BALANCED OCCLUSION AND ITS
IMPORTANCE
IN COMPLETE DENTURE FABRICATION
CONTEN
TS
Introduction
Definitions
Requirements of complete denture occlusion
Concepts of occlusion (ie spectrum of occlusion and complete
dentures)
Balanced occlusion: Definition
Pre-Requisites
Pro and Cons
Parameters to success of occlusal balance
Types
Hanaus Law of articulation
Steps
Contacts in balanced occlusion: Selective grinding
Balancing Ramps
Review of literature
Summary & conclusion
References
INTRODUCTION
“A judicious selection and use of teeth is necessary to obtain stable
occlusion in harmony with the function and the state of the
supporting structures”
DEFINITIONS:
Occlusion:
Is defined as any contact between the incising or
masticating surfaces of the maxillary and mandibular teeth.-
GPT
According to Heartwell this is a static position and the jaws
can be in either centric or eccentric relation. Every time the
teeth contact there is a resultant force which may vary in
magnitude and direction.
Dental Articulation:
The static and dynamic contact relationship
between the occlusal surfaces of the teeth during
function.-GPT
Centric Occlusion:
Refers to the relationship of the mandible to the
maxilla, when the teeth are in maximum occlusal
contact, irrespective of the position or alignment of
the condyle disk assemblies. This is also referred to
as the acquired position of the mandible or the
maximum interocclusal position. (MIOP).
“When the intercuspation of the teeth is in harmony with both correctly
positioned and aligned condyle-disk assemblies, centric relation and
centric occlusion are the same. This is the goal of occlusal treatment.”
Requirements of complete denture occlusion:
-Stability of occlusion at centric relation position and in an area
forward and lateral to it.
-Balanced occlusal contacts bilaterally for all eccentric
mandibular movements.
-Unlocking the cusps mesio-distally to allow for gradual but
inevitable settling of the bases due to tissue deformation and bone
resorption.
-Control of the horizontal force by buccolingual cusp height
reduction according to residual ridge resistance form and
interarch distance.
-Functional lever balance by favourable tooth-ridge crest
position.
-Cutting, penetrating, and shearing efficiency of occlusal
surfaces.
-Anterior incisal clearance during all posterior masticatory
function and bruxing activity.
-Minimum occlusal contact areas for reduced pressure in
comminuting food (lingual contact occlusion).
-Sharp ridges or cusps and generous sluiceways to shred food
with the minimum of force necessary.
REQUIREMENTS FOR BALANCING
OCCLUSAL UNITS:
-They should contact on the molars when the incising units contact
in function.
-They should contact at the end of the chewing cycle when the
working units contact.
-They should have a smooth gliding contacts for lateral and
protrusive excursions.
Axioms for Artificial occlusion: (Sears)
1. The smaller the area of occlusal surface acting on food
the smaller will be the crushing force on food transmitted
to the supporting structures.
2. Vertical force applied to an inclined occlusal surface
causes non vertical force on the denture base.
3. Vertical force applied to a denture base supported by
yielding tissue causes the base to teeter when the force is
not centered on the base.
4. Vertical force applied outside to the ridge crest creates
tipping force on the base.
5. Vertical forces applied to inclined supporting tissues
will cause non-vertical forces on the denture base.
THE OCCLUSAL SPECTRUM AND
COMPLETE DENTURES:
occlusal schemes in use today:
-Balanced occlusion: -Non-balanced occlusion
Anatomic Spherical occlusion
Semianatomic Organic occlusion
Non-anatomic Transiographics
Lingualised Lingualised
Lingualized
Occlusion
Semi- Non-anatomic
anatomic (balanced)
(balanced)
Anatomic Neutrocentric
(Balanced) Occlusion
Occlusion
Advantages Disadvantages
1. Better Esthetics 1. Less esthetic
2. Ease of Penetration (Decreased 2. Poor penetration (Feel dull,
vertical stress) increased vertical forces on ridge)
3. Denture stability during 3. Encourage lateral chewing
parafunctional movements component.
