1. OCCLUSION IN
COMPLETE DENTURES
23/04/2018 1
Presented by
Dr.Bini.K.Ravi
Junior resident
Dept. Of Prosthodontics and Crown & Bridge
Govt. Dental College, Thiruvananthapuram
2. INDEX
• Introduction
• History
• Terminology
• Development of dental occlusion
• Mandibular movements
• Difference between natural and artificial occlusion
• Requirements of complete denture occlusion
• Concepts of complete denture occlusion
• Balanced occlusion
• Lingualized occlusion
• Monoplane occlusion
• Linear occlusion
• Lineal occlusion
• Organic occlusion
• Physiologically generated occlusion
• Neutrocentric occlusion
• Conclusion
• Review of literature
• References.
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3. