Occlusal rims

Ehtesham Khan
BDS, MFDS RCSEd, FCPS
Assistant Professor
Definition
• Occluding surfaces fabricated on interim or final denture bases for the
purpose of making maxillomandibular relation records and arranging teeth
Uses
• Determination of lip support
• Determination of arch form
• Determination of plane of occlusion
• Establish tooth size and position
• Establish contour of polished surface
• Establish, record and transfer the jaw relation
• Arrangement of artificial teeth
Fabrication
• Soften base plate wax over a flame
• Roll it into a cylindrical shape
• Preshape it into the form of an arch
• Adapt to trial denture base
• Follow approximate contour of the arch
• Seal to the base with heated wax knife
• Refine the shape
Dimensions of the rims
• Heights

 Maxilla

 Anteriorly: 22mm from labial vestibule

 Posteriorly: 18 mm from buccal vestibule

 Mandible

 Anteriorly: 16mm from labial vestibule

 Posteriorly: 2/3rd the height of retromolar pad

Dimensions of the rims
• Width

• Anterior: 4-5 mm

• Premolar: 5-7 mm

• Posterior: 8-10 mm
Sequence of use by dentist
• Establish the neutral zone by designing an arch form on each wax occlusion
rim

• Determine the level/height of the occlusal plane on the occlusion rim

• Modify the opposing rims to meet evenly at the desired vertical dimension of occlusion
(VDO), and

• Make a preliminary centric relation (CR) record.

Nuetral zone/ Arch
form desigh
The contour of the arch form of the occlusion rims is established to:
• simulate the desired arch form of the artificial teeth
Neutral zone
• Definition

• Space in the oral cavity where the forces exerted by the musculature of the tongue are
equal and balanced with the forces exerted by the buccinator of the cheek laterally and
the orbicularis oris anteriorly.

• The potential space between the lips and cheeks on one side and the tongue on the
other; where the forces between the two are equal.
Significance
• Natural teeth occupy a zone of equilibrium

• Each tooth assumes a stable position that is the result of all the various forces
acting on it.

• When natural teeth are replaced by artificial teeth, it is logical to set the artificial teeth
in a position as close as possible to the one the natural teeth occupied.

• The same forces that stabilized the natural teeth can then be used to stabilize
the dentures
Determination of neutral zone/arch
form
• The best guide for determining and designing the arch form is

 The pattern of bone resorption where the teeth are lost

 The use of anatomical landmarks that are relatively stable in position

 Nuetral zone impression technique

Mandibular Arch
• Arch formed following pattern of resorption

• Anterior mandible:
 Larger proportion of bone loss occur labially
 Hence wax rim placed labial to crest of edentulous ridge

• Premolar area:
 Resorption occur equally on either side i.e. buccal and lingual
 Wax rim placed on crest of ridge

• Posterior mandible
 Greater resorption occur on lingual side
 Wax rims placed lingual to crest
Mandibular Arch
• Arch formed using aids from anatomical landmarks
• Mark landmarks on the cast
 Lingual of retromolar pad
 Lingual of crest of the ridge in the premolar region

• Draw line from the lingual of RMP to lingual of crest of the ridge in PM area

• This line
 Aids in positioning the lingual surfaces of the posterior teeth
 Establishes the lingual extent of the occlusion rim
Mandibular arch
• Nuetral zone impression technique

• Severely resorbed ridge

• Numerous failed mandibular dentures
• Large tongue
• Tongue defects
• Poor Nueromuscular control
Maxillary Arch
• Arch formed following pattern of resorption

• Anteriorly:
 Larger proportion of bone loss occurs from labial direction
 Hence wax rims placed labial to the crest of edentulous ridge

• Posteriorly:
 More ridge resorption occurs from buccal direction
 Wax rims placed buccal to the crest of the ridge
Maxillary Arch
• Arch formed using aids from anatomical landmarks
• Incisve papilla (IP)

 Stable landmark

 Incisal edge of maxillary central incisors usually 8-10 mm anterior to center of the
incisive papilla

 Line passing distally through IP passes through canines

Maxillary Arch
• Arch formed using aids from anatomical landmarks
• Palatal gingival vestige
 After extraction, little resorption happens on palatal

 Labial and buccal gingival margins collapse and join palatal gingival margins

 This union of outer and inner gingival margins leaves a cord like thickened line which
remains permanent and stable.