Disadvantages Advantages
1. Precise records, Exact mountings 1. Simpler technique, less precise
required. records.
2. Greater lateral forces on inclines 2. Decreased lateral forces
(more bone deformation) 3. Faster to adjust (sandpaper)
3. Results short level 4. Permits area of closure
4. Harder to adjust 5. Good for class II and III jaw
relations.
6. Good stability, forces centralized
and neutralized.
BALANCED OCCLUSION:
It is defined as “The simultaneous contacting of the maxillary and
the mandibular teeth on the right and left side and in the posterior
and anterior occlusal areas in centric and eccentric positions,
developed to lessen or limit the tipping or rotating of the denture
base in relation to the supporting structures.-GPT
-When forces act on a body in such a way that no motion
results, there is balance or equilibrium.
-A stable base is the ultimate goal. Total stability is not
possible because of the yielding nature of the supporting
structures.
Following axioms should be considered:
1. The wider and larger the ridge and closure the teeth are
to the ridge, the greater the lever balance.
2. Conversely, the smaller and narrower the ridge and the
farther the teeth are placed from the ridge the poorer the
lever balance.
3.The wider the ridge and the narrower the teeth, the greater the
balance.
4.Conversely, the narrower the ridge and wider the teeth the
poorer the balance.
5.The more lingual the teeth are placed in relation to the ridge the
better the balance.
6.The more buccal the teeth are placed to the ridge crest, the
poorer the balance.
7.The more centered the force of occlusion anterior-posteriorly,
the greater the stability of the base.
Balanced occlusion involves a definite arrangement of tooth
contacts in harmony with the mandibular movements.
If the positions, dimensions and occlusal surfaces of the teeth are
such that during functional jaw movements; mandibular cusp
blades contact maxillary cusp blades throughout the dentures,
those dentures can perform their masticatory function most
effectively, and their occlusion can be termed as balanced
occlusion….
Pre-Requisites for balancing:
1.Mandibular posterior teeth must be set so that occlusal surfaces
are horizontal.
2.Plane of occlusion must have a proper orientation.
3.A compensating curve must be set.
4.Teeth must be modified so that there are no interlocking
transverse ridges.
PROS AND CONS –BILATERAL
BALANCED OCCLUSION:
“Enter bolus, exit balance” has cast suspicion as to
whether smooth, gliding, non-interfering, bilateral tooth
contacts are possible. It implies that occlusal balance is
impossible during mastication.
Brewer and Hudson (1961) have shown that complete
denture teeth do contact at times during mastication.
Pros:
1.The contact varies in frequency with different foods and different
persons. If this contact is interruptive and deflective; and not
bilateral, the denture base will not be stable. Hence, bilateral
balanced contacts during the terminal arc of closure help to seat the
denture in a stable position.
2.Also bilateral balanced occlusion is important during activities
such as swallowing saliva, closing to reseat the dentures, and the
bruxing of the teeth during times of stress.
3.Patient with a balanced design do not upset the normal static,
stable and retentive qualities of their dentures.
4.In bilateral balance the bases are stable during bruxing activity and
they are tight when the patient separate the teeth.
Cons:
There are some possible disadvantages of bilateral balanced
articulation:
1.It may tend to encourage lateral and protrusive grinding, although
this habit may be confined to those people who are subjected to
irrelevant muscle activity.
2..It is difficult to achieve in mouths where an increased vertical
incisor overlap is indicated, and is better to retain the vertical
overlap, than to sacrifice it in order to achieve articular balance.
3.A semi-adjustable or fully adjustable articulator is required.
PARAMETERS TO SUCCESS OF
OCCLUSAL BALANCE:
1.Accurate record of relation of maxilla to T.M.J. (which is
registration of 3 dimensional spatial relation of maxilla to T.M.J. to
maintain biological soundness of the joint.)
