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Balanced occlusion

Balanced Occlusion and Various Tooth Arrangement Procedures

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Balanced occlusion

  1. 1. Department of prosthodontics Presented by, Shiji margaret CRRI
  2. 2. • Introduction • Definition •Concepts of balanced occlusion •Factors affecting balanced occlusion (hanau’s quint) •Pre-requisites •Types of balanced occlusion •Selection of posterior teeth •Teeth arrangement in various condition •Conclusion •Reference
  3. 3. INTRODUCTION Relationship between the occlusal surface of the maxillary and mandibular teeth when they are in contact. TYPES OF OCCLUSION SLIDING OCCLUSION CENTRIC OCCLUSION ECCENTRIC OCCLUSION BALANCED OCCLUSION BALANCED SLIDING OCCLUSION Syllabus of complete denture-Heartwell -4th edition 231&232 OCCLUSION
  4. 4. BALANCED OCCLUSION
  5. 5. BALANCED OCCLUSION = BALANCE+OCCLUSION BALANCE = When forces act on a body in such a way that no motion results,-there is balance or equilibrium OCCLUSION = Relationship between the occlusal surface of the maxillary and mandibular teeth when they are in contact.
  6. 6.  DEFINITION: Balanced occlusion is defined as “The simultaneous contact of the opposing upper and lower teeth in centric relation position and a continuous smooth bilateral gliding from the position to any eccentric positions with the normal range of mandibular function. Sheldon winkler 2nd edition page 240 “The simultaneous contacting of the maxillary and mandibular teeth on the right and left and in the posterior and anterior occlusal areas in centric and eccentric positions, developed to lessen or limit tipping or rotating of the denture bases in relation to the supporting structures” –GPT
  7. 7. 1) Gysi’s concept 2) French’s concept 3) Sears’s concept 4) Pleasure’s concept 5 )Frush’s concept 6) Hanau’s Quint 7) Trapozzano’s concept 8) Boucher’s concept 9) Lott’s concept 10) Levin’s concept
  8. 8. Sheldon winkler 2nd edition page 242 These five factors are now called as hanau’s quint The five basic factors that determine the balance of an occlusion are: 1) Inclination of condylar guidance. 2) Inclination of Incisal guidance 3) plane of occlusion 4) Compensating curves 5) Cusp inclination
  9. 9. (Incisal guidance)(condylar guidance) (cusp) (plane) (curve) I x CG = CS x P x CV I = CS x P x CV CG BALANCED OCCLUSION
  10. 10. C -BALANCED OCCLUSION C = CONDYLAR INCLINATION× INCISALGUIDANCE OCCLUSAL PLANE ×CUSPAL INCLINATION × COMPENSATORY CURVE Syllabus of complete denture-Heartwell -4th edition
  11. 11. Hanau’s quint (Incisal guidance)(condylar guidance) (cusp) (plane) (curve)
  12. 12. CONDYLAR GUIDANCE  Mandibular guidance generated by condyle and articular disc traversing contour of glenoid fossa  Condylar guidance is due to path followed by condyle in temporomandibular joint  Obtained by protrusive registration record Sheldon winkler 2nd edition page 242,243
  13. 13. •“The influence of the contacting surfaces of the mandibular and maxillary anterior teeth on mandibular movements”- GPT. •For complete dentures the incisal guidance should be as flat as esthetics and phonetics will permit. Incisal guidance Sheldon winkler 2nd edition page 243 •When the arrangement of the anterior teeth necessitates vertical overlap, a compensating horizontal overlap should be set to prevent dominant incisal guidance, from upsetting the occlusal balance on the posterior teeth
  14. 14. PLANE OF OCCLUSION OR OCCLUSAL PLANE DEFINITION: “An imaginary surface which is related anatomically to the cranium and which theoretically touches the incisal edges of the incisors and the tips of the occluding surfaces of the posterior teeth. It is not a plane in the true sense of the word but represents the mean curvature of the surface”- GPT. •It represents the mean curvature of the surface. Established anteriorly by height of lower cuspid and posteriorly by height of retromolar pad.
