This document discusses maxillo-mandibular records and occlusion for removable partial dentures (RPDs). It covers assessing the vertical dimension of occlusion (VDO) and horizontal relationships, as well as determining centric relation. Methods for making jaw relation records including face bow transfers and bite registrations are described. The document also discusses considerations for developing occlusion for complete dentures, RPDs, and mixed dentition cases. Bilateral balanced occlusion is recommended when one arch is edentulous to prevent tipping of the denture and resorption. Anterior guidance is preferred for distal extension RPDs. Maintaining the ideal occlusal plane is also important.

1. Maxillo-mandibular records
and Occlusion for RPD’s
Michael Hamada DDS
George Perri DDS
John Beumer III DDS, MS
and
Ting Ling Chang DDS
Division of Advanced Prosthodontics, Biomaterials and
Hospital Dentistry
UCLA School of Dentistry
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2. Maxillo-mandibular records
and Occlusion for RPD’s

3. Maxillo-mandibular records
 Assessment of the existing VDO and
occlusion
 Determine the proper VDO for the patient
 Assess the horizontal occlusal relationship
 Centric occlusion vs centric relation
 Make jaw relation records

4. Assessment of the VDO
 Acceptable VDO: Vertical stops (posterior tooth contacts)
maintained without tooth displacement or horizontal
interference with the correct physiological function.
 When an existing VDO is correct, there often exists sufficient
inter-jaw space for denture teeth and proper occlusal
guidance .

5. Assessment of the VDO
 During speech there is little or no contact between the
dentition in the opposing dental arches
 Assess the interocclusal space. It averages 2-4 mm
 When an existing VDO is acceptable, preserve it

6. Assessment of the VDO
Loss of interocclusal space does not always imply loss
of VDO
 Super-eruption of teeth commonly leads to loss of
interocclusal space

7. Assessment of the VDO
 When an existing VDO is correct, there usually is sufficient
space for positioning denture teeth
 In some patients however, even though the existing VDO is
correct super-eruption of teeth may need correction before the
RPD is made

8. Assessment of the VDO
 In these patients the vertical dimension of occlusion
has been lost or reduced
 There are no posterior occlusal stops remaining in
either patient
 A treatment plan will require reestablishment of a
vertical dimension occlusion compatible with
speech and swallowing

9. Assessment of the VDO
Phenomenon that lead to reduced VDO
 Loss of multiple tooth contacts through tooth loss
and migration of teeth

10. Assessment of the VDO
Phenomenon that lead to reduced VDO
 Excessive wear
Courtesy Dr. A Davodi Courtesy Dr. A Davodi

11. Reestablishing the proper VDO
 When it is believed that the VDO needs to be restored it is
necessary to fabricate a temporary partial denture (treatment
partial denture)
 The new VDO is assessed by observing speech and swallowing.
 After a period of wear by the patient, the VDO is reassessed. If
correct, the new RPD is fabricated at this VDO
 The minimum diagnostic trial period is 3-4 weeks
Courtesy Dr. A Davodi Courtesy Dr. A Davodi

12. Reestablishing the proper VDO
This patient presented with a reduced VDO secondary to
wear and erosion
 The current VDO is assessed by observing speech and swallowing.
 The interocclusal space was excessive, and temporary treatment
RPD’s were planned
Courtesy Dr. A Davodi Courtesy Dr. A Davodi

13. Reestablishing the proper VDO
Treatment Partial Dentures Purpose
 Replace missing teeth
 Establish posterior occlusion
 Test changes in vertical dimension
 Trial prostheses—Can the patient adapt to RPD’s
Courtesy Dr. A Davodi Courtesy Dr. A Davodi
Note the occlusal rests on both treatment RPD’s

14. Reestablishing the proper VDO
Treatment Partials
Note occlusal platform on
maxillary treatment partial
to restore patient’s vertical
dimension
Courtesy Dr. A Davodi
Courtesy Dr. A Davodi Courtesy Dr. A Davodi

15. Reestablishing the proper VDO
Courtesy Dr. A Davodi
 A new VDO will be determined by observing
freeway space, phonetics and swallowing position
 Changes are made as deemed appropriate
 A minimum diagnostic trial period for the treatment
RPD is 3 to 4 weeks.