2.Optimal relation of condyles.
3.Bilateral muscle balance of horizontal movers of the mandible.
4.Eccentric relation record of functional protrusion of the mandible.
TYPES OF BALANCED OCCLUSION:
Balance may be: Unilateral, bilateral, or protrusive.
Unilateral lever balance:
This is present when there is equilibrium of base on its supporting
structures when a bolus of food is interposed between teeth on one
side and space exists between teeth on the opposite side…
Unilateral occlusal balance:
This is present when occlusal surfaces of the teeth on one side
articulate simultaneously with smooth uninterrupted glide.
Bilateral occlusal balance:
-This is present when there is
equilibrium on both sides of denture
due to simultaneous contact of teeth
in centric and eccentric occlusion.
-It requires a minimum of three
contacts. The more the contacts the
more assured the balance.
Protrusive occlusal balance:
-This is present when the mandible moves essentially forward and
occlusal contacts are smooth and simultaneously in posterior region
both on right and left sides as well as anterior teeth.
-It requires a minimum of three contacts, one on each side
posteriorly and one anteriorly
-The tooth size and position in relation to the ridge size and shape.
-The extent of denture base coverage.
-Occlusal balance with stable contacts at the retruded border
position and in an area anterior to it.
-Right and left eccentric occlusal balance by simultaneous contacts
at the limit of functional and parafunctional activity.
-Intermediate occlusal balance for all positions between centric
occlusion and all other functional or parafunctional excursions to
the right and left and protrusive.
‘Rudolph L.Hanau’ proposed nine factors that govern the
articulation of artificial teeth.
-Laws of articulation.
-Hanaus Quint
HANAU’S QUINT
TRAPOZZANO’S CONCEPT:
Bouchers concept:
Occlusal plane be located exactly as it was when the natural teeth
were present.
States that:
-There are 3 fixed factors :
1. The orientation of the occlusal plane, the incisal guidance, and
the condylar guidance.
2. The angulation of the cusp is more important than the height of
the cusp.
3. The compensating curve enables one to increase the effective
height of the cusps without changing the form of the teeth.
Lotto’s concept:
“Related the laws of occlusion, by relating them to the posterior
separation which is a result of the guiding factors”……
AUTHORS CONCEPT:
CONDYLAR GUIDANCE:
“The condylar path should be
determined on the patient and
set on the instrument so that the
patients TMJ is in harmony with
the occlusion as programmed on
the articulator”.
INCISAL GUIDANCE:
This is defined as “The
influence of the contacting
surfaces of the mandibular
and maxillary anterior teeth
on mandibular movements”-
GPT.
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”.-GPT
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”.-GPT
Determined by the inclination of the posterior teeth and their
vertical relationship to occlusal plane so that occlusal surface results
in a curve that is in harmony with the movement of the mandible as
guided by the condylar path.
INCLINATION OF THE CUSPS:
These are important determinants, as they modify the effect of plane
of occlusion and the compensating curve.
The mesiodistal cusp heights that interdigitate and lock the
occlusion so that resorption of the teeth due to settling of the bases
cannot take place.
To prevent this, it is advocated that mesiodistal cusp heights be
eliminated in anatomic type teeth.
The cusp of teeth modify the plane of occlusion and compensating
curve
STEPS INVOLVED IN BALANCING:
-The teeth have to be inclined to develop a balanced occlusion.
-The upper and lower incisal units meet only when the mandibular
teeth are protruded and protrusive balancing unit functions only
when upper and lower units contact.
-To develop a balanced occlusion one needs an adjustable
articulator which should:
-Receive a face-bow transfer.
-Adjust to individual inter condylar guidance.
-Have an adjustable incisal guide table.
-To adjust the articulator requires:
-A centric relation relation record.
-Eccentric protrusive record.
-Right and left lateral relation records are desirable if the
articulator is capable of accepting the records.
