Balanced occlusion

BALANCED OCCLUSION
DELLA S INDRAN
II MDS

CONTENTS
• INTRODUCTION
• CENTRIC ,ECCENTRIC OCCLUSION
• REQUIREMENTS IN COMPLETE DENTURE OCCLUSION
• THEORIES IN COMPLETE DENTURE OCCLUSION
• CONCEPTS IN OCCLUSION
• STEPS INVOLVED IN BALANCING
• TEETH ARRANGEMENT
• SELECTIVE GRINDING
• ERRORS IN OCCLUSION
• CONCLUSION
• REVIEW OF LITERATURE
• REFERENCES

INTRODUCTION
• Occlusion is the term to describe the contact between upper
and lower teeth.
• Teeth whether natural or artificial are not immobile, so occlusion
can never be a static relationship.
• Natural teeth move in the socket under load and returns back to
position when load is removed.
• In artificial occlusion, teeth moves as in group on a common
base because of nature of supporting structures.
• Hence its difficult to obtain purely static artificial 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.
ARTICULATION
The contact relationship between the occlusal surfaces of the
teeth during function.
MAXIMUM INTERCUSPAL POSITION
MIP is the patients maxillomandibular relationship where the
teeth are in maximum occlusal contact irrespective of the
of the condyle disk assemblies.

• Balanced occlusion:
The bilateral, simultaneous, anterior, and posterior occlusal
contact of teeth in centric and eccentric positions.
• Centric occlusion:
 The occlusion of opposing teeth when the mandible is in
centric relation.
 This may or may not coincide with the maximal intercuspal
position.(GPT 8)
 Centric occlusion the tooth-to-tooth relation whereas centric
relation is a static position and a bone-to-bone relation.

• Eccentric occlusion
 Eccentric occlusion refers to contact of teeth that occurs during
movement of the mandible.
It is of two types:-
1. Functional occlusion
2. Non fucntional occlusion

1.Functional occlusion
 Functional occlusion (also called working side occlusion) refers
to tooth contacts that occur in the segment of the arch towards
which the mandible moves.
 Two types :
a. Lateral functional occlusion
b. Protrusive functional occlusion

a) LATERAL FUNCTIONAL OCCLUSION:
It includes tooth contacts that occur on canines and posterior
teeth on the side towards which the mandible moves.
 Two types :
1. Canine guided occlusion
2. Grouped lateral occlusion

i) Canine guided occlusion:
 During lateral mandibular movement, the opposing upper &
lower canines of the working side contact thereby causing
disclusion of all posterior teeth on the working & balancing
sides.
 Canine guided occlusion is usually seen in young individuals
with unworn dentition.

ii) Grouped lateral occlusion :
 In addition to canine guidance, certain other posterior teeth on
the working side also contact during lateral movement of the
mandible. Such a type of contact during lateral movement is
called grouped lateral occlusion.

B) PROTRUSIVE FUNCTIONAL OCCLUSION:
 It includes eccentric contacts that occur when the mandible
moves forward.
 Ideally the six mandibular anterior teeth contact along the
lingual inclines of the maxillary anterior teeth while the
posteriors disocclude.
CHRISTENSENS PHENOMENA
A gap occurring in the natural dentition or between the
opposing posterior flat occlusal rims when the mandible is
protruded (posterior open bite). It can lead to instability in full
dentures unless compensating curves are incorporated into the
dentures.

Requirement of Complete Denture Occlusion (Winkler)
 Stability of occlusion in centric relation and in areas forward
and lateral to it.
 Balanced occlusal contacts bilaterally for all eccentric
mandibular movements.
 Unlocking the cusp mesiodistally to allow for gradual but
inevitable settling of the bases due to tissue deformation and
bone resorption.
Control of horizontal forces by buccoligual cusp height
reduction according to the residual ridge resistance.

Functional lever balance by favorable tooth to-ridge crest
position

 Cutting, penetrating and shearing efficiency of the occlusal
surface (sharp cusps or ridges)
 Anterior clearance of teeth during mastication.
Minimum occlusal contact between the upper and lower teeth
to reduce pressure during function.(lingual occlusion).
Sharp ridges or cusps and generous sluiceways to shear and
shred food with minimum of force.