  15. 15. • These landmarks also creates an occlusal plane essentially parallel to the ala-tragus line( Camper`s plane). Sheldon winkler 2nd edition page 243
  16. 16.  DEFINITION: “The anteroposterior and lateral curvatures in the alignment of the occluding surfaces and incisal edges of artificial teeth which are used to develop balanced occlusion”-GPT. Sheldon winkler 2nd edition page 243 COMPENSATING CURVE • Determined by inclination of posterior teeth and their vertical relationship to occlusal plane. • Steep condylar path requires steep compensating curve to produce balanced occlusion
  17. 17. Cuspal Inclination  DEFINITION: “The angle made by the average slope of a cusp with the cusp plane measured mesiodistally or buccolingually”-GPT.  angle made by average slope of cusp with cusp plane measured mesiodistally or bucco lingually  It is an important factor that modify the effect of plane of occlusion & the compensating curves. Sheldon winkler 2nd edition page 243
  18. 18. •The angulation of the cusp is more important than the height of the cusps. •The mesiodistal cusp heights that interdigitate lock the occlusion so that reposition of the teeth due to setting of the base cannot take place. •To prevent this problem, it is advocated that all mesiodistal cusp heights be eliminated in anatomic type teeth. •With the teeth so modified, only the buccolingual inclines need be considered as determinants of balanced occlusion. Sheldon winkler 2nd edition page 243
  19. 19. The MANDIBULAR posterior teeth must be set 1) With horizontal occlusal surfaces 2) the plane of occlusion must have proper orientation 3) a compensating curve must be set 4) no interlocking transverse ridges The MAXILLARY teeth must be 1) no buccal cusp contact 2) static centric occlusal contact 3)no buccal cusp contacts in lateral excursions Sheldon winkler 2nd edition page 261,262
  20. 20. UNILATERAL balance occlusion BILATERAL balance occlusion PROTRUSIVE balance occlusion Sheldon winkler 2nd edition page 241
  21. 21.  This is present when there is equilibrium of the base on supporting structures when a bolus of food is interposed between the teeth on one side and a space exits between the teeth on the opposite side. Sheldon winkler 2nd edition page 241 a) Teeth placement should be such that to direct the resultant force on the functioning side over the ridge or slightly lingual to it. b) Having the denture base cover as wide an area on the ridge as possible. c) Placing the teeth as close to the ridge as other factors will permit. d) Using as narrow a buccolingual width occlusal food table as practical
  22. 22.  This is present when the occlusal surface of teeth on one side articulate simultaneously as a group with a smooth uninterrupted glide Sheldon winkler 2nd edition page 241  This is present when there is equbilibrium on both sides of the denture due to simultaneous contact of teeth in centric and eccentric occlusion  It requires a minimum of three contacts for establishing an equilibrium.  This type of balance is dependent on interaction of the incisal guidance, the plane of occlusion, the angulation of teeth, cusp height, compensating curve and inclination of condylar path.
  23. 23.  This is present when mandible moves essentially forward and occlusal contact are smooth and simultaneous in the posterior both on right and left side and on anterior teeth. Sheldon winkler 2nd edition page 241 Posterior contact during protrusion to maintain balance
  24. 24.  Selection of posterior teeth: Artificial teeth are the important part of the denture to establish occlusion. These teeth can be divided into 3 main groups- - Anatomic teeth - Semi - anatomic - Non-anatomic teeth. Syllabus of complete denture-Heartwell -4th edition
  25. 25.  An anatomic tooth is one that is designed to simulate the natural tooth form.  It has cusp heights of varying degrees of inclination that will intercuspate with an opposing tooth of anatomic form.  The standard anatomic tooth has inclines of approximately 33 degrees or more and somewhat resembles natural teeth Syllabus of complete denture-Heartwell -4th edition CUSPAL ANGLE > 30° ( CUSPED TEETH ) GOOD RIDGE
  26. 26.  When the cusp incline is less steep than the conventional anatomic tooth form of 33 degree, it can be classified as a modified or semi-anatomic tooth. CUSPAL ANGLE < 30° (SEMI-ANATOMIC TEETH) MODERATE RIDGE Syllabus of complete denture-Heartwell -4th edition
  27. 27.  A nonanatomic tooth is essentially flat and has no cusp heights to interdigitate with an opposing tooth.  Non anatomic teeth articulate on an essentially flat surface in only two dimensions. CUSPAL ANGLE 0°- 5° ( FLAT TEETH ) POOR RIDGE Syllabus of complete denture-Heartwell -4th edition