-If the articulator will not receive the lateral records (Hanau
type) then lateral condylar guidance is calculated as:
L = H/8 + 12
SELECTIVE GRINDING FOR CENTRIC
CONTACTS:
-After the complete arrangement of teeth, place an articulating
paper and tap the articulator.
Only the lower central fossa or marginal ridges should be ground
not the upper lingual cusps.
-If any upper buccal cusps or inclines are in contact, they should be
ground out of contact.
“The final result should be upper lingual cusp in common lower
central fossa”.
SELECTIVE GRINDING FOR WORKING
AND BALANCING CONTACTS:
There should be working and balancing contacts that are in
harmony with guidance of condylar inclination and incisal
guidance.
If the mandible moves to left, the upper left lingual cusps should
contact lower left lingual cusps (on working side) and the upper
right lingual cusps contact lower buccal cusps (balancing side).
‘If any prematurity exist, selective grinding is done’.
-“BULL Principle”
-In anterior teeth, lingual of upper and labial surface of lower teeth is
grinded to eliminate any interference.
-Final result should be smooth gliding lateral excursion with five
working and five balancing contacts.
-The multiple contacts should be smooth, uniform and in harmony
with the TMJ’s and the neuro-muscular activity.
BALANCING RAMPS IN NON-ANATOMIC
COMPLETE DENTURE OCCLUSION:
-Non anatomic teeth have no cusp inclines.
-flat plane with no overbite.
-Inclined molar technique
-Improvement of above technique , by using balancing ramps.
Two techniques.
-Tripodization of the dentures
REVIEW OF LITERATURE
Finn Tengs Christensen (1960) described the importance of
balanced occlusion in arrangement of teeth. He stressed the
introduction of compensating curves for achieving balance.
-In order to achieve balance, the compensating curve must be in
harmony with other factors.
-This is determined by ‘Thielmanns’ formula of occlusion which is
expressed as: KI
OP.C.O.K.
-By means of compensating curves, complete antagonist contact
during protrusive movements can be obtained with lower cusp
angulation.
-’So the orientation in one factor influences the other’.
Vincent R. Trappozano(1960) carried out tests to check the
efficiency of balanced and non-balanced occlusion.
-He selected few patients depending on inter-ridge space,
intelligence and experience of wearing dentures and on basis of type
of residual ridge. Patients were from 55 years to 70 years.
-All had worn dentures with 23degrees posterior teeth in balanced
occlusion.
- Comparative chewing tests of occlusal efficiency were made with
carrots and freshly roasted peanuts.
-These were selected as test foods because they don’t readily
disintegrate into fine particles.
-The number of strokes made upto time of deglutition were counted
and averaged.
-The average was noted for each patient and this was the number of
strokes permitted.
-A 100 mesh screen was used as sieve to study the size of remaining
particles and weight changes in test materials after mastication by
the patient.
-Out of 12 patients examined, 9 patients had greater efficiency of
chewing with balanced occlusion.
- In 3, efficiency was greater with non balanced occlusion when
carrots were chewed. When peanuts were chewed no difference was
noticed.
Honorato Villa(1962) recommended a technique for the use of non-
anatomic posterior teeth. He used the incisal guidance for attaining
balanced occlusion.
-The lower bicuspids were placed first on lower occlusal rims. The
two bicuspids represent the central transverse axis.
-When cusps are placed against a flat plane, there will be balancing
contacts only in working position and not in protrusive and
balancing positions.
-A groove is made in upper denture where the lower cusp will
occlude, inorder to overcome the difficulty and this makes the
balanced occlusion possible in protrusive and lateral occlusion.
-The logistic behind this arrangement is that balancing incline
requires less inclinations when it is placed on upper first bicuspid
instead of second molar because of anterior position of bicuspid.
H.O. Beck (1973) grouped the balanced and non-balanced
occlusions into five categories each.
