,

balanced occlusion is important to maintain the stability of the

denture. Hence, balanced occlusion is more critical during

parafunctional movements.

General Considerations or Principles for Balanced Occlusion:

The following points should be considered while developing

balanced occlusion:

 Ideal-balanced occlusion can be achieved in cases with wide

and large ridges and in complete dentures, with teeth

arranged close to the ridge.

 Complete dentures that have teeth arranged away from the

ridge and those that rest on narrow and short ridges will have

poor balanced occlusion.

 Teeth that have a narrow buccolingual width and those that

rest on wide ridges provide ideal-balanced occlusion.

 Ideal balance can be achieved by arranging the teeth slightly

on the lingual side of the crest of the ridge. Arranging the

teeth buccally will lead to poor balanced occlusion. If the

teeth are set outside the ridge the denture may elevate on one

side during tooth contact. Stability of the denture against

these lever forces is called as lever balance. Lever balance is

different from balanced occlusion. It can be safely quoted that

DEPT. OF PROSTHODONTICS 14
Seminar - I Balanced Occlusion

lever balance is also necessary for balanced occlusion (Refer

ideal requirements of balanced occlusion).

 The complete denture should be designed in such a way that

the forces of occlusion are centered anteroposteriorly in the

denture.

Types of balanced Occlusion:

Occlusion balance or balanced occlusion can be classified as

follows:-

 Unilateral balanced occlusion

 Bilateral balanced occlusion

 Protrusive balanced occlusion

 Lateral balanced occlusion

Unilateral balanced occlusion: This is a type of occlusion seen on

occlusal surfaces of teeth on one side when they occlude

simultaneously with a smooth, uninterrupted glide. This is not

followed during complete denture construction. It is more pertained

to fixed partial dentures.

Bilateral balanced occlusion: This is a type of occlusion that is seen

when simultaneous contact occurs on both sides in centric and

eccentric positions. Bilateral balanced occlusion helps to distribute

the occlusal load evenly across the arch and therefore helps to

improve stability of the denture during centric, eccentric or

parafunctional movements.

DEPT. OF PROSTHODONTICS 15
Seminar - I Balanced Occlusion

For minimal occlusal balance, there should be at least three

points of contact on the occlusal plane. More the number of

contacts, better the balance. Bilateral balanced occlusion can be

protrusive or lateral balance.

Advantages of bilateral balanced occlusion:

The statement “enter bolus exit balance” has cast suspicion

on the value of smooth, gliding, non-interfering bilateral tooth

contacts.

It implies that when a food bolus is kept on one side there will

not be occlusion on other side and the denture will tend to drop on

that side. This will occur whether the occlusion is balanced/not. It

has therefore been argued that conventional “balanced occlusion”

is not necessary in eccentric position.

The advantage of balanced occlusion however occurs when

the teeth do finally penetrate the food in eccentric position then the

all-around contact reseals the dentures.

The bilateral balanced occlusion is more important during

activities such as swallowing saliva, closing to reseat the denture,

and the bruxing of the teeth during times of stress.

A combination of tissue resiliency and denture movement

during function accounts for the high frequency of the non-

chewing/ balancing side contacts.

Sheppard (1964) suggested the expression “Enter bolus, enter

balance”.

DEPT. OF PROSTHODONTICS 16
Seminar - I Balanced Occlusion

Balancing the occlusion in complete denture is like changing

stumbling prose to poetry.

Advantages:

 Better masticatory efficiency

 Better stability of denture base

 Reduced trauma, improved comfort

 The functional movements are possible

Disadvantages:

 Time consuming

 Cannot be used in all patients

Protrusive balanced occlusion:

This type of balanced occlusion is present when mandible

moves in a forward direction and the occlusal contacts are smooth

and simultaneous anteriorly and posteriorly. There should be at

least three points of contact in the occlusal plane. Two of these

should be located posteriorly and one should be located in the

anterior region. This is absent in natural dentition.

The factors that govern protrusive balance:

 The inclination of the condylar path: This inclination recorded

on the patient represents the path traveled by the condyle in

protrusion which is modified by the combined action of all the

DEPT. OF PROSTHODONTICS 17
Seminar - I Balanced Occlusion

tissues in the temoromandibular joint and the ridges covered

by the recording bases.

 Angle of the incisal guidance chosen for the patient.

 Angle of the plane of occlusion.

 The compensating curves chosen for orientation with the

condylar path and the incisal guidance.

 Cuspal height and inclination of the posterior teeth.

Lateral balanced occlusion:

In lateral balance, there will be a minimal simultaneous three

point contact (one anterior, two posterior) present during lateral

movement of the mandible.

Lateral balanced occlusion is absent in normal dentition.