 Distance of the Palatal gingival vestige and the buccal surface of premolar: 10mm

 Distance of the Palatal gingival vestige and the buccal surface of molar: 12 mm
Establish maxillary arch labial form
• Aim:
 Establish the buccolingual positioning of anterior teeth and esthetics of lips and face

• Use facial esthetics as a guide

 Fullness of the lip

 Philtrum

 Nasolabial fold

 Commisure of the mouth

Labial form
• Fullness of lips:
• Inadequate support
 Rolled in lips
 Thin lips
 Wax rims placed too palatal

• Excessive support
 Stretched look
 Too much wax on the labial surface
Labial form
• Nasolabial fold
• Inadequate support:
 Deep nasolabial folds

• Excessive support:
 Filled out folds

 Almost invisible

 Excess wax placed labial and buccal

 Labial form
• Philtrum

• Excess support:
 Philtrum is flat

 Filled out

 Too much wax placed labially

 Labial flange too thick

 Labial form
• Wrinkles and creases

• Senile appearance:
 Wrinkles in lips and cheeks
 Exagerrated when teeth are lost

• Support improved:
 Wrinkling reduced
Level or height of the
occlusal plane
Establishing the correct level or height of the occlusal plane demands an
understanding of the neutral zone concept together with lingual and specifically
modiolus muscle function in denture stability.
Occlusal plane level
• Food bolus triturated on mandibular occlusal surfaces (occlusal table)
• This area is bounded by:
• Lingually: Tongue
• Bucally: Cheek
• Distally: Pterygomandibular raphe
• Mesially: Contraction of corner of mouth (MODIOLUS
MUSCLE)
Occlusal plane level
• The modiolus becomes fixed every time the buccinator muscle
contracts in all chewing efforts.

• The contraction of the modiolus presses the corner of the mouth against
the premolars so the occlusal table is closed in front.

• Food is crushed by the premolars and molars and does not escape at the
corner of the mouth

• The practical application of this lies in establishing the height of the

occlusal plane
Mandibular occlusal plane level
• Anterior landmark
 Corners of the mouth marked on the occlusal rims: Height of the first
premolars

• Posterior landmark
 Retromolar pad is a stable landmark
 Mark the wax rims 2/3rd the height of retromolar pad: Height of first molar

•The anterior and posterior landmarks are joined when the wax is
melted to this level
Mandibular occlusal plane level
• Its height will conform to activities of the tongue, cheek, and corner of the
mouth

• This will enhance mandibular denture stability.

• The maxillary occlusion rim is next adjusted to meet evenly with the
mandibular rim.
Maxillary occlusal plane level
• Upper lip used as a guide for height

• Anterior height of occlusal plane: 1-2 mm incisal show at rest

• Horizontal occlusal plane: parallel to interpupillary line

• Antero posterior occlusal plane: parallel to ala tragus line

• Then the lower occlusion rim is adjusted to meet evenly with the upper rim
Maxillo mandibular
relations (MMR)
Once the ideal arch form and occlusal plane level of each occlusal rim is
determined separately, they are now used to determine the relationship of
mandible to the maxilla
Definition
• Any spatial relationship of the maxilla to the mandible
Classification
• Classified into 3 groups

 Vertical relation

 Horizontal relation

 Orientation relation
 Vertical relations
Determines the amount of separation between the two jaws
It has to be established correctly for the proper comfort, health and
function
Definition
• The distance between two selected anatomic or marked points

 one on fixed and

 one on movable member

Types
• Rest vertical dimension (RVD) or vertical relation of rest

• Occlusal vertical dimension (OVD) or vertical relation of occlusion

• The difference between RVD and OVD is known as “Freeway space” or

“Inter Occlusal Dimension”
Rest Vertical Dimension (RVD)
• The distance between two selected points measured when
the mandible is in the physiological rest position

• Physiological rest position is the postural position of the

mandible when an individual is resting comfortably in an upright
position and the associated muscles are in a state of minimal
contractual activity
 Factors affecting the Rest position
• Tone and elasticity of muscles

• Posture of the body

• Effect of gravity (significant when patient

upright position)

• Nuero muscular disorders

 Factors affecting the Rest position
• Presence or absence of teeth/dentures/rims in the mouth

• Certain drugs eg muscle relaxants

• Emotional and psychological state of the patient

• Infection, inflammation or pain in oral and peri oral regions

Rest position variability
• Many factors affect the rest position of the mandible

• Hence the mandible does not occupy a single position but will occupy a variety
of positions
Establishing patients RVD
• Seat the patient upright

• Head straight

• Rims in place

• Ask patient to swallow and relax his jaws

• Ask patient to say “M” words

• Measure the distance between the two points

 Occlusal Vertical Dimension (OVD)
• The distance measured between two points when the occluding members are
in contact
OVD in dentate patient
• The occluding members are the patients existing teeth

• It may be affected by

 Tooth loss

 Caries

 Tooth wear
OVD in edentulous patient
• Established with the help of the occlusal rims

• Usually determined by finding the RVD and then

reducing 2-4 mm

• OVD= RVD – 2-4mm (Freeway space)