• Requirements of Incising units
• These units:
 Should be sharp in order to cut efficiently
 Should not contact during mastication
 Should contact only during protrusive incising function
 Should have as flat incisal guidance as possible considering
esthetics and phonetics
 Should have horizontal overlap to allow for base settling
without interference

• Requirements of Working occlusal units
 Should be efficient in cutting and grinding.
 Should have less bucco-lingual width – to minimize the
workload.
 Should function as a group with simultaneous harmonious
contacts at end of the chewing cycle and eccentric excursions.
 Should be over the ridge crest in the masticating area for lever
balance.
 Should have surface to receive and transmit force of occlusion
essentially vertically.
 Should center the work load near the anteroposterior center of
the denture.
 Present plane of occlusion as parallel as possible to mean
foundation plane.

• Requirements of Balancing occlusal units
 Should contact on the second molars when the incising units
contact in function
Should contact at end of the chewing cycle when the working
units contact
Should have smooth gliding contacts for lateral and protrusive
excursions

• AXIOMS FOR ARTIFICIAL OCCLUSION –SEARS (1952)
 The smaller the area of occlusal surface acting on food, smaller
will be the crushing force on food transmitted to the supporting
structures.
 Vertical force applied to an inclined occlusal surface causes
non-vertical forces on the denture base.
 Vertical force applied to an inclined supporting tissue causes
non-vertical force on the denture base.
 Vertical forces applied to a denture base supported by yielding
tissue causes the base to teeter when the force is not centered
on the base.
 Vertical force applied outside (lateral) to the ridge crest creates
tipping forces on the base.

Theories of complete denture occlusion
• BONEWILL Theory
• Bonewill theory (1858)
• Equilateral triangle
• Teeth move in relation to each other as guided by the condylar
controls and incisal point

CONICAL THEORY
• CONICAL THEORY(1915)
• The lower teeth move over the surfaces of the upper teeth as
over the surfaces of a cone and with a central axis of cone
tipped at 45 degree angle to the occlusal plane.

Spherical theory
• Proposed by G S MONSON in 1918.
• Lower teeth move over the surface of upper teeth as over the
surface of sphere with a diameter of 8 inches.
• Centre of sphere – glabella
• Sphere passed through glenoid fossa along through articulating
eminences.

•Various concepts of occlusion
 In pertinence to occlusion the concept of occlusion for
complete denture falls in to two broad disciplines
1) Balanced occlusion. (Heartwell 5th ed)
2) Non-balanced occlusion.
 Concepts of occlusion acc. to Boucher (13th ed)
• Balanced
• Monoplane
• Lingualized

Balanced Occlusion
 Reported by Brewer.
 “Stable simultaneous contact of the opposing upper and lower
teeth in centric relation position and a continuous smooth
bilateral gliding from this position to any eccentric position
within normal range of mandibular function.”- Winkler

• OBJECTIVES OF BALANCED OCCLUSION
 To improve the stability of denture.
 To reduce resorption of the residual ridge and soreness.
 To improve oral comfort & well being of the patient.

• CHARACTERISTIC REQUIREMENTS OF BALANCED OCCLUSION
• All the teeth of working side should glide evenly against
opposing teeth
• No single tooth should produce any interference or
disocclusion of other teeth
• There should be contacts in balancing side but they shouldn’t
interfere with smooth gliding movements of working side
• There should be simultaneous contact during protrusion

• GENERAL CONSIDERATIONS FOR BALANCED OCCLUSION:
 The wider and larger the ridge & the teeth closer to the ridge,
the greater the lever balance.
Wider the ridge & narrower the teeth buccolingually, greater
the balance.
 The more lingual the teeth are placed in relation to the ridge
crest, the greater the balance.
 The more centered the force of occlusion anterioposteriorly,
the greater the stability of the base.

TYPES OF BALANCED OCCLUSION:
Balance may be: Unilateral, bilateral, or protrusive.
• UNILATERAL LEVER BALANCE
 This is present when there is equilibrium of the base on its
supporting structures when bolus of food is interposed between
the teeth on one side and a space exits between the teeth on
the opposite side.
Following points encourages the lever balance
a) Placing the tooth so that the resultant direction of force on the
functional side is 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.

1.Unilateral ooclusal balance:
 It is present when occlusal surface of teeth on one side
articulate simultaneously, as a group, with smooth uninterupted
glide.
This is not followed during complete denture construction.
 It is more pertained to fixed partial dentures.
2.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.