When a dentulous person with canine guided occlusion moves his

mandible to the right, there will be canine guided disocclusion of all

his teeth. That is, the canine will be the only tooth that contacts

the opposing tooth. Even the canine of the opposite side will not

have contact.

If this relationship is followed during teeth arrangement, then

the denture will lose its stability due to lever action. To prevent this

the teeth should be arranged such that there is simultaneous tooth

contact in the balancing and working sides.

DEPT. OF PROSTHODONTICS 18
Seminar - I Balanced Occlusion

LAWS OF LATERAL BALANCE:

 Angle of inclination of the condylar path on the balancing

side.

 Angle of inclination of the incisal guidance and cuspid lift.

 Angle of inclination of the plane of occlusion on the balancing

side and working side.

 Compensating curve on the balancing side and working side.

 The buccal cusp heights or inclination of the teeth on the

balancing side.

 The lingual cusp heights or inclination on the working side.

 The Bennett side shift on the working side.

Steep cusps produce more displacement of the denture base

than shallower or cuspless forms. The forces of occlusion acting on

a complete dentures should be balanced from right to left and

anterior to posterior direction.

An increase in any of the above factors will affect balanced

occlusion leading to compromised stability in the denture.

If the vertical overlap of the anterior teeth is increased for

aesthetic and phonetic reasons, then the horizontal overlap should

be adjusted to reduce the incisal guidance angle.

This adjustment provides space for free movement of the

anterior teeth. Without this adjustment, there will be increased

anterior interference leading to initial instability of the denture

base during protrusion. In the long run, this may lead to resorption

of the residual alveolar ridge in the anterior region.

DEPT. OF PROSTHODONTICS 19
Seminar - I Balanced Occlusion

Concepts Proposed to Attain Balanced Occlusion:

Many authors proposed different concepts for obtaining

balanced occlusion. Most of them are not in use now and carry

only a historical significance. Any way, we must know these

concepts to understand how the present concepts have been

derived from them.

Gysi’s Concept: He proposed the first concept towards balanced

occlusion in 1914. He suggested that arranging 330 anatomic teeth

could be used under various movements of the articulator to

enhance the stability of the denture.

French’s concept (1954): He proposed lowering the lower occlusal

plane to increase the stability of the dentures along with balanced

occlusion. He arranged upper first premolars with 5 0 inclination,

upper second premolars with 100 inclination and upper molars

with 150 inclination. He used modified French teeth to obtain

balanced occlusion.

Sears’s concept: He proposed balanced occlusion for non-

anatomical teeth using posterior balancing ramps or an occlusal

plane which curves anteroposteriorly and laterally.

Pleasure’s concept: Pleasure introduced a pleasure curve or the

posterior reverse lateral curve to align and arrange the posterior

teeth in order to increase the stability of the denture.

Frush’s Concept: He advised arranging teeth in a one-dimensional

contact relationship, which should be reshaped during try-in to

obtain balanced occlusion.

DEPT. OF PROSTHODONTICS 20
Seminar - I Balanced Occlusion

Hanau’s Quint: Rudolph L. Hanau proposed nine factors that

govern the articulation of artificial teeth. They are:

 Horizontal condylar inclination

 Compensating curve

 Protrusive incisal guidance

 Plane of orientation

 Buccolingual inclination of tooth axis

 Sagittal condylar pathway

 Sagittal incisal guidance

 Tooth alignment

 Relative cusp height

These nine factors are called the laws of balanced articulation.

Hanau later condensed these nine factors and formulated five

factors, which are commonly known as Hanau’s quint:

 Condylar guidance

 Incisal guidance

 Compensating curves

 Relative cusp height

 Plane of orientation of the occlusal plane

These factors are described in detail later.

Trapozzano’s Concept of Occlusion:

He reviewed and simplified Hanau’s quint and proposed his

Triad of Occlusion. According to him, only three factors are

necessary to produce balanced occlusion. He dismissed the need

for determining the plane of occlusion to produce balanced

DEPT. OF PROSTHODONTICS 21
Seminar - I Balanced Occlusion

occlusion. He said that the plane of occlusion could be shifted to

favour weak ridges, hence, its location is not constant and is

variable within the interarch distance.

He also dismissed the need for setting compensating curves,

because, he suggested that when we arrange cusped teeth in

principle these curves are produced automatically. He considered

that compensating curve as a passive factor, which is a resultant of

setting cusped teeth.

Though his triad was simpler than the Hanau’s quint, it

eliminated the important compensating curves and plane of

orientation.

Boucher’s concept: Boucher confronted Trapozzano’s concept and

proposed the following three factors for balanced occlusion.