16. Determination of the proper VDO
 Incorrect horizontal relationships usually accompany an
incorrect VDO
 When there are occlusal interferences caused by malpositioned
teeth, it is necessary to eliminate the interference before the
proper VDO can be determined

17. Centric Relation (CR)
The relation of the mandible to the maxillae when
the condyles are in their most anterior/superior
position in the glenoid fossa from which unstrained
lateral movements can be made at the occluding
vertical dimension normal for the individual
 Unstrained Orthopedic
relationship
 Attributed to Restraining
action of
 Ligaments
 Muscles
 Meniscus

18. Centric Relation (CR)
The relation of the mandible to the maxillae when
the condyles are in their most anterior/superior
position in the glenoid fossa from which unstrained
lateral movements can be made at the occluding
vertical dimension normal for the individual
 On the border of the
envelope of mandibular
motion (at intersection of
right and left border
positions)
 Is part of the functional
range of motion during
chewing & swallowing
CR

19. Centric Jaw Relation (CR)
The relation of the mandible to the maxillae when
the condyles are in their most anterior/superior
position in the glenoid fossa from which unstrained
lateral movements can be made at the occluding
vertical dimension normal for the individual
 CR is the only constant
repeatable position at
which to start a stable
occlusion
 And from which smooth
gliding non-interfering
movements to a
comfortable muscular
CR
position are possible

20. Centric Jaw Relation (CR)
The relation of the mandible to the maxillae when
the condyles are in their most anterior/superior
position in the glenoid fossa from which unstrained
lateral movements can be made at the occluding
vertical dimension normal for the individual
 Unstrained Orthopedic
relationship
 Learnable
 Repeatable
 Recordable
CR

21. When do we use Centric Occlusion?
 Centric relation - The most retruded relation of the
mandible to the maxilla, when the condyles are also in
the most retruded unstrained position in the glenoid
fossa. This position corresponds to the apex of bilateral
movement in Gothic Arch tracing.
Glenoid fossa
Disc
Articular eminence
Condyle
CR

22. When do we use Centric Relation?
 The Centric Relation position is especially useful
when existing occlusion is lost or distorted.
 When one arch is edentulous
CR

23. Centric Relation vs Intercuspation and
Centric Occlusion
 Maximum intercuspation (centric occlusion) in a healthy
dentition is usually .5 to 1.0 mm anterior to centric relation

24. When do we use Centric Occlusion?
 If a diagnostic evaluation determines that no disease or
adverse symptoms are occurring within the entire supporting
masticatory system, the existing jaw relationship is considered
acceptable.

25. Centric Jaw Relation: When do we use it?
 The rationale for use of this jaw position is that the position
can be repeated and reproduced by duplicate records which
do not depend on the patients neuro-muscular system.
Because of the most retruded position, we might remove the
possibility of occlusal interference.
Glenoid fossa
Disc
Articular eminence Condyle
CR

26. Assessment of the horizontal relationships
 It is ideal when the horizontal relationship determined by
positional tooth contact (Centric Occlusion) or tapping is
coincident with or within one mm of centric relation.
 If the discrepancy is excessive, use of a TX RPD is
recommended to determine the desired centric occlusion
position.
CR

27. Jaw relation records
 Face bow transfer record
 Centric jaw position record
 Protrusive position record
 Adjustment of condylar inclination
 Record the protrusive position of the mandible,
when the anterior teeth are edge to edge contact
or 3-6 mm protrusive position from the centric
relation position

28. Jaw relation records
 In most cases involving a distal
extension base RPD, record
bases are required. Record
bases have to be well adapted to
the cast and intraorally to the
tissue surface. The reliability of
the registration depends on
support from the edentulous
mucosa being equal to the
support that will be provided by
the final prosthesis.

29. Jaw relation records
 Wax rims ideally should
represent the buccal-
lingual contour of the teeth
being replaced and be
positioned to record the
opposing dentition or wax
rim. Wax rims must be
well adapted and stable.

30. Jaw relation records
 Face bow record
 Wax rims have to be adjusted until consistent occlusal
clearance is achieved. Undesirable contacts will guide
and distort the records
 The bite registration material should exert no
opposition or interference to jaw closure.
 Avoid applying an excessive amount of the material.
 When sufficient tooth contacts remain, orient the
mandible accordingly. Especially when the edentulous
area is extensive, patients should understand and
rehearse the procedures under doctor’s instruction for
accurate and reliable registration.