Advantages:
• Better stability of denture base
• Reduced trauma, improved comfort
• The functional movements are possible
Disadvantages:
• Time consuming
• Cannot be used in all patients

ADVANTAGES OF BILATERALLY BALANCED OCCLUSION
Sheppard gave the concept of “ ENTER BOLUS EXIT
BALANCE” which implies that introduction of food on one
side will prevent the teeth of opposite side from contacting
and hence occlusal balance is impossible during mastication.

• However Sheppard (1964) later gave the concept of ENTER
BOLUS ENTER BALANCE according to which even while chewing,
the teeth cut through the bolus and come in contact with each
other, for few fractions of a second. Hence the stability of the
denture is maintained during various movements of mandible
during chewing.

• Brewer and hudson (1963) found in a 24 hour test that:
 Normal individual makes masticatory tooth contact only for 10
mins in one day compared to 4hrs of total tooth contact during
other functions.
 So, for these 4hrs of tooth contact, balanced occlusion is
important to maintain denture stability
 It improves the stability of denture, reduce resorption of the
residual ridge and soreness and improve oral comfort & well-
being of the patient.

• Pros (as stated in winkler)
 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.
 Also bilateral balanced occlusion is important during activities
such as swallowing saliva, closing to reseat the dentures and
bruxism of teeth during times of stress.
Patient with a balanced design do not upset the normal static,
stable and retentive position of their dentures.
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:
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.
 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.
A semi-adjustable or fully adjustable articulator is required.

3.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 is slightly different from bilateral balanced occlusion as it
requires a minimum of three contacts, one on each side
posteriorly and one anteriorly.

• Factors influencing balanced occlusion
(1) Inclination of the condylar path
(2) Incisal guidance
(3) Orientation of the plane of occlusion
(4) Cuspal angulation
(5) Compensating curve

1. CONDYLAR GUIDANCE
 Condylar guidance is due to path followed by condyle in
temporomandibular joint.
 Obtained by protrusive registration record.

HANAU states that inclination of condylar guidance is definite
anatomical conception.
 This path is precise & constant and it guides mandible so
precisely that it is primary dictator of occlusion.
 KURTH claims that condylar path is not same for varying incisal
guidances.
 WEINBERG showed that condylar path varies owing to variable
pressures of function.
Significance
 Increase in condylar guidance will increase jaw separation
during protrusion.
 In patients with steep condylar guidance, incisal guidance
should be decreased to reduce amount of jaw separation
produced during protrusion.

2. INCISAL GUIDANCE
It is the effect of contact of upper and lower anterior tooth on
the movement of mandible.
Expressed in degrees of angulation from the horizondal by a
line drawn from sagittal plane between the incisal edges of
upper and lower incisor teeth when closed in centric relation.
If incisal guidance is steep, it requires steep cusp, a steep
occlusal plane or a steep compensatory curve for a balanced
occlusion.

• Angle of incisal guidance is largely under influence of dentist
• This factor is influenced by amount of horizontal, vertical
overlap •
• Greater horizontal overlap = lesser angle of inclination
• Lesser the vertical overlap = lesser angle of inclination

 During protrusive movements mandibular teeth move
downward & forward as per incisal guidance.
 For complete dentures the incisal guidance should be
as flat as esthetics and phonetics will permit.
 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.

3.PLANE OF OCCLUSION OR OCCLUSAL PLANE
• Defined as “An imaginary surface which is related anatomically
to the cranium and which theoretically touches the incisal edges
of the incisors & the tips of the occluding surfaces of posterior
teeth.
• It represents the mean curvature of the surface.
• Established anteriorly by height of lower canine and posteriorly
by height of retromolar pad. (winkler).

It is related to ala-tragus line or camper’s line.
 The plane of occlusion can be altered to a maximum of 10°

HANAU states plane of orientation is purely geometrical factor
and pass through central incisal point & summits of
mesiobuccal cusps of molars.
According to Sharry, plane of orientation established intially can
be altered subsequently to serve purposes.
 Its existence is temporary as it is lost in establishing
compensating curves.

• If soft tissues surrounding dentures are to work around them as
they did around natural teeth, occlusal plane should be oriented
exactly as it was when natural teeth are present
• By positioning anterior teeth correctly for esthetic appearance
& locating posterior end of occlusal plane approximately level
with top of retromolar pad-factor of orientation of occlusal
plane is fixed.