 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 height of

the cusp without changing the form of the teeth.

He also stated that, “the plane of occlusion should be

oriented exactly as it was when natural teeth were present”.

According to him, the plane of occlusion cannot be changed to

favour weak ridges and that the teeth should be located in their

original position. He believed it was necessary to fulfill the

anatomical and physiological needs.

DEPT. OF PROSTHODONTICS 22
Seminar - I Balanced Occlusion

Boucher also emphasized the need for the compensating

curve. He stated that, “the value of the compensating curve is that

it permits alteration of cusp height without changing the form of

the manufactured teeth… If the teeth themselves do not have any

cusps, the equivalence of a cusp can be produced by a

compensating curve”.

Lott’s concept: Lott clarified Hanau’s laws of occlusion by relating

them to the posterior separation that is a resultant of the guiding

factors.

 The greater the angle of the condylar path, the greater is the

posterior separation during protrusion.

 The greater the angle of the overbite, the greater is the

separation in the anterior and posterior regions irrespective of

the angle of the condylar path.

 The greater the separation of the posterior teeth the greater or

higher must be the compensating curve.

 Posterior separation beyond the balancing ability of the

compensating curve can be balanced by the introduction of

the plane of orientation.

 The greater the separation of the teeth, the greater must be

the height of the cusps of the posterior teeth.

Levin’s concept: Bernard Levin believed that it was not necessary

to consider the plane of occlusion because it was not very useful

practically. Levin also states that the plane of occlusion can be

DEPT. OF PROSTHODONTICS 23
Seminar - I Balanced Occlusion

slightly altered by 1-2 mm in order to improve the stability of a

denture.

He named the other four factors of occlusion as the Quad.

The essentials of a quad are:-

 The condylar guidance is fixed and is recorded from the

patient. The balancing condylar guidance will include the

Bennett movement of the working condyle. This may or may

not affect the lateral balance.

 The incisal guidance is usually obtained from patient’s

aesthetic and phonetic requirements. However, it can be

modified for special requirements. E.g., the incisal guidance

is decreased for flat ridges.

 The compensating curve is the most important factor in

obtaining occlusal balance. Monoplane or low cusp teeth

must employ the use of compensating curve.

 Cusp teeth have the inclines necessary for balanced occlusion

but nearly always are used with a compensating curve.

FACTORS INFLUENCING BALANCED OCCLUSION:

Though many authors questioned the necessity of all the five

factors in a Hanau’s quint, it is still considered as the basic

determinant of balanced occlusion. The five basic factors that

determine the balance of an occlusion are:-

i. Inclination of the condylar path or condylar guidance

ii. Incisal guidance

iii. Orientation of the plane of occlusion or occlusal plane

DEPT. OF PROSTHODONTICS 24
Seminar - I Balanced Occlusion

iv. Cuspal angulation

v. Compensating curves.

There should be a balance within these five factors. The

incisal and condylar guidances produce a similar effect on

balanced occlusion (they increase posterior tooth separation).

Similarly, the other three factors have a common effect on balanced

occlusion (they decrease the posterior tooth separation). The effect

of the incisal and condylar guidances should be counteracted by

the other three factors to obtain balanced occlusion. If this

counteractive mechanism is lost, the balance of occlusion is lost.

Let us discuss in general how these factors affect the balance

during protrusion. The incisal guide angle denotes the angle

formed by the palatal surface of the upper anterior against the

horizontal plane. The incisal guidance can be raised by altering the

labial proclination, overjet and overbite of the maxillary anterior, so

that the incisal guide angle becomes steeper.

When the patient with a steep incisal guidance brings his

mandible forward, there will be more jaw separation. This is

because the movement of the mandible is controlled by the lingual

surface of the upper anteriors (The upper incisors are more

vertically placed in cases with a steep incisal guidance). Increase

in jaw separation will lead to disocclusion of the posterior teeth

leading to loss of tripod contact which in turn lead to lifting of the

posterior part of the denture during incising functions. If the

posterior part of the denture lifts during incisal function, it simply

DEPT. OF PROSTHODONTICS 25
Seminar - I Balanced Occlusion

means that the balanced occlusion is absent. The condylar

guidance has a similar effect on the denture.

To prevent the lifting of the posterior part of the denture, the

compensating curve, cuspal angulation of the teeth, and the plane

of occlusion should be modified such that a tripod contact is

preserved during protrusion.

If the compensating curve is made steeper (raised), the

posterior contact will be preserved during protrusion. If the cuspal

height or angulation is increased, again the posterior contact will

be maintained during protrusion. Similarly, if the plane of

occlusion is oriented / tilted so that it is higher posteriorly, then

the posterior contact will be maintained during protrusion.