31. Jaw relation records
 Make face bow transfer record
The face bow
transfer record
orients the maxillary
cast on the articulator
in a proper position
relative to the
condyles.

32. Jaw Relation Registration with record
bases and wax rims
 In some cases involving a distal
extension base RPD, record bases
are required.
 Record bases should be well
adapted to the cast and intraorally to
the tissue surface.
 The reliability of the centric position
registration depends on support
from the edentulous mucosa being
equal to the support that will be
provided by the final prosthesis.

33. Jaw Relation Registration with record
bases and wax rims
 Wax rims ideally should
represent the buccal-lingual
contour of the teeth being
replaced and be positioned to
record the opposing dentition
or wax rim.

34. Jaw Relation Registration with record
bases and wax rims
 Centric jaw position record mounted on the articulator
 Protrusive position record is made and the condylar
inclination is adjusted accordingly

35. Altered cast - CR record
 Mount the tentative centric relation record with the compound
occlusal index
 This record must be verified at the try-in appointment
 Only reliable and time saving in experienced hands

36. Occlusal Considerations
 General Occlusal Considerations
 Biologic/Organic Occlusion
 Complete Denture Occlusion
 Removable Partial Denture Occlusion
 Restorative Considerations
 Anterior Guidance vs. Fully Balanced Occlusion
 RPD’s Opposing Complete Dentures
 Class II and Class III Occlusions
 Prosthetic Tooth Selection
 Morphology and Materials Considerations

37. Natural Dentition:
Organic Occlusion Characterized by:
 Bilateral Posterior Centric Contact
 Anterior Guidance
 Mutually Protective Scheme of Occlusion

38. Complete denture occlusion – Bilateral balance
Why?
Denture teeth are part of the denture base which rests on
movable/displaceable tissues
Premature, deflective contacts between artificial teeth cause
movement of the denture resulting in damage to the supporting
tissues.

39. Developing occlusion
 Bilateral balance vs anterior guidance and or group
function
 Weakest arch dictates the occlusal scheme
 Whenever one arch is edentulous, bilateral balanced
occlusion is employed
 Otherwise the denture will tip and move during mastication
and parafunction and the edentulous arch will rapidly resorb

40. Complete denture opposing RPD
Bilateral Balanced Occlusion: When the opposing
arch requires prosthetic stabilization
When a complete denture is opposed by a RPD, it is necessary
to develop balanced occlusion in all eccentric positions.

41. Complete Dentures Opposing an Extension
Base RPD
What are the consequences of not developing
bilateral balanced occlusion?
Centric occlusion Protrusive position
The vertical overlap of the anterior teeth was excessive and with the
patient in the protrusive position there are no posterior contacts.
As a result the denture is tipped anteriorly during function leading eventually
to severe resorption of the premaxilla

42. Maxillary Denture Opposing a
Kennedy Class I RPD
What are the consequences of not
developing bilateral balanced occlusion?
Severely resorbed premaxilla
As a result the denture is tipped anteriorly during function
leading eventually to severe resorption of the premaxilla

43. Complete denture opposing RPD
Bilateral Balanced Occlusion: When the opposing arch
requires prosthetic stabilization
When a complete denture is opposed by a RPD, it is necessary
to develop balanced occlusion in all eccentric positions.

44. Complete denture opposing Kennedy
Class I RPD
Patient presents with edentulous maxilla opposing a partially
dentulous mandible requiring a Kennedy Class I RPD
Note the molar teeth tilted mesially and the occlusal plane
discrepancies.
Bilateral balanced occlusion must be employed, otherwise the
edentulous maxilla will resorb rapidly
Courtesy Dr. GE KIng

45. Complete denture opposing Kennedy
Class I RPD
Courtesy Dr. GE KIng Courtesy Dr. GE KIng
Bilateral balanced occlusion must be employed, otherwise
the edentulous maxilla will resorb rapidly
Bilateral balanced occlusion requires that the plane of
occlusion be restored and tooth contours be made more
favorable. This can be accomplished with fixed restorations
or an RPD

46. Complete Denture Opposing Kennedy
Class I RPD
 The occlusal plane discrepancies
and occlusal contours have been
restored with an overlay RPD as well
as the missing dentition making it
possible to develop bilateral
balanced occlusion.
Courtesy Dr. GE KIng
Courtesy Dr. GE KIng Courtesy Dr. GE KIng

47. Developing Occlusion
Anterior guidance- - protects against overload and
occlusal interference on posterior teeth
The location and number
of remaining teeth
determine anterior
guidance.
Is always preferred for a
distal extension partial
The magnitude of the
canine guidance will create
posterior disclusion.