4.Cuspal Inclination
It is an important factor that modify the effect of plane of
occlusion & the compensating curves.
The angulation of the cusp is more important than the height of
the cusps.
It is advocated that all mesiodistal cusp heights are eliminated
in anatomic type teeth, only the buccolingual inclines need to
be considered as determinants of balanced occlusion.
In shallow bite cases - cuspal angle should be reduced to
balance the incisal guidance.
 Deep bite cases with steep incisal guidance , the jaw separation
is more during protrusion .Teeth with high cuspal inclines are
required.

5.COMPENSATING CURVE
• “The anterioposterior and lateral curvatures in the alignment of
the occluding surfaces and incisal edges of artificial teeth which
are used to develop balanced occlusion”(GPT -8)
• Determined by inclination of posterior teeth and their vertical
relationship to occlusal plane.
• The primary function thus of compensating curve is to provide
balancing contacts for protrusive mandibular movements.
• Steep condylar path requires steep compensating curve to
produce balanced occlusion. In case lesser compensating curve
given for same condylar path ,anterior interference can occur.

 With compensating curve it is possible to produce eccentric
balance in monoplane occlusal scheme, which is otherwise said
to be deficient in this.
 The compensating curve incorporated in a properly oriented
plane of occlusion starts with the first replacemental tooth by
raising it at distal and continuing this initiated curve with
further rise in the 2nd molar with distal surface located at or
above the top of retromolar pad.
 Anteroposteriorly it should not exceed 20 degree and

TYPES OF COMPENSATING CURVES in natural dentition
Curve of spee
 Monson’s curve
Wilson’s curve

Curve of spee
• Von Spees or Spee’s curve.
• Defined as the curvature of the mandibular occlusal plane
beginning at the canine and following the buccal cusps of the
posterior teeth, continuing to the terminal molar.

• Curve of wilson
 GEORGE.H.WILSON
 eponym for mediolateral curve
 contacts buccal and lingual cusp tips of molars on each side of
arch.

• In mandibular arch results from inward inclination of lower
posterior teeth-making lingual cusps lower than buccal cusps –
curve being concave.
In maxillary arch-results from outward inclination of posterior
teeth-making buccal cusp higher than lingual cusps-curve being
convex.
Teeth set on this curve will have lateral balance of occlusion.

CURVE OF MONSON:
 GEORGE S. MONSON
 eponym for proposed ideal curve of occlusion in
which each cusp and incisal edge touches or
conforms to segment of surface of sphere 8 inches
in diameter with its center in region of glabella.

Compensatory curves in complete denture
• Defined as “The antero-posterior and lateral curvatures in the
alignment of the occluding surfaces and incisal edges of
artificial teeth which are used to develop balanced occlusion” –
GPT
• Used to develop balanced occlusion.
• Determined by inclination of posterior teeth and their vertical
relationship to occlusal plane and there are two curve:
1- Anteroposterior compensating curve
2- Mediolateral compensating curve

• Anteroposterior Compensating Curves: These are compensatory
curves running in an anteroposterior direction. They
compensate for the curve of Spee seen in natural dentition

• Lateral Compensating Curves These curves run transversely from
one side of the arch to the other.

• Interaction of the five factor
• Condylar guidance cannot be changed,as it’s anatomic factor.
• The incisal guidance and the plane of occlusion can be altered
only a slight amount because of esthetic and physiologic
factors.
• The important working factors for the dentist to manipulate
are the compensating curve and the inclinations of cusp on the
occlusal surfaces of the teeth.

CONTACTS IN BALANCED OCCLUSION
Working side:
The mandibular buccal cusp ridges makes articular contact with
the maxillary buccal cusp ridges as the mandibular lingual cusp
ridges are making contacts with the maxillary lingual cusp ridges.
 Balancing side:
The mandibular buccal cusps & their occlusal facing ridge,
contacts maxillary lingual cusps & ridge.
 Protrusion:
Incisal edges of the mandibular anterior teeth contact with the
lingual surface of the maxillary anterior teeth. The mesiobuccal &
lingual cusp ridges of the mandibular teeth contact the
distobuccal & lingual cusp ridges of the maxillary teeth.

Concepts proposed to attain balanced occlusion
GYSI’S CONCEPT
 FRENCH’S CONCEPT
SEARS’S CONCEPT
PLEASURE’S CONCEPT
 FRUSH’S CONCEPT
HANAU’S QUINT
 TRAPAZZANO’S CONCEPT
 LOTT’S CONCEPT
 BOUCHER’S CONCEPT
 LEVIN’S CONCEPT

GYSI’S CONCEPT
He proposed the 1 st concept towards balanced occlusion in
1914.
He suggested arranging 33 degree anatomic teeth could be
used under various movements of the articulator to enhance the
stability of the denture.