Thus, we understand that when the incisal guidance or

condylar guidance is high, the other three factors should also be

raised to compensate the effects of the incisal and condylar

guidance and vice-versa.

Now we shall discuss in greater detail about the significance

of each factor in balanced occlusion.

Inclination of the condylar path is also called as the first factor of

occlusion. This is the only factor, which can be recorded from the

patient. It is registered using protrusive registration (i.e. the

patient is asked to protrude with the occlusal rims. Inter-occlusal

record material is injected between the occlusal rims in this

position. The occlusal rims with the inter occlusal record are

transferred to the articulation. Since the occlusal rims are in a

protrusive relation, the upper member of the articulator is moved

DEPT. OF PROSTHODONTICS 26
Seminar - I Balanced Occlusion

back to accommodate them. The inter-occlusal record is carefully

removed and the upper member is allowed to slide forward to its

original position. The condylar guidance should be adjusted

(rotated) till the upper member slides freely into position. It is

transferred to the articulator as the condylar guidance.

Increased in the condylar guidance will increase the jaw

separation during protrusion. This factor of balance occlusion

cannot be modified. All the other four factors of occlusion should

be modified to compensate the effects of this factor. In patients

with a steep condylar guidance, the incisal guidance should be

decreased to reduce the amount of jaw separation produced during

protrusion and vice versa. But it should be remembered that the

incisal guidance cannot be made very steep because it has its own

ill effects.

Incisal guidance:

This is defined as, “The influence of the contacting surface of

the mandibular and maxillary anterior teeth on mandibular

movements”.

It is called as the second factor of occlusion. It is determined

by the dentist and customized for the patient during anterior try-in.

It acts as controlling path for the movements of the casts in an

articulator. It should be set depending upon the desired overjet

and overbite planned for the patient. If the overjet is increased, the

inclination of the incisal guidance is decreased. If the overbite is

increased, then the incisal inclination increases. The incisal

DEPT. OF PROSTHODONTICS 27
Seminar - I Balanced Occlusion

guidance has more influence on the posterior teeth than the

condylar guidance. This is because the action of the incisal

inclination is closer to the teeth than the action of the condylar

guidance.

During protrusive movements, the incisal edge of the

mandibular anterior teeth move in a downward and forward path

corresponding to the palatal surface of the upper incisors. This is

known as the protrusive incisal path or incisal guidance. The angle

formed by this protrusive path to the horizontal plane is called as

the protrusive incisal path inclination or the incisal guide angle.

This influences the shape of the posterior teeth. If the incisal

guidance is steep compensatory curve is needed to produce

balanced occlusion (explained previously). In a complete denture,

the incisal guide angle should be as flat (more acute) as possible.

Hence, while arranging the anterior teeth, for aesthetics, a suitable

vertical overlap and a horizontal overlap should be chosen to

achieve balanced occlusion. Also, the incisal guidance cannot be

altered beyond limits. The location and angulation of the incisors

are governed by various factors like aesthetics, function and

phonetics, etc. The procedure for setting up the incisal guidance

was described under articulation.

Plane of occlusion or occlusal plane:

It is defined as, “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 surface of

DEPT. OF PROSTHODONTICS 28
Seminar - I Balanced Occlusion

the posterior teeth. It is not a plane in the true sense of the word

but represents the mean curvature of the surface.

It is established anteriorly by the height of the lower canine,

which nearly coincides with the commissure of the mouth and

posteriorly by the height of the retromolar pad. It is usually

parallel to the ala-tragus line or Camper’s line. It can be slightly

altered and its role is not as important as other factors. Tilting the

plane of occlusion beyond 100 is not advisable.

Orientation of the Occlusal Plane

The term “Plane of orientation” (by Hanau) refers to the

vertical location of the anteroposterior alignment of the occlusal

plane in the space between the upper and lower ridges.

The plane of occlusion is established in the anterior by the

height of the lever 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 ala-tragus line/camper’s

plane.

1) Orientation of occlusal plane to the ala-tragus or Camper’s line:

Boucher defines it as “The line running from the inferior

border of the ala of the nose to the superior border of the tragus of

the ear”.

2) Cephalometrically planned adjustable plane:

Cephalometrically, a relationship has been shown to exist

between the angle of occlusal plane relative to the Frankfurt plane

on one hand and the angle formed between cephalometric points,

porion, nasion and the anterior nasal spine (The Po NANS angle).

DEPT. OF PROSTHODONTICS 29
Seminar - I Balanced Occlusion

Y’ = 83.4307 – (0.9907 – X)

Where X = PoNANS angle value

Y’ = Occlusal plane angle

Compensating curve:

It is defined as, “The antero-posterior and lateral curvatures

in the alignment of the occluding surfaces and incisal edges of

artificial teeth which are used to develop balanced occlusion” –

GPT.