  28. 28. Teeth arrangement in various condition
  29. 29. •Mesio buccal cusp of the lower 1st molar occludes in the fossa between upper 2nd premolar and 1st molar. •Mesio buccal cusp of the lower 2nd molar occludes in the fossa between upper 1st and 2nd molars. Class 1 Sheldon winkler 2nd edition
  30. 30. Molar relation class I Maxillary anterior teeth larger Mandibular 1st premolar is eliminated class II Sheldon winkler 2nd edition
  31. 31. •Molar relation class I •Mandibular anterior teeth larger •Maxillary 1st premolar eliminated •Anterior edge to edge Class III Sheldon winkler 2nd edition
  32. 32. Pre treatment frontal view of the patient Resorbed maxillary and mandibular ridge Impression using Mc.cord’s technique Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march RESORBED RIDGE
  33. 33. Custom tray with spacer Primary impression with putty Primary cast with special tray Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march
  34. 34. Max and Mand impressions with light bodied impression material Rims cut from three regions Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march
  35. 35. Record bases with vertical stops and retentive loops Record bases delivered in pt’s mouth Neutral zone is recorded Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march
  36. 36. Record bases with plaster indices Wax flowed into plaster indices Try in done Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march
  37. 37. Flabby Ridge Intraoral view of maxillary arch. Intraoral view of mandibular arch. 1 mm thick sheet placed on the invested master cast prior to packing. 1 mm thick sheet being removed from the processed denture at recall appointment. Management of flabby ridges using liquid supported denture: a case report DOI:10.4047/jap.2011.3.1.43
  38. 38. Primary impressions were made with alginate Border molding was performed by using low fusing impression compound The flabby tissue was marked in the mouth and transferred on the tray. Vaccum heat pressed polyethylene sheet of 1 mm thickness was adapted on the master cast. The sheet was made 2 mm short of the sulcus and was not extended in the PPS area. This sheet was incorporated in the denture at the time of packing. At recall appointment, the 1 mm thick sheet which was used as a spacer was removed from the denture Management of flabby ridges using liquid supported denture: a case report DOI:10.4047/jap.2011.3.1.43
  39. 39. The polyethylene sheet was cut using the putty index as guide. The borders of the 0.5 mm thick sheet were placed in the crevice formed due to removal of 1mm thick sheet. The space created due to the replacement of a 1 mm thick sheet with a 0.5 mm thick sheet was filled with glycerine. Finally the upper liquid supported denture was delivered Denture care instructions were given to the patient. Patient was told to clean the tissue surface using soft cloth. Recall appointments were scheduled at 1 day, 1 week, 1 month and 3 months. At 1 week appointment, patient complained of floating feeling. But, at 3 months recall appointment, patient was comfortably using the denture. The denture was well maintained. Management of flabby ridges using liquid supported denture: a case report DOI:10.4047/jap.2011.3.1.43
  40. 40. Stone cast poured from the putty impression to mark the exact junction of polyethylene sheet. Intra oral view with upper and lower dentures. Upper liquid supported complete denture and lower cast partial denture. Schematic representation of the cross sectional view of the upper denture with polyethylene sheet and glycerin. Management of flabby ridges using liquid supported denture: a case report DOI:10.4047/jap.2011.3.1.43
  41. 41. Thus A Dentist Should Have A Thorough Knowledge On Occlusion. To Provide A Balanced Occlusion For Patients The responsibility for complete understanding of all of the basic principles of occlusion is inherent in the professional license  Sheldon Winkler: Essentials Of Complete Denture Prosthodontics.
  42. 42.  Sheldon Winkler: Essentials Of Complete Denture Prosthodontics.  Charles M.Heartwell . Jr. , Artur O.Rahn : Syllabus Of Complete Dentures  Zarb-bolender : Prosthodontic Treratment For Edentulous Patients  Beck H.O. (1972): Occlusion As Related To Complete Removable Prosthodontics. Journal Of  Prosthodontic management of resorbed mandibular ridges-journal of dental science and oral rehabilitation 2013-; jan-march REFERENCES

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