FRENCH’S CONCEPT (1954)
• Proposed that lowering lower occlusal plane to increase the
stability of the denture along with balanced occlusion.
• He arranged upper first premolars with 5 degree ,upper second
premolar with 10 degree and upper molars with 15 degree
inclinations.
• He used modified French teeth to obtain balanced occlusion.

SEARS’S CONCEPT(1920)
• He proposed the balanced occlusion for non-anatomic teeth
using posterior balancing ramps or an occlusal plane which
curves anteroposteriorly & laterally.

Pleasure’s concept
In 1937, Dr. Max Pleasure presented an occlusal scheme called
the “pleasure curve”
Buccal tilt is given at the premolars , no tilt or flat occlusal
surface at first molars and a lingual tilt to second molars
The curve is created to direct forces of occlusion lingually to
favor stability of lower denture
Lingual tilt of the second molar provides a buccal rise for a
lateral balancing contact.

FRUSH’S CONCEPT(1966)
He advised arranging teeth in a one – dimensional contact
relationship, which should be reshaped during try – in to obtain
balanced occlusion.
 Intent of this occlusion was to remove occlusal deflective
contacts and provides greater stabilization of dentures.
Buccal blades of the lower posterior teeth should form a perfect
straight blade. This blade should be perfectly straight to support
one-dimensional contact against the opposing occlusion.

“ Hanau’s Laws of articulation ” RUDOLPH L. HANAU
Nine factors governing the articulation are-
 Horizontal condylar guidance
Compensating curve
 Protrusive incisal guidance
 Plane of orientation
 Buccolingual inclination of the tooth axis
 Sagittal condylar pathway
 Sagittal incisal guidance
 Tooth alignment
 Relative cusp height

• Later Hanau combined the original nine factors and reduced
them to five.
• The five factors are (HANAU QUINT)
 Condylar guidance
 Compensating curve
 Relative cusp height
 Incisal guidance
 Plane of orientation

Trapozzano concept
He simplified Hanau’s quint.
3 factors necessary for determining plane of occlusion
1. Condylar guidance
2. Incisal guidance
3. Cuspal angle
He stated occlusal plane could be shifted at various heights to
favor weaker ridge.
He also stated that by arranging cusped teeth-these curves are
produced automatically.

Boucher’s concept
3 fixed factors :
The orientation of the occlusal plane, the incisal guidance, and
the condylar guidance.
The angulation of the cusp is more important than the height of
the cusp.
The compensating curve enables one to increase the effective
height of the cusps without changing the form of the teeth.

• He recommended that the occlusal plane should be orientated
exactly as where natural teeth were present.
• “The value of the compensating curve is that it permits
alteration of cusp height without changing the form of the
manufactured teeth… If the teeth themselves do not have any
cusps, the equivalence of a cusp can be produced by a
compensating curve”.

The Lott concept
He clarified the laws of occlusion by relating them to the
posterior separation that is the resultant of the guiding factor.

Levin’s concept:
Levin’s concepts are similar to that of Lott’s, but he eliminates
the plane of occlusion.
 Levin has put forth the four factors in the form of a Quad.
The essentials of a Quad are:-
 The condylar guidance is fixed & is recorded from the patient.
 The incisal guidance is usually obtained from patient’s esthetic
& phonetic requirements.
However it can be modified for special requirements. E.g., the
incisal guidance is decreased for flat ridges.

• The compensating curve is the most important factor in
obtaining occlusal balance. Monoplane or low cusp teeth must
employ the use of compensating curve.
• Cusp teeth have the inclines necessary for balanced occlusion
but nearly always are used with a compensating curve.

