This document discusses balanced occlusion in complete dentures. It defines balanced occlusion and describes different types such as unilateral, bilateral, and protrusive balanced occlusion. The importance of balanced occlusion for denture stability is highlighted. Techniques for achieving balanced occlusion are described, including using ramps and lingualized occlusion. Studies comparing outcomes of complete dentures made with and without facebow transfer and the influence of balanced occlusion on reducing ridge resorption are summarized. The conclusion is that balanced occlusion preserves the edentulous ridge and improves denture stability.

1. BALANCED OCCLUSION
Presented by:
Dr. Srishti Relan
I MDS

2. Introduction
 Occlusion:
Is defined as any contact between the incising or
masticating surfaces of the maxillary and mandibular
teeth. -GPT
 Balanced occlusion:
“The simultaneous contact of opposing upper and
lower teeth in centric relation position and a
continuous smooth bilateral gliding from this position
to any eccentric position with in normal range of
mandibular function”
- GPT

3.  Bonwill in 1864, who has been called “the father of
anatomic (balanced) three point contact occlusion”’
 Sheppard stated that, “Enter bolus, Exit balance”
According to this statement, the balancing contact is
absent when food enters the oral cavity

4.  Brewer and Hudson (1961) reported the importance
of balanced occlusion.
 He stated that on an average, a normal individual
makes masticatory tooth contact only for 10 minutes
in one full day compared to 4 hours of total tooth
contact during other functions.
 So, for these 4 hours of tooth contact, balanced
occlusion is important to maintain the stability of the
denture.

5. Importance of Balanced occlusion
 Improved stability of denture
 No interference of cusp during mastication
 Preservation of ridges by better distribution of forces
 Absence of occlusal balance will result in leverage of
the denture during mandibular movement.

6. Requisites For Occlusal Scheme
• 4 Incisors
INSCIAL
• Canine &post.
teeth on the
moving side
WORKING
• Canine &post.
on the non-
working side
BALANCING

7. 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

8. Types of Balanced occlusion
Unilateral
balanced
occlusion
Bilateral
balanced
occlusion
Protrusive
balanced
occlusion
Lateral
balanced
occlusion

9.  Unilateral balanced occlusion:
 Seen on occlusal surfaces of teeth on one side when
they occlude simultaneously with a smooth,
uninterrupted glide
 NOT followed in complete denture construction – FPD

10. Bilateral balanced occlusion
 Seen when simultaneous contact occurs on both sides in
centric and eccentric positions.
 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.
 For minimal occlusal balance, there should be at least
three points of contact on the occlusal plane. More the
number of contacts, better the balance.
Bilateral balanced occlusion can be protrusive or lateral
balance

11. Protrusive balanced occlusion:
 This type of balanced occlusion is present when mandible
moves in a forward direction and the occlusal contacts are
smooth and simultaneous anteriorly and posteriorly.
 There should be at least three points of contact in the
occlusal plane. Two of these should be located posteriorly
and one should be located in the anterior region.
 This is absent in natural dentition.

12.  Lateral balanced occlusion
 In lateral balanced there will be a minimal
simultaneous three point contact (one anterior, two
posterior) present during lateral moment of the
mandible.
 Lateral balanced occlusion is absent in normal
dentition.

13. Principles Of Balanced Occlusion
• Narrower & smaller the ridge and wider the teeth
the poorer the balance
• Farther the teeth from the ridge ,poorer the balance
• Arranging the teeth buccally will lead to poor
balanced occlusion.
• If the teeth are set outside the ridge the denture may
elevate on one side during tooth contact.
Hence, C.D should be designed – forces of occlusion are
centered anteroposteriorly in the denture

14. Rudolph L.Hanau (1926)-
He proposed nine factors that govern the articulation of
artificial teeth. -
Laws of BALANCED articulation.
1. Horizontal condylar inclination
2. Compensating curve
3. Protrusive incisal guidance
4. Plane of orientation
5. Bucco lingual inclination of tooth axis
6. Sagittal condylar pathway
7. Sagittal incisal guidance
8. Tooth alignment
9. Relative cusp height

15.  Condylar guidance
 Incisal guidance
 Orientation of the plane of occlusion
or occlusal plane.
 Cuspal angulation
 Compensating curves.
Hanau later condensed these nine factors and
formulated five factors, which are commonly known
. Hanau’s quint

16.  There should be a balance within these five factors.
 The incisal and condylar guidances --- increase
posterior tooth separation
COUNTERACTED TO OBTAIN BALANCED OCCLUSION.
 The other three factors ---- decrease the posterior
tooth separation

17. This article discusses treatment with nonanatomic teeth
arranged on a flat plane with the use of balancing ramps

18.  Nonanatomic teeth have no cusp inclines;
therefore balancing contacts must be obtained by
other means.
 One method is to arrange teeth (maxillary and
mandibular)to a flat plane with no overbite
(vertical overlap).
 The plane can be positioned to prevent disturbing
protrusive interferences, but it may compromise
phonetics and esthetics

19.  Another method is to incline the
mandibular second molar to
provide contact with the maxillary
denture in all excursions. The
maxillary second molars are
similarly inclined but left out of
centric contact.
 The inclined second molars
provide balancing contacts in
protrusive movements but may
lack balancing contacts in lateral
excursions.
An improvement on the inclined molar technique is
the use of customized balancing ramps placed
posterior to the most distal mandibular molars

20.  Balancing ramps provide a tripodization of the
denture bases. As a patient moves the mandible from
centric relation to protrusive or lateral positions,
there is smooth contact anteriorly on the teeth and
posteriorly on the ramps.
 The balancing contacts give improved horizontal
stability to the dentures.
 Esthetics and phonetics are greatly enhanced
because there is more freedom in placing the
anterior teeth.