It is an important factor for establishing balanced occlusion.

It is determined by the inclination of the posterior teeth and their

vertical relationship to the occlusal plane. The posterior teeth

should be arranged such that their occlusal surfaces form a curve.

This curve should be in harmony with the movements of the

mandible guided posteriorly by the condylar path.

A steep condylar path requires a steep compensatory curve to

produce balanced occlusion. If a shallow compensating curve is

given for the same situation, there will be loss of balancing molar

contacts during protrusion (explained before).

There are two types of compensating curves namely:

 Anteroposterior curves

 Lateral curves

Curve of Spee, Wilson’s curve and Monson’s curve are

associated only with natural dentition. In complete dentures

compensating curves similar to these curves should be

incorporated to produce balanced occlusion.

DEPT. OF PROSTHODONTICS 30
Seminar - I Balanced Occlusion

Anteroposterior Compensating Curves:

These are compensatory curves running in an anteroposterior

direction. They compensate for the curve of Spee seen in natural

dentition.

Compensating Curve for Curve of Spee:

Curve of Spee is defined as, “Anatomic curvature of the

occlusal alignment of teeth beginning at the tip of the lower canine

and following the buccal cusps of the natural premolars and

molars, continuing to the anterior border of the ramus as described

by Graf von Spee” – GPT.

It is an imaginary curve joining the buccal cusps of the

mandibular posterior teeth starting from the canine passing

through the head of the condyle. It is seen in the natural dentition

and should be reproduced in a complete denture. The significance

of this curve is that, when the patient moves his mandible forward,

the posterior teeth set on this curve will continue to remain in

contact. If the teeth are not arranged according to this curve, there

will be disocclusion during protrusion of the mandible

(Christensen’s phenomenon).

Prominence of Compensating Curve:

According to Glossary of Prosthodontic terms, compensating

curve is defined as, “anteroposterior and lateral curvature in the

alignment of occlusal surfaces and the incisal edges of artificial

teeth which is used to develop balanced occlusion”.

DEPT. OF PROSTHODONTICS 31
Seminar - I Balanced Occlusion

It is determined by the inclination of the posterior teeth and

their vertical relationship to the occlusal plane so that it is in

harmony with the movement of mandible as guided posteriorly by

the condylar path.

Thielmann’s Formula:-

In order to obtain smooth balanced occlusion, the

compensating curve must be in harmony with other factors of

occlusion.

This relationship is expressed in Hanau Quint. It is expressed

even more clearly by Thielmann’s formula.

Balanced occlusion = K.I

Op. C. OK

K – inclination of condylar guidance

I – inclination of incisal guidance

C – height of cusps

OP – inclination of plane of orientation

OK – prominence of compensating curve

Cusp plane and Cusp plane angle:

When the two buccal cusp tips and the highest situated

lingual cusp tip are connected with straight lines these lines

circumscribe a small plane, which is called “Cusp plane”.

The connecting line between the buccal cusps indicates the

sagital slope, and the alignment of these lines forms the

compensating curve.

The inclination of cusp plane to the plane of orientation is

called “Cusp plane angle”.

DEPT. OF PROSTHODONTICS 32
Seminar - I Balanced Occlusion

Compensating curve formula:-

The action of compensating curve is as follows:-

The cusp angulation () of the protrusive facets of the molars

must be reduced with an equal to the cusp plane angle (w). This

relation can be expressed by –

C=-W

C – Cusp angulation

 - Cusp angulation according to cusp incline table

W – Cusp plane angle

This formula is called “formula of the compensating curve”.

Lateral Compensating Curves:

These curves run transversely from one side of the arch to the

other. The following curves fall in this category:

Compensating curve for Monson Curve:

Monson’s curve is defined as, “The curve of occlusion in

which each cusp and incisal edge touches or conforms to a

segment of the sphere of 8 inches in diameter with its center in the

region of the Glabella”. GPT.

This curve runs across the palatal and buccal cusps of the

maxillary molars. During lateral movement the mandibular lingual

cusps on the working side should slide along the inner inclines of

the maxillary buccal cusp. In the balancing side the mandibular

buccal cusps should contact the inner inclines of the maxillary

palatal cusp. This relationship forms a balance.

DEPT. OF PROSTHODONTICS 33
Seminar - I Balanced Occlusion

Only if the teeth are set following the Monson’s curve there

will be lateral balance of occlusion.

Compensating Curve for Anti-Monson or Wilson Curve:-

Wilson’s curve is defined as, “A curve of occlusion which is

convex upwards”. – GPT.