STEPS INVOLVED IN BALANCING:
• To develop a balanced occlusion one needs an adjustable
articulator which should
-Receive a face-bow transfer.
-Adjust to individual condylar guidance.
-Have an adjustable incisal guide table.
• 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 adjust the articulator, it requires:
• A centric 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

Position of lower teeth should be guided by following factors:
ANTERIORLY
The position and height of first bicuspid is determined by
the setting of anterior teeth to the proper phonetic and incisial
guidance position.
POSTERIORLY
The last tooth should be over foundation tissue that is
firm and not be set on a steep lower molar slope and never
extend distally to the apex of the retromolar pad

BUCCALY
The tooth should be out of occlusal contact for centric and
mandibular working positions.
LINGUALLY
The tooth should not crowd the tongue or project lingually
inside the mylohyoid ridge

OCCLUSAL PLANE
• Anteriorly by the esthetic and function of anterior teeth.
• Posteriorly by a height projected from the occlusal surface to
the middle third of retromolar pad.
COMPENSATING CURVE
• Is set to provide harmony between incisal guidance and
inclination of condylar path.
HORIZONTAL PLANE
• The cusp teeth are set with the lower buccal and lingual cusps
on the same horizontal plane.

SETTING THE UPPER POSTERIOR TEETH
The upper posterior teeth are set so that in centric occlusion
only the lingual cusp occludes with the central fossa of lower
teeth.
 Check and refined for dynamic cusp contacts in working,
balancing and protrusive movements

Balancing the occlusion in Class Ⅱ and Class Ⅲ relation
CLASS Ⅱ OCCLUSION
 In Orthognathic the lower denture foundation is small and
weak especially in anterior and bicuspid area.
 In class ii there is large buccal horizontal overlap in the first
bicuspid area so the lingual tip of the upper and buccal tip of
the lower first bicuspid is flattened to a horizontal table to
provide a stable centric contact.
 Usually non-anatomic teeth with pleasure curve is given.
A reverse occlusal curve is set in bicuspid region to favour the
stability of lower denture.
 Molar is set to flat scheme of occlusion and Second molar is set
to spherical scheme.

CLASS Ⅲ OCCLUSION
 In Prognathic relationships the lower arch is located too far
bucally . To control the tipping force on upper denture base
the teeth are set in Cross bite relationship.
 Non-anatomic teeth is indicated because with this type of teeth
the buccolingual and mesio –distal relation is not as critical.

SELECTIVE GRINDING
Selective grinding is defined as the, “intentional alteration of the
occlusal surfaces of the teeth to change their form’’ – GPT 9
Rational :
1) Eliminate occlusal interferences and to achieve occlusal
harmony.
2) Contacts in harmony with TMJ and neuromuscular system
Failure to achieve it
-soreness
-loss of supporting bone
-TMJ problems

-“BULL’S LAW-
Reduce the inner inclines of the Buccal cusps of the maxillay
teeth Lingual cusps of the mandibular teeth.

Final result should be smooth gliding lateral excursion with fine
working and fine balancing contacts.

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 lower central
fossa

SELECTIVE GRINDING FOR WORKING AND BALANCING
CONTACTS:
There should be working and balancing contacts that are in harmony with
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).
WORKING
SIDE
BALANCING
SIDE

 Grind the marked premature balancing contacts, heavily
marked working side contacts on the lower teeth
 Do not grind the upper lingual cusps
 Do not grind the lower buccal cusps
 No upper buccal cusp contact in any excursion
 The lingual of the upper anterior incisal edges and the labial of
the lower anteriors are ground to eliminate any interference

Selective grinding for the protrusive contacts
Maxillary lingual cusp gliding over the distal lingual cusp of the
mandibular teeth.
The upper second molars riding up the distal inclines of the lower second
molars created by the compensating curves.

 All the premature contacts are gently ground off.
 Anterior teeth prematurities- anterior mandibular teeth are being
modified keeping aesthetics in mind

•HOW TO FIX ERRORS IN OCCLUSION?

Contact in the posterior region
with the cast in a protrusive relation
Prominence of
antero posterior
curve
Cusp height
Plane of orientation
in posterior region
Absence of
contact
Premature
contact

• Increase the lateral cusp height
on the balancing side
• Increase the prominence of the
lateral compensating curve on
that side
• Raise the plane of orientation
Absence of
contact on the
balancing side
with the cast in a
lateral relation
• Decrease the lateral cusp height on
the balancing side
• Decrease the prominence of the
lateral compensating curve on that
side
• If extreme, lower the plane of
orientation in the posterior region
on that side
Premature
contact on the
balancing side
with the cast in a
lateral relation

Premature contact of the anterior teeth with the casts in the
protrusive relation
• Rearrange the lower anterior teeth closer to the lower ridge.
• Use shorter lower anterior teeth
• Shorten them by grinding

LINGUALIZED OCCLUSION
 It was first proposed by Gysi (1927)
 Acc. to GPT-9, lingualized occlusion is defined as the form of
denture occlusion in which the maxillary palatal cusps
articulate with the mandibular occlusal surfaces in centric,
working and balancing mandibular positions.