Freeway space or Inter occlusal
distance
• The difference between RVD and OVD

• The distance between the teeth or the rims when the mandible is in
physiological rest position

• In dentate patient it may range from 1-8 mm

• In complete dentures a distance of 2-4mm is best tolerated

Importance
• Comfort of the patient

• Tissue health

• Proper functioning
Methods of
determining vertical
relations
No single absolute accurate method exists
All methods are considered as aids to determining the vertical relation
Mechanical methods
• Ridge relations
 Distance from incisive papilla

• Measurement from former dentures

• Pre extraction records

 Profile radiographs

 Profile photographs

 Articulated casts

 Facial mesurements
Ridge relations
• Distance from incisive papilla
 Distance from incisive papilla to mandibular incisal edge = 4mm

 Distance from incisive papilla to maxillary incisal edge = 6mm

 Create overbite of 2mm

• This method is most useful for making single complete dentures

 Measurement of former dentures
• Former dentures can be measured
 From the border to maxillary denture
 To the border of mandibular denture

• Most useful when previous dentures have intact occlusal surfaces

Pre extraction records
• Used in patients seen by the dentist prior to having the teeth extracted

• Profile radiograph
• Made with teeth in occlusion

• Compared with those made with rims in occlusion

Pre extraction records
• Profile photograph

• Compare

 Before extraction photograph

 To photograph with rims or with dentures in place

Pre extraction records
• Articulated casts

• Measurements made between stable landmarks with the

teeth in occlusion
Facial mesurements
• Use different instruments to measure the distance
between landmarks

• Compare before extraction measurements to after

treatment

• Willis gauge can be used

 Base of nose

 Base of chin
Physiological methods
• Physiological rest position tests

• Phonetics as a guide

• Esthetics as a guide

• Swallowing threshhold

• Tactile or neuromuscular perception methods

• Electromyography
Physiological rest position tests
• Niswonger method
• Two markings made
 One on nose
 One on chin

• Patient told to swallow and relax

• Distance between the marks measured

• Rims adjusted till the OVD is 2-4 mm less than RVD

Phonetics as a guide
• “M” sound

• Patient repeats the letter “M” or “meem”

• Bilabial sound when lips touch jaw movements are stopped

• The occlusion rims adjusted till OVD is 2-4 mm shorter than RVD
Phonetics as a guide
• “ch” “s” “j” sounds
• When these sounds are pronounced the mandibular incisors come
immediately beneath the maxillary incisors but do not touch

• There should be a 1 mm gap between the rims when pronouncing these sounds
 If rims contact remove wax from rims
 If too much of a dark space between them add wax to rims

• This is also known as closest speaking space

Phonetics as a guide
• “f’ or “v” sounds

• Maxillary incisal edge should lightly contacts the posterior 3rd /vermillion border of
the lower lip

• Maxillary rim should also contact the same area

• If lips pushed too much outward max rim too long

• If rim contacting too forward max rim too labial or man rim too lingual
• If rim contacting too posterior max rim too lingual or man rim too labial
Esthetics as a guide
• Facial expressions
• At normal OVD the facial muscles are all in a relaxed state

• If OVD is restored too high

 Strained expression
 Pursed lips

• If OVD is insufficient
 Corners of the mouth droop
 Chin too close to nose
Esthetics as a guide
• Facial proportions
• At the correct OVD, lower face height, middle face height and upper face height
are all equal

• If OVD high Lower face height more

• If OVD low Lower face height less

OVD LOW
• Decreased chewing efficiency

• Cheek biting

• Lower face height too short

• Angular cheilitis

• TMDs

• Limited tongue space

OVD HIGH
• Discomfort
• Trauma to underlying mucosa
• Accelerated ridge resorption
• Clicking of teeth
• Rapid wear of teeth
• Strained appearance
• Difficulty in closing lips
• Difficulty in swallowing
Summary
• Determine the ideal arch form independently

• Determine the ideal occlusal plane levels for both arches independently

• Determine the rest vertical dimension position with only maxillary rim in
place

• Determine the Occlusal Vertical Dimension with both rims in place

 RVD- (2-4mm)= OVD
 Verify by using phonetics as a guide
 Verify by using esthetics as a guide
 Lines
Midline
Canine line
Smile line
Midline
• Coincide with midline of face

• Nose, philtrum, labial frenum may be used as guides

• Mark both upper and lower midlines

Canine line
• Helps in
 Selection of tooth size (width)
 Position of tip of canine

•Vertical line dropped from ala of nose to the maxillary

wax rim
Smile line
• Patient asked to smile

• Line marked on the maxillary rim along the upper lip

• Determines
 Amount of tooth show
 Amount of denture base show
 Size of teeth (Height)

• Height of artificial teeth should be from smile line to occlusal plane level