This curve runs opposite to the direction of the Monson’s

curve. This curve is followed when the first premolars are arranged.

The premolars are arranged according to this curve so that they do

not produce any interference to lateral movements.

Reverse Curve:-

“A curve of occlusion which in transverse cross-section

conforms to a line which is convex upward”. –GPT. It was originally

developed to improve the stability of the denture. The reverse curve

was modified by Max Pleasure to form the pleasure curve.

Pleasure Curve:-

“A curve of occlusion which in transverse cross-section

conforms to a line which is convex upward except for the last

molars”. – GPT.

It was proposed by Max Pleasure. He proposed this curve to

balance the occlusion and increase the stability of the denture.

Hence the first molar is horizontal, the second premolar is lingually

tilted and second molar is buccally tilted. It is a modification of

reverse curve in that it does not involve the second molars. This

DEPT. OF PROSTHODONTICS 34
Seminar - I Balanced Occlusion

curve runs from the palatal cusp of the first premolar to the

distobuccal cusp of the second molar.

Cuspal angulation:

Cusp angle is defined as, “The angle made by the average

slope of a cusp with the cusp plane measured mesiodistally or

buccolingually”. – GPT.

The cusps on the teeth or the inclination of the cuspless teeth

are important factors that modify the effect of plane of occlusion

and the compensating curves. The mesiodistal cusps lock the

occlusion, such that repositioning of teeth does not occur due to

settling of the base.

In order to prevent the locking of occlusion, the mesiodistal

cusps are reduced during occlusal reshaping. In the absence of

mesiodistal cusps, the buccolingual cusps are considered as a

factor for balanced occlusion.

In cases with a shallow overbite, the cuspal angle should be

reduced to balance the incisal guidance. This is done because the

jaw separation will be less in cases with a decreased overbite. Teeth

with steep cusps will produce occlusal interference in these cases.

In cases with a deep bite (steep incisal guidance), the jaw

separation is more during protrusion. Teeth with high cuspal

inclines are required in these cases to produce posterior contact

during protrusion.

Thus, we discussed the various concepts and factors affecting

balanced occlusion. The method of occlusal reshaping is not

DEPT. OF PROSTHODONTICS 35
Seminar - I Balanced Occlusion

discussed in detail due to its complexity. It is necessary for a

dentist to at least know that occlusal reshaping is done after teeth

arrangement to produce balanced occlusion.

Inclination of the Cusps:

It refers to the angle between the total occlusal surface of the

tooth and the inclination of the cusp in relation to that surface. For

e.g. 33-degree tooth indicates that the mesial slopes of the cusp

make 330-angle with a plane touching the tips of all the cusps of

teeth. In other words the plane of reference (the horizontal plane)

would be at right angles to the vertical axis of the tooth.

Swenson’s Formula:-

Swenson’s formula is an empirical formula and clarifies the

relationship between the sagital cusp inclination of the incisal

guidance.

Cusp inclination = Incisal inclination + Fraction of distance from

incisal guidance (Condyle inclination - Incisal inclination) on the

working side.

Cusp inclination = Incisal inclination + Fraction of distance from

incisal guidance (Difference between incisal guidance and condylar

path inclination) here incisal inclination becomes zero.

Gysi’s formula for the second molar:

Gysis formula for the angulation of second molar is –

Angulation of M2 = Condyle guide inclination + Incisal guide inclination
2

DEPT. OF PROSTHODONTICS 36
Seminar - I Balanced Occlusion

That is EM2 = B + V
2

B – Condyle guide inclination

V – Incisal guide inclination

Gysi’s formula assumed to be an empirical formula, giving the

dentist a conception of the approximate cusp angulation and

setting of the incisal table of an adjustable articulator.

Impact of Selected Variables on Occlusal Form of Restoration:

Posterior Determinants Variation Impact on Restoration

* Inclination of articular - Steeper - Posterior cusps may be
eminence taller
- Flatter - Posterior cusp may be
shorter
* Medial wall of glenoid - Allows more lateral - Posterior cusp must be
fossa translation shorter
- Allows minimal lateral - Posterior cusp may be
translation taller
* Intercondylar distance - Greater - Smaller angle between
the laterotrusive and
mediotrusive
movement
- Lesser - Increased angle
Anterior Determinants
* Horizontal overlap of - Increased - Posterior cusps must
anterior teeth be shorter
- Reduced - Posterior cusps may be
taller
* Vertical overlap of - Increased - Posterior cusps may be
anterior teeth taller
- Reduced - Posterior cusps must
be shorter
Other
- Occlusal plane - More parallel to - Posterior cusp must be
condylar guidance shorter
- Less parallel to - Posterior cusp may be
condylar guidance taller
* Curve of spee - More convex (short - The post-cusp mustbe
radius) shorter
- Less convex (larger - Post-cusp ma be longer
radius)

DEPT. OF PROSTHODONTICS 37
Seminar - I Balanced Occlusion

ARRANGEMENT

Arrangement of anatomic type artificial teeth into balanced

occlusion:

1. Amount of overjet should not be less than 2mm in centric

relation. Anterior teeth set according to best possible

esthetics, phonetics and function.

2. Steep condylar guidance or steep incisal guidance and

combination of them suggest prominent compensating curve

with steep anteroposterior and lateral cusp height. This is

detrimental to the stability of denture. Condylar guidance

must be accepted as recorded but the incisal guidance

should be kept as flat as possible.

3. The upper premolars should be positioned so as to present a

normal dental arch outline. Practically a straight line from

the canines to the mesiobuccal cusp of upper first molar,

thus, contributing to esthetics. In other words, the buccal

vestibule should be in evidence when the patient smiles.

4. The lower first premolars may be positioned buccally to the

crest of the ridge occasionally in order to occlude correctly

with the upper premolars.

5. When it is found necessary to grind artificial teeth at the

gingival end, care should be used to preserve as much as the

buccal side of the ridge lap as possible, even though the

tooth material representing the buccal surface may then be

very thin. Both the upper and lower premolars should

present buccal surface of sufficient length to place the

DEPT. OF PROSTHODONTICS 38
Seminar - I Balanced Occlusion

gingival finishing line in harmony with that of the canines,

short premolars are detrimental to esthetics and should not

be used.

6. Before cusp inclines are altered by grinding, the inclinations

of long axes of the opposing teeth should be rotated about

centric occlusal contact in an attempt to establish the

desired balancing contact.

7. After artificial teeth have been satisfactorily arranged, the

final waxing should be done in a manner which will provide

the desired buccal, labial and lingual contours without

destroying the occlusion, already established.

8. Once the bases are sealed to their respective casts, all

routine laboratory procedures are carried out.

MONOPLANE OR NON-BALANCED OCCLUSION:

It is an arrangement of teeth with form or purpose. It includes

the following concepts of occlusion:

 Spherical theory

 Organic occlusion

 Occlusal balancing ramps for protrusive balance

 Transographics

Concepts of Non-balanced Occlusion:

The concept of monoplane occlusion was a result of

Sheppard’s statement “Enter Bolus, Exit Balance”. This statement

questioned the need for balanced occlusion.

DEPT. OF PROSTHODONTICS 39
Seminar - I Balanced Occlusion

Consecutively many clinicians came with different concepts of

non-balanced occlusion for complete dentures.

Pound’s Concept:-

He proposed a monoplane occlusion which stresses the

importance of phonetic and aesthetics for anterior teeth. The

posterior teeth on the other hand have a sharp upper lingual cusp

and a wide lower central fossa. The buccal cusps of the lower

posterior teeth were reduced to avoid non-vertical occlusal forces.

Effectively, it was a lingualized occlusion wherein there is no buccal

contact of upper and lower teeth and the occlusal surfaces are

reduced such that they lie in a triangle formed between the mesial

end of the canine and the two sides of the retromolar pad.

Cusp form gold occlusal concept:-

As the name suggests, it uses teeth with a 33 0 cusp form

made on a gold surface. According to this concept, the anteriors are

set by aesthetic and phonetic requirements and the posteriors are

set with vertical overlap such that there is disocclusion due to the

canine during eccentric movement of the mandible.

Hardy’s concept:-

He proposed a flat occlusal plane set with non-anatomical

teeth for complete denture occlusion. Metal insert teeth were also

proposed.

DEPT. OF PROSTHODONTICS 40
Seminar - I Balanced Occlusion

Occlusal pivot by Sear:

The pivots were used to place the mandible in equilibrium by

concentrating the load in the molar regions. This scheme reduced

the injury to the temporomandibular joint and also reduced the

stress in the anterior region.

Kurth’s concept:-

He proposed a non-balanced occlusion set with flat posterior

teeth in a horizontal plane without any balancing ramps. The teeth

were set in a flat plane anteroposteriorly with a reverse lateral

curve. This reverse lateral curve is not a compensating curve.

Philip M. Jones scheme of non-balanced occlusion:

In this scheme, non-anatomical teeth were arranged with the

following modifications:

 A different articulator that could fit large casts were used.

 The maxillary and mandibular teeth are arranged without any

vertical overlap. The jaw relation determined the amount of

horizontal overlap.

 The maxillary posteriors are set first. The occlusal plane

should fulfill the following requirements:

- The occlusal plane should divide the inter-arch space

equally.