• GYSI in 1927 introduced this type of concept.
• POUND used it for non balanced articulation.
• PAYNE in 1941 used it for balance articulation.

INDICATIONS
 When the patient places high priority on esthetics but non-
anatomic occlusal scheme is indicated because oral
conditions such as severe alveolar resorption, a Class II jaw
relationship, or displaceable supporting tissue.
 Patients having parafunctional habits, so that reduced
amount of horizontal forces are transmitted to supporting
tissues.

Principles of lingualized occlusions (Becker)-
 Anatomic posterior (30-33 degree) teeth are used for maxillary
denture. Tooth forms with prominent palatal cusps are useful.
 Non anatomic or semi anatomic teeth are used for mandibular
denture . Either a shallow or a flat cusp form is used. Narrow
occlusal form is preferred where resorption of residual ridge has
occurred.
Lingualized Occlusion: An Emerging Treatment Paradigm - Journal of
Medical and Dental Science Research (2015)

 Modification of mandibular posterior teeth is accomplished
by selective grinding which is always necessary regardless of
the material used.
 Maxillary palatal cusp contact mandibular teeth in centric
occlusion
 Balancing and working contacts should occur only on the
maxillary palatal cusps.
Protrusive contacts only between upper palatal cusps and
lower teeth.

Advantages-
1. Improved denture stability and enhanced patient comfort.
2. Reduced lateral forces because only the palatal cusp of the
maxillary teeth provides the sole contact with the mandibular
posterior teeth.

3. Vertical forces are centered upon the mandibular residual
ridges
4. Simplified tooth arrangements , simplified occlusal
adjustments, good esthetics.
5. Provides mortar and pestle type of occlusion with cusp teeth to
provide a smaller occlusal contact for more efficiency and control
of resultant forces.

MONOPLANE OCCLUSION
Non anatomic tooth form may be occlusion of choice for given
situation.
Like poor neuro-muscular control, highly resorbed residual
ridge.
ADVANTAGES
 Preservation of structure of basal seat.
 Efficient occlusal form.
 Simplicity of technique involved

MAIN FEATURES
• Anterior teeth primarily set for length and proper lip support.
• Elimination of cuspal inclines and teeth must be set in flat
monoplane arrangement,
• Zero incisal guidance should be established

BALANCING IN MONOPLANE OCCLUSAL SCHEME
In this occlusal scheme problem arises because flat teeth occlude in two
dimension but the mandible moves in three dimension because of this
there will be cuspal rise and loss of contact.
This problem can be resolved by
1. Flat incisal guidence
2. Inclined occlusal plane and compensating curve
3. Balancing ramp
4. Reverse curve and pleasure curve

ADVANTAGES
The patient has sense of freedom because they do not lock
the mandible in one position only.
They are more adaptable to unusual jaw relations such as
Class II and Class III malocclusions
Minimal horizontal pressures are created because of
elimination of inclined planes.
Simplified and less time consuming technique and offer
greater comfort

• Disadvantages
1. Poor esthetics
2. Decreased masticatory efficiency
3. More difficult to obtain balanced occlusion

Occlusal
schemes in
use today
Balanced
occlusion
Anatomic
Semi -
anatomic
Non -
anatomic
Lingualize
d
Non-
balanced
Spherical
occlusion
Organic
occlusion
Transiogra
phics
lingualise
d
Gregory R
,Parr (1985)
The occlusal spectrumand complete
dentures

The occlusal spectrum-collection of occlusal schemes (toothformand arrangement) arrangedto
match patients need and requirement.
Anatomic
(Balanced)
Occlusion
Semi-
anatomic
(balanced)
Lingualized
Occlusion
Non-anatomic
(balanced)
Neutrocentric
Occlusion
Concluded- Lingualized occlusion is an outstanding occlusal scheme with
maximum advantages.

CONCLUSION
• Many investigations on a scientific level have not proved
conclusively that any one scheme of occlusion is
♦ superior in function,
♦ safer to the supporting oral structures, or
♦ more acceptable to patients.
• Thus the prosthodontist should provide an occlusion, which is
compatible with the stomatognathic system and provides
efficient mastication and esthetics, without any physiologic
abnormality.