48. Bilateral distal extension RPD’s
In such a patient anterior guidance is
preferred

49. Developing occlusion
 Occlusal plane- base line for organized and compatible inter-
arch set up.
 The ideal occlusal plane is an imaginary line that connects the
middle third of the retromolar pad and maxillary incisal edges,
when the jaws are at the correct VDO.

50. Developing Occlusion
Occlusal plane- base line for organized and compatible
inter-arch set up.
The ideal occlusal plane is
an imaginary line that
connects the middle third
of the retromolar pad and
maxillary incisal edges,
when the jaws are at the
correct VDO.
Supererupted teeth off
the occlusal plane
create interferences.

51. Developing Occlusion
Kennedy Class II RPD
 We prefer a lingualized form of occlusion
 With this occlusal scheme it is less likely that
there will occlusal contact during excursions

52. Developing Occlusion
Kennedy class I RPD
 Anterior guidance restored with full veneer crowns
 Lingualized scheme of occlusion was used in the
posterior region

53. Developing Occlusion
 Rather than filling the edentulous space, place posterior teeth
in the most advantageous position for centric and eccentric
positions.
If the first tooth is located in an ideal position, the following
teeth can be organized in their ideal positions. Esthetic
difficulties, such as reduced mesial-distal or inter-dental space,
can be rectified by altering, recontouring teeth, adding tooth
colored acrylic, or leaving a slight space.

54. Developing Occlusion
 Rather than filling the edentulous space, place posterior teeth
in the most advantageous position for centric and eccentric
positions.
If the first tooth is located in an ideal position, the following
teeth can be organized in their ideal positions. Esthetic
difficulties, such as reduced mesial-distal and inter-dental
space, can be rectified by altering, recontouring teeth, adding
tooth colored acrylic, or leaving a slight space.

55. Developing Occlusion
Controlling and preserving remaining oral structures is a
prime objective in RPD treatment. The replacement of key
structures or mastication surfaces may not be proper
treatment if it jeopardize the health or survival of a remaining
structure. Developing proper occlusion may be the key to
preventing further loss or damage.
Proper occlusion must take into account:
 Occlusal plane
 Anterior guidance
 Condylar guidance
 Occlusal scheme

56. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
Maxillary arch is edentulous
Occlusion therefore will be bilateral balance

57. Complete Denture vs. RPD:
Skeletal Class II
 Study cast surveyed
 RPD is designed
 Tooth contours will be modified with either fixed restorations
or recontouring the enamel of the existing teeth to facilitate
the development of bilateral balanced occlusion
Courtesy Dr. T Berg

58. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg Courtesy Dr. T Berg
 Lower study cast is mounted in centric relation with a
maxillary master cast made with a border molded
impression
 Diagnostic wax-up is completed consistent with obtaining
bilateral balanced occlusion with the planned opposing
complete denture

59. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
 Completed maxillary wax up
 Note the horizontal overlap
 Patient will tend to function down and forward during speech
and swallowing

60. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
 Semi-anatomic teeth are chosen to accommodate for the so-
called protrusive convenient positions
 Full veneer crowns are planned for the left mandibular premolar
and the right mandibular cuspid

61. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
 The teeth are prepared, impressions are made, a centric
relation record is obtained and the cast containing the
dies is mounted as shown

62. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
Crowns are contoured to:
 Restore the proper level of the occlusal plane
 Provide ideal contours to develop bilateral occlusion
with opposing complete denture

63. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg Courtesy Dr. T Berg
Partial denture is then completed in the usual manner
 Impression for RPD framework
 RPD framework fabricated, physiologically adjusted
 Altered cast impression
 Centric relation records
 Try in and prove centric relation record
 The occlusal plane has been modified to enable the development of bilateral
balanced occlusion

64. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg Courtesy Dr. T Berg Courtesy Dr. T Berg
 Note the occlusion has been modified to allow the patient to
function in a more anterior position and everywhere in
between
 This is accomplished with a protrusive record and modifying
the occlusal contours of the semi-anatomic denture teeth

65. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg Courtesy Dr. T Berg
 In such cases it may not possible to develop cusp to cusp
and tooth to tooth balance
 A balancing ramp (circle) was used to obtain bilateral
balanced occlusion

66. Complete Denture vs. RPD:
Skeletal Class II
Courtesy Dr. T Berg
 Inserted RPD
 Despite the malposition of some teeth, the RPD reestablishes
the integrity of the arch and restores the occlusal plane
enabling the development of bilateral balanced occlusion
 The occlusal scheme based on the status of the weakest arch

67. Complete Denture vs. RPD:
Skeletal Class II
 Sometimes the morphology of the natural dentition does not permit the
freedom of anterior movement in function to maintain bilateral balanced
occlusion
 Using trans-occlusal rests may be modified to provide an occlusal
morphology that permits the range of movement required between centric
relation and the more anterior centric occlusion position

68. Complete Denture vs. RPD:
Skeletal Class III
 Maximum intercuspation may be anterior to centric relation
 May be exaggerated by loss of posterior teeth and loss of
vertical dimension

69. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg Courtesy Dr. T Berg
 Mounted study casts in centric relation position
 If you compare with the previous clinical slide you can
see the position is more edge to edge

70. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg
 Condylar inclination needs to be recorded so that the
patient can be placed in a protrusive position that is
compatible with their maximum intercuspation position

71. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg
 Lateral incisors were restored with full veneer crowns
 Note the cingulum rests

72. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg
 Following completion of the fixed restorations the RPD is
fabricated
 Total palatal coverage was used to maximize support
 Note the positive cingulum rests
 These will prevent the incisors from being displaced anteriorly

73. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg Courtesy Dr. T Berg
 Reestablishment of the posterior support and the vertical
dimension of occlusion and the development of positive
cingulum rests is essential for maintaining the health of
the arch as a functional unit.

74. Complete Denture vs. RPD:
Skeletal Class III
Courtesy Dr. T Berg Courtesy Dr. T Berg
 Restoration of the vertical dimension and providing
posterior occlusion prevents continued wear of the
remaining incisors
 Guidance is provided by the natural incisors
 However, most class III patient present with vertical
chewing motions
 Note the esthetic result

75. Anterior Extension RPD’s
Kennedy Class IV
Courtesy Dr. GE KIng Courtesy Dr. GE KIng Courtesy Dr. GE KIng
Challenges regarding occlusion
 Phonetics and esthetics dictate the position of the anterior
teeth
 The anterior teeth may be cantilevered significantly anteriorly

76. Anterior Extension RPD’s
Kennedy Class IV
Challenges regarding occlusion
 Phonetics and esthetics dictate the position of the
anterior teeth
 The anterior teeth may be cantilevered significantly
anteriorly as a result

77. Anterior Extension RPD’s
Kennedy Class IV
Courtesy Dr. GE KIng Courtesy Dr. GE KIng Courtesy Dr. GE KIng
Challenges regarding occlusion
 Phonetics and esthetics dictate the position of the anterior
teeth
 The anterior teeth may be cantilevered significantly anteriorly

78. Anterior Extension RPD’s
Kennedy Class IV
 Maintain guidance with natural dentition
 In this patient the cuspids and premolars provided anterior
guidance
 Note there is no contact with the incisors during lateral
excursion

79. Anterior Extension RPD’s
Kennedy Class IV
Courtesy Dr. GE KIng Courtesy Dr. GE KIng
 In this patient guidance in lateral excursions was
provided by the cuspids and the premolars

80. Anterior Extension RPD’s
Kennedy Class IV
 Note the absence of retainers
 This is a rotational path RPD

81. Conclusion
 RPD occlusion lies somewhere in the
continuum between the completely
edentulous arch and the intact, healthy
complete dentate arch
 Requirementsfor RPD occlusion will be
dependent on the requirements for the
weakest arch
 Bilateral balance vs anterior guidance

82. Conclusion
 Within the constraints of the “weakest arch” the
type of guidance established is dependent upon the
condition, number and position of the remaining
anterior teeth (sometimes including the 1st premolar
in the case of Kennedy Class IV RPD’s)
 Once determined and established, maintenance of
the occlusion is critical for the long term health of
the dentition
 Restorative materials choices
 Maintenance and recalls are most important

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