Non-balanced occlusions are:
a. Modified cusp teeth with upper lingual cusps opposing
widened lower fossa and a reduction of buccal cusps of
lower posterior teeth.
b. Cusp teeth arranged in typical occlusion with
disocclusion by cuspid guidance in eccentric positions.
c. Non-anatomic teeth arranged in flat occlusal plane
anteroposteriorly and laterally.
d. Non-anatomic teeth arranged high in second and first
molar regions.
e. Non-anatomic teeth arranged in flat plane anteriorly but
with reverse lateral curve.
Five balanced occlusions are:
a. Anatomic and semi-anatomic teeth arranged in classic interdigitations.
b. Semi anatomic teeth with buccal reduction of lower posterior teeth.
c. Non-anatomic teeth arranged on curves anteroposteriorly and laterally.
d. Non-anatomic teeth arranged reverse curve laterally but with second
molar ramps for balancing contacts.
e. Semi-anatomic teeth with only a linear contact of lower posterior teeth
with upper occlusal surfaces balanced anteroposteriorly and laterally.
‘Sir Willford Fish’ described a denture as having three surfaces
playing an independent role in the fit and stability of dentures.
-The first two are impression and occlusal surfaces. The third
termed by Fish is the polished surface.
-It is the denture base material and teeth surfaces which come in
contact with the cheeks, lips and tongue.
L.G. Jordan (1978) described the Hanaus Quint while describing
the factors of balanced occlusion.
Hanau prepared a scientific summary of possible influence of each
of the factors of articulation on established tooth arrangement and
balanced occlusion.
He termed his statements as ‘Laws of Articulation’.
His statements were assembled into a condensed form in Hanaus
Quint
The Quint describes the changes to be carried out in factors
corresponding to changes in other factors.
SUMMARY
The nature of the supporting structures for the complete
dentures and the forces directed to them by the occlusion
creates a special biomechanical problem.
Balanced occlusion is one of the most important factors
which will favor the stability of the base; and help in
preservation of the supporting structures by reducing the
lateral forces.
“ Thereby signifying its importance in complete denture
fabrication.”
CONCLUSION
“Regardless of ones belief about the superiority of
a particular form of occlusion; the anatomical,
mechanical, physiologic and esthetic limits
presented by the patient should determine the
choice of the occlusal scheme”.
REFERENCES:
-Arthur N.: Balancing ramps in non-anatomic complete denture occlusion.
JPD,1985;53:431-433.
-Beck H.O.: Occlusion as related to complete removable prosthodontics.
JPD,1972;27:246-256.
-Becker C.M., Swoop P.C.: Lingualised occlusion for removable
prosthodontics.JPD,1977;38:601-608.
Bernard Levin: Reevaluation of Hanaus Laws of Articulation and the Hanaus
Quint. JPD,1978;39:254-258.
-Bolender-Zarb: Prosthodontic Treatment For Edentulous Patient,12th Edition,
2004 Mosby.
-Dawson P.E.: Evaluation, diagnosis and treatment of occlusal problems,2 nd
edition, 1989 Mosby.
Gregory R.P., Gerald H.L.: The Occlusal Spectrum and Complete Dentures.
-Heartwell Charles M.:Sylabbus of complete dentures.
-Kydd W.L.: Comlete debture base deformation with varied
occlusal tooth form. JPD., 1959;6:714-718.
-Kurth L.E.: Balanced Occlusion. JPD’1954’4:150-167.
-Ramjford S. and Ash: Occlusion
-Sharry J.J.: Complete Denture Prosthodontics;1962 McGraw-Hill
Book Company.
Sheldon Winkler: Essentials of complate denture prosthodontics2nd
Edition;2000, Ishiyaku EurAmerica Inc. U.S.A.
-Trappozano V.R.: An experimental study of the testing of occlusal
patterns on the same denture bases. JPD.;1952; 440-457.
THANK
YOU