Influence of the Occlusal Concept of Complete Dentures on Patient Satisfaction in
the Initial Phase After Fitting: Bilateral Balanced Occlusion vs Canine Guidance.
Rehmann P, Int J Prosthodont. 2008 Jan-Feb;21(1):60-1
• OBJECTIVE
To evaluate the impact of the occlusal concept on patient satisfaction
in the initial phase after fitting new CDs.
Materials and methods
• One maxillary and 2 nearly identical mandibular CDs were fabricated
for 38 edentulous patients.
• The inclusion criteria were patients wearing CDs for at least 6 months
with insufficient occlusion.
• The exclusion criteria were CD cases with adequate bbO or cG.

• After 2 weeks, the patients' satisfaction was evaluated and the OC
was changed.
• Two weeks later, the patients' satisfaction was reevaluated.After 2nd
and 4 th week, 63% and 47% of the patients preferred bilateral
balanced occlusion and 5% and 11% preferred canine guidance,
respectively.
• conclusion
Thus, a bilateral balanced occlusion primarily facilitates the adaptation
of a new CD

Comparison of patient satisfaction in complete denture patients with different
occlusal schemes
International Journal of Applied Dental Sciences 2017; 3(4): 51-52
• AIM
The aim of this study was to evaluate effect of Bilateral Balanced
Occlusion (BBO) & Canine guided occlusion (CGO) on patient
satisfaction in complete denture patients.
Materials and Methodology
• Twenty completely edentulous patient’s (12 males and 8
females) with an average age of 65 years were included in the
study.
• Exclusion criteria being dysfunctional disorders of masticatory
system.

• 10 patient’s received dentures with bilateral balanced occlusion
scheme and other 10 with canine guided occlusal scheme.
• patient satisfaction was evaluated with a standard 5 point Likert
scale questionnaire, which included subjective parameters such
as initial adaptability, post insertion problems, aesthetics,
masticatory ability, speech, retention.
• RESULT
OCCLUSION MEAN
BBO 19.33
CGO 18.33

• Conclusion
• Bilateral balanced occlusion is not the only occlusal concept
recommended for the success of complete dentures. Even,
canine guided occlusion can be used with success.
• However, results suggest that initial patient’s adaptation is
better with balanced dentures when compared to canine guided
dentures

Masticatory Efficiency in Denture Wearers with Bilateral Balanced Occlusion and
Canine Guidance
• Braz Dent J (2010) 21(2): 165-169
AIM
The aim of this study was to evaluate the masticatory efficiency
in complete dentures wearers with bilateral balanced occlusion
and canine guidance.
MATERIALSAND METHODS
• Sample composed of 24 patients with mean age of 59.7 years.
• All patients had previously worn CD.
• After giving informed consent, patients were randomized to one
of the 2 treatment groups (BBO-CG or CG-BBO) with different
treatment sequences.

• Three months after insertion of the new dentures, the occlusal
concept was changed.
• Thus, patients were subjected to both occlusal concepts for the
same period of 3 months.
• Data were collected by the masticatory efficiency test and
questionnaires at 3 and 6 months after denture insertion.
Result

Patient response to variations in denture techniques. Part VI: Mastication
of peanuts and carrots.
Westly RC, J Prosthet Dent,1984, 51:467-469
• Materials and method
• Sixty-four patients who had been edentulous for at least 1 year
were selected for this study and divided into two equal groups
to test two different denture techniques.
• The techniques were designated “complex” and “standard.”

• The complex technique involved location of the hinge axis to
mount the maxillary cast on a semiadjustable articulator.
• In the standard technique a face-bow transfer was not used. The
maxillary cast was mounted arbitrarily, and the mandibular cast
was mounted in centric relation.
• RESULT
• No significant statistical differences in masticatory ability existed
between the two groups.

LIST OF REFERENCES
• ESSENTIALS OF COMPLETE DENTURE PROSTHODOTICS ,
SECOND EDITION, by Sheldon Winkler
• BOUCHER’S PROSTHODONTIC TREATMENT FOR EDENTULOUS
PATIENTS, ELEVENTH EDITION, by Hickey , Zarb and Bolender.
• SYLLABUS OF COMPLETE DENTURES, by Charles M. Heartwell
and Arthur O. Rahn
• Beck H.O.: Occlusion as related to complete removable
prosthodontics. JPD,1972;27:246-256.
• Trappozano V.R.: An experimental study of the testing of
occlusal patterns on the same denture bases. JPD.;1952; 440-
457.

Balanced occlusion

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