Occlusion in complete denture

Dr. Farah Ragheed

Prosthodontics
5th stage
Occlusion is defined as, “any contact between the incising or masticating surfaces
of the maxillary and mandibular teeth”. 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 (as they move against each
other)”.
 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.
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.
Centric relation: maxilla-mandibular relationship, independent of tooth contact,
in which the condyles articulate in the anterio-superior position against the posterior
slopes of the articular eminences. It is a clinically useful, repeatable reference
position (bone to bone).

Centric occlusion: the occlusion of opposing teeth when the mandible is in

centric relation, this may or may not coincide with the maximal intercuspal position
(tooth to tooth).
Occlusal balance: a condition in which there are simultaneous contacts of
opposing teeth or tooth analogs on both sides of the opposing dental arches
during eccentric movements within the functional range.
Occlusal harmony: a condition in maximal intercuspal position and eccentric jaw
relation in which there are no interceptive or deflective contacts of occluding
surfaces.
Maximal intercuspal position: the complete intercuspation of the opposing
teeth, independent to condyle position.
Occlusal interference
1) Any tooth contact that inhibits the remaining occluding surfaces from achieving
stable and harmonious contacts.
2) Any undesirable occlusal contact.

Mandibular movement can be: opening, closing, protrusive and lateral, in lateral it
may be:
• Working side is the side that the mandible move toward it in lateral excursion.
• Nonworking side is the side that the mandible move away from during lateral
excursion.
Objectives of occlusion in complete denture:
• Preservation of the remaining tissues.
• Proper masticatory efficiency.
• Enhancement of denture stability, retention and support.
• Enhancement of phontics and esthetics.
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.
Natural teeth Artificial teeth

• Natural teeth function independently and each • Artificial teeth function as a group and the
individual tooth disperses the occlusal load. occlusal loads are not individually managed.

• Malocclusion can be non-problematic for a • Malocclusions pose immediate drastic

long time. problems.
• Non-vertical forces are well tolerated. • Non-vertical forces damage the supporting
tissues.

• Incising does not affect the posterior teeth. • Incising will lift the posterior part of the
denture.
• Natural teeth • Artificial teeth

• The second molar is the favoured area for • Heavy mastication over the second molar
heavy mastication for better leverage and can tilt or shift the denture base.
power.

• Bilateral balance is not necessary and • Bilateral balance is mandatory to produce

usually considered a hindrance. stability of the denture.

• Proprioceptive impulses give feedback to • There is no feedback and the denture rests
avoid occlusal prematurities. This helps in centric relation. Any prematurities in
the patient to have a habitual occlusion this position can shift the base.
away from centric relation.
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.
All occlusal forms of the teeth should at least have a tripod contact in centric
relation. Balanced occlusion should have tripod contact even in eccentric relation.
Ideal requirements of complete denture occlusion
Complete denture occlusion should fulfil 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.
• Functional lever balance should be obtained by vertical tooth to ridge crest
relationship. (Lever balance is the 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).
• The cuspal height should be reduced to control the horizontal forces.
• Cutting, penetrating and shearing efficiency of the occlusal surface 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.
• Unlocking (removing interferences) the cusps mesiodistally so that the denture can
settle when there is ridge resorption.
Each occlusal scheme has three characteristics (parts), 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.

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 for esthetics and phontics.
• 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.
• The occlusal load should be directed to the anteroposterior center of the denture.
• The plane of occlusion should be parallel to the mean foundation plane of the
ridge.

Forces on a denture should be concentrated over the first molar region

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 or un-interfered lateral and protrusive
Movements.
Types of complete denture occlusion
• Balanced occlusion
• Monoplane occlusion
• Lingualized occlusion
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”.
A 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.
In lateral excursion: (working side)

Anterior teeth: the maxillary and mandibular anterior teeth contact on working side.

Posterior teeth: the buccal and lingual cusps of the maxillary and mandibular posterior
teeth are in contact. If lingualized occlusion, the maxillary lingual cusp will be in contact
with the mandibular lingual cusp.

In lateral excursion: (balancing side)

Anterior teeth: the maxillary and mandibular anterior teeth may contact on balancing side.

Posterior teeth: the lingual cusps of the maxillary teeth will be in contact with the buccal
cusps of the mandibular teeth. With monoplane balanced occlusion, usually only the
second molars are in contact or the balancing ramp.
Characteristic requirements of balanced occlusion
• 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.
General considerations for 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.
• The complete denture should be designed in such a way that the forces of
occlusion are centred anteroposteriorly in the denture.
• Ideal balance can be achieved by arranging the teeth slightly on the lingual
side of the crest of the ridge. The teeth should be placed over the ridge to
provide lever balance to the denture.
Types of balanced occlusion
• Unilateral balanced occlusion
• Bilateral balanced occlusion
• Protrusive balanced occlusion
• Lateral balanced occlusion
• Unilateral balanced occlusion is not followed during complete denture
construction. It is more pertained to fixed partial dentures.
• 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.
• Protrusive balanced occlusion is present when mandible moves in a forward
direction and the occlusal contacts are smooth and simultaneous anteriorly and
posteriorly.
• Lateral balanced occlusion, there will be a minimal simultaneous three point
contact (one anterior, two posterior) present during lateral moment of the
mandible.
Advantages of balanced occlusion:
• Distribution of load.
• Stability.
• Reduced trauma.
• Functional movement.
• Efficiency.
• Comfort.
Factors influencing balanced occlusion (laws of articulation)
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:
• Inclination of the condylar path or condylar guidance.
• Incisal guidance.
• Orientation of the plane of occlusion.
• Cuspal angulation.
• Compensating curves.
Inclination of the condylar path: the angle formed by an imaginary horizontal line
at the superior head of the condyle and the path that the condyle will pass through
during function. It varies from individual to individual because of anatomical
differences about 33⁰.
• Condylar guidance: Mandibular guidance generated by the condyle and articular
disk traversing the contour of the articular eminence.
• Condylar guidance: The mechanical form located in the posterior region of an
articulator that controls movement of its mobile member.
• The first factor of occlusion and recorded from the patient so it is fixed factor
cannot be modified by the dentist.
Incisal guidance: is defined as, “the influence of the contacting surfaces of the
mandibular and maxillary anterior teeth on mandibular movements”. It is
determined by the dentist and customized for the patient during anterior try-in. It
acts as a controlling path for the movement 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 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.
The incisal guidance depends on:
• Desired overjet
• Overbite:
This angle varies directly with the vertical overbite and inversely with the horizontal
over jet.
This angle is set to 10⁰ in complete denture and not exceeding 20⁰.
This angle determined by esthetic, phonetic, ridge relation, interalveolar distance, this
means it is under the control of the dentist.
Plane of occlusion: 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 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”.
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. The plane
of occlusion can be altered to a maximum of 10°
Compensating curve: It is defined as, “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”.
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. (Curve of Spee, Wilson’s curve and Monson’s curve are associated only with
natural dentition).
Cuspal angulation: is defined as, “The angle made by the average slope of a cusp
with the cusp plane measured mesiodistally or buccolingually”.
It depends on several factors residual ridge, neuromuscular control, esthetics, etc.
however, its better to reduce the cuspal inclination to help reduce horizontal forces
of occlusion.

(a) Cuspal angulation.

(b and c) Teeth with low cuspal inclines do not
provide tooth contact during protrusion.
(d) Teeth with high cuspal inclines are required
to obtain posterior tooth contact during protrusion.
Interaction of five factors
For the four that dentist can control, two of them ( the incisal guidance
and the plane of occlusion) can be altered only a slight amount because of
esthetic and physiologic factors. The important working factors for the
dentist to manipulate are the compensating curve and the inclinations of
cusp on the occlusal surfaces of the teeth.
Lingualized Occlusion
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 and the cusp incline of mandibular teeth relatively flat result
in less lateral force and displacement during function. According to some studies
67% of the patients preferred lingualized occlusion due to its superior chewing
efficiency.
Indications of lingualized occlusion:
• High esthetic needed.
• Week muscle of mastication.
• Displaceable supporting tissue.
• Sever alveolar bone resorption.
• Discrepancy in jaws size, narrow upper arch and wide lower arch.
• Implant supported over denture.
• Previous successful denture with lingualized occlusion.
Advantages:

1. Simpler tech, less precise centric relation records. 2. Esthetics. 3. Better

penetration of the food bolus. 4. Easer to adjust occlusion. 5. It may be used in
cl. II, III and cross bite. 6. Centralization of vertical forces. 6. Minimizing tipping
force. 7. Potentially of bilateral balance.

Disadvantages:

1. Difficulty in obtaining repeatable centric record (incoordination, jaw mal-

relation).

2. Sever ridge resorption (lateral forces displace the denture) may more easily be
handled with a monoplane scheme.
Monoplane occlusion (neutrocentric):
• Flat occlusal plane set with non anatomic teeth.
• The anterio-posterior occlusal plane parallel to the denture foundation area.
• There is no vertical overlap of anterior teeth.
• Tooth Contact should occur only when mandible in centric relation.
• Opposing artificial teeth should not contact when jaws in eccentric relation.
• In protrusion there is disclosure of posterior teeth as a result of arrangement in
single plane, the patient is instructed not to incise the bolus.
• There is no curve of spee or curve of Wilson (Compensating curves).
Indications of monoplane occlusion:
1. Jaw size discrepancies CI II, CI III ,malocclusion and cross bite.
2. Uncoordinated jaw movement.
3. Mostly for geriatric patients.
4. Minimal ridge ,resorbed ridge ,it reduces horizontal forces.
Advantages:

1. Simple tech. and less time consuming. 2. Less precise jaw relation records. 3.
Lateral forces are reduced by eliminating cuspal inclines. 4. Simpler and easier
occlusal adjustments. 5. Occlusion is not locked.

Disadvantages:

1. Least esthetic.

2. Poor bolus penetration.

3. Can not be balanced in eccentric excursions.

Types of occlusal scheme:
Anatomic teeth resemble normal newly-erupted teeth. They provide the best
aesthetics and are the most commonly used type of artificial teeth. The cusps
resemble normal dentition with an angle of 33⁰. Anatomic teeth with 30⁰ cuspal
angulation are also available and are commonly known as Pilkington-Turner teeth.
Advantages:

1. Esthetic. 2. Better food penetration. 3. Vertical stress decrease.

4. Harmony with TMJ and muscle of mastication. 5. Balance occlusion in

eccentric position.

Disadvantages:

1. Precise tech. requires. 2. More time. 3. Difficult teeth position in cl. II and III.
4. Greater lateral force.
Semi-anatomic Teeth: they are also known as modified-cusp or low-cusp teeth. They
may have 20⁰ or 10⁰ cuspal angulation. 10⁰ semi-anatomic teeth are commonly
known as functional or anatoline teeth. They are used in cases with mild
discrepancies in jaw relation. They are more flexible to arrange than anatomic teeth
but they are not as flexible as nonanatomic teeth.
Advantages:

1. Esthetic. 2. Good chewing efficacy. 3. Less lateral force. 4. Balance

occlusion.

Disadvantages:

1. Less esthetic than anatomic teeth.

2. Poor bolus penetration.

3. Can not be balanced in eccentric excursions.

Cuspless Teeth: they are also known as 0⁰, flat, or monoplane teeth. They have no
cuspal angulation hence are very flexible to set. It is easy to set non-anatomic teeth
in balanced occlusion. Cuspless teeth can be used for the following occlusal
schemes:
• Bilateral balance with a compensating curve.
• Three-point balance with a balancing ramp.
• Flat plane-balance in centric only.
• Reverse-pitch (Anti-Monson) curve.
Advantages:

1. Used for patient with poor neuromuscular coordination. 2. Used for patient
with mal-relation jaws. 3. Used for patient with cross bite or cl. III. 4. More
comfortable. 5. Less time required in set up. 6. Slightly more esthetic than
neutrocentric occlusion.

Disadvantages:

1. Use of compensatory curve may cause the same damaging effects as cuspal
inclines. 2. Occlusal adjustment are more difficult to accomplish.
Factors that control the selection of the form of a tooth:
• Characteristics of occlusal scheme
-Tooth form and arrangement
-balanced or not
. Characteristics of the patient
-Height and width of the residual ridge
-Aesthetic demands of the patient
-Skeletal relations
-Neuromuscular control
-Tendency for parafunctional activity
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