- The occlusal plane should be parallel to the mean

denture base foundation.

DEPT. OF PROSTHODONTICS 41
Seminar - I Balanced Occlusion

- The occlusal plane should lie at the junction of the

upper and middle thirds of the retromolar pad.

 During final arrangement, there should be complete

intercuspation between the upper and lower posterior teeth

except the second molar.

 The occlusal surface of the upper second molar should be 2

mm above the plane of occlusion (hence it is out of occlusion)

and parallel to the occlusal surface of the lower second molar.

These modifications are done so that the premolars and the

first molars are the primary masticators and the second molars are

just non-functional space fillers.

General Considerations:

The following points have to be considered while using a non-

balanced occlusion for a denture:

 Opposing artificial teeth should not contact when the jaws

are in eccentric relation, because it may give destabilizing

forces to the basal seat area. The architecture of the basal

seat does not allow tooth contact when the mandible is in

eccentric position.

 Tooth contact should occur only when the mandible is in

centric relation to the maxilla.

 The patient should be encouraged to repeat the mandibular

movements till there is no discomfort in centric relation.

DEPT. OF PROSTHODONTICS 42
Seminar - I Balanced Occlusion

Lingualized Occlusion

It was first proposed by Alfred Gysi in 1927. This type of

occlusion involves the use of a large upper palatal cusp against a

wide lower central fossa. In this scheme, the buccal cusps of the

upper and lower teeth do not contact each other. Clough reported

that 67% of the patients preferred lingualized occlusion due to its

superior chewing efficiency.

Many clinicians contributed to the concept of lingual

occlusion. Pound proposed non-balanced lingualized occlusion.

Payne proposed the use of 300 anatomical teeth which are later

reshaped to obtain lingual occlusion. This scheme had complete

intercuspation without any deflective occlusal contacts.

Myerson’s Lingualzied Integration (MLI):

Myerson proposed specialized tooth molds for arranging teeth

in lingualized occlusion. He proposed two different molds for the

maxillary posteriors namely control contact (cc) mold and

maximum contact (MC) mold. The remaining teeth are common for

both these molds.

He advocates the use of ‘MC’ mold for patients who can

reproduce accurate centric position and the ‘CC’ mold for patients

with variations in centric position.

These teeth provide maximal intercuspation, good cuspal

height to perform occlusal reshaping, and a natural and pleasing

appearance. The ‘MC’ mold maxillary posteriors have taller cusps

DEPT. OF PROSTHODONTICS 43
Seminar - I Balanced Occlusion

with a more anatomical appearance compared to the ‘CC’ mold. The

‘MC’ mold also offers a more ‘exacting occlusion’.

CONCLUSION

Occlusion should be smooth running, the importance of

occlusion and articulation for maintenance of CD stability has

never been underestimated, but overlooked. No matter how great

amount of initial retention, the impression may demonstrate.

Because the occlusion we are going to provide gives more stability

which indirectly gives the retention.

“Balanced occlusion is making a stumbling phrase into a

beautiful poem” so dentist (prosthodontist) should provide

occlusion, which should compatible with the stomatognathic

system and should provide a efficient mastication and esthetics,

without any physiologic abnormality.

DEPT. OF PROSTHODONTICS 44
Seminar - I Balanced Occlusion

REFERENCES:

1) Boucher’s Prosthodontic Treatment for Edentulous Patient”,

12th edition, Zarb-Bolender.

2) Boucher’s Prosthodontic Treatment for Edentulous Patient”,

10th edition, Zarb-Bolender, Hickey, Carlsson.

3) Essentials of Complete Denture Prosthodotics, 2 nd Edition,

Sheldon-Winkler.

4) Complete Denture Prosthodontics – Swenson.

5) Text Book of Complete Dentures, 5th edition, Rahn, Charles

Heartwell.

6) Complete Denture Prosthodontics – Sharry.

7) Journal of Prosthetic Dentistry 1972; 27:246

8) Journal of Prosthetic Dentistry 1978; 39 : 484.

9) Journal of Prosthetic Dentistry 1977; 38:601.

10) Journal of Prosthetic Dentistry 1972; 25:94-100.

11) Journal of Prosthetic Dentistry 2001; 85(1):15-19.

12) Journal of Prosthetic Dentistry 1971; 25(2):121-138.

13) Journal of Prosthetic Dentistry 1971; 26(5):448-455.

14) Journal of Prosthetic Dentistry 1981; 57 : 704-707.

15) British Dental Journal 1997; 128:1140.

16) Journal of Prosthetic Dentistry 2000; 84(4):390-393.

DEPT. OF PROSTHODONTICS 45