23. Modifications of the technique for use at
clinical remount
 The balancing ramps can be incorporated at the insertion
appointment in conjunction with the clinical remount.
 Roughen the denture base posterior to the most distal
mandibular molar with a carbide bur.
 Mix autopolymerising resin -doughy stage it is added to the
roughened surface.
 Perform all eccentric positions on the articulator whiIe the
resin is still soft. The denture can be placed in a pressure pot
to cure the resin.
 Refine and smooth the balancing ramps after curing is
complete, and carefully evaluate the contacts in eccentric
occlusion

24. Lingualized occlusion should not be confused
with placement of the mandibular teeth
lingual to the ridge crest, as suggested by
several authors.

25.  Lingualized occlusion is an attempt to maintain the
esthetic and food-penetration advantages of the
anatomic form while maintaining the mechanical
freedom of the nonanatomic form.
 It is particularly helpful when the patient places high
priority on esthetics but a nonanatomic occlusal
scheme is indicated by oral conditions such as severe
alveolar resorption, a Class II jaw relationship, or
displaceable supporting tissue.

26. PRINCIPLES OF LINGUALIZED
OCCLUSION
 Anatomic posterior (30 or 33 degree) teeth are used for
the maxillary denture
 Nonanatomic or semianatomic teeth are used for the
mandibular denture.
 Modification of the mandibular posterior teeth is
accomplished by selective grinding -smooths the central
fossae of the mandibular teeth, lowers marginal ridges,
and forms slight buccal and lingual inclines .This creates a
slight concavity in the occlusal surface.

27.  Maxillary lingual cusps should contact mandibular teeth
in centric occlusion.
 The mandibular buccal cusps should not contact the
upper teeth in centric occlusion,
 It is helpful to slightly rotate the maxillary posterior teeth
buccally to allow for slight clearance of the buccal cusps in
the working position and to reduce the need for extensive
grinding.

28. • Balancing and working contacts should occur only on
the maxillary lingual cusps.[This helps to reduce
lateral movement of the lower denture by placing
occlusal forces more lingual to and toward the center
of the mandibular teeth].
• Protrusive balancing contacts should occur only
between the maxillary lingual cusps and the lower
teeth

29. ADVANTAGES OF LINGUALIZED OCCLUSION
 Most of the advantages attributed to both the anatomic
and nonanatomic forms are retained.
 Cusp form is more natural in appearance compared to
nonanatomic tooth form.
 Good penetration of the food bolus is possible
 Vertical forces are centralized on the mandibular teeth

30.  Aim: compare complete dentures made by 2
techniques: with facebow and without facebow.

31. Technique 1:
Upper cast –facebow
Lower cast-were aligned and fixed to articulator[Hanau
H2]in centric relation position
Horizontal and lateral condylar guidance were
individualised by following the individual centric and
protrusive relation records.

32.  Technique 2:
Casts were mounted on articulator using average
values.
This tech. was specific for this type of
articulator[stratos 100]-avoid facebow.
Lower cast was fixed-by horizontal guide plane
Teeth arrangement-Bio Functional prosthetic system
with 2D template

33.  Then the dentures were processed as usual
 Occlusal contacts of each pair were registered using
articulating paper and kept for reference.
Pt was given 1pair of denture asked to wear for 10 days
and then recalled for questionnaire.
After 10 days-other pair was inserted-pt recalled
after10 days for questionnaire

34.  Results concerning about the questionnaire and the
number of contacts of group A and group B were
statistically analysed .

36. Article concluded that:

37. The aim of this study was to assess the influence of
balanced occlusal arrangement of artificial teeth on the
decrease in reduction of edentulous alveolar ridge

38.  Method: longitudinal study on 91 fully edentulous
patients was conducted using their panoramic
radiographs and parameters of vertical dimension of
edentulous ridges.

39. Parameters:
 heights of edentulous ridges of corpuses of
mandibles in the areas of mental foramen to the right
side and to the left side,
 heights of the areas in which were roots of molars to
the right and to the left side.
Two control parameters :
 in the regions of distal edges of retromolar pads to
the left and to the right side.
These were measured in the control group and the
experimental group

40. Article Concluded that
 This study confirmed the same level of edentulous
residual ridge prior the therapy and after the therapy
by acrylic complete dentures with balanced
occlusion.

41. Conclusion
 Balanced Occlusion is a favoured occlusal design in
setting artificial teeth in conventional complete
dentures since it preserves edentulous ridge and
influences the stability of dentures.
 Should be applied not only in setting of artificial teeth
in conventional complete dentures, but also in
construction of complete dentures on implants

42. References:
 Becker CM, Swoope CC, Guckes AD. Lingualized occlusion
for removable prosthodontics. The Journal of prosthetic
dentistry. 1977 Dec 1;38(6):601-8.
 Kumar M, D'souza DS. Comparative evaluation of two
techniques in achieving balanced occlusion in complete
dentures. Medical Journal Armed Forces India. 2010 Oct
1;66(4):362-6.
 Poštić SD. Influence of balanced occlusion in complete
dentures on the decrease in the reduction of an
edentulous ridge. Vojnosanitetski pregled.
2012;69(12):1055-60.
 Nimmo A, Kratochvil FJ. Balancing ramps in nonanatomic
complete denture occlusion. Journal of Prosthetic
Dentistry. 1985 Mar 1;53(3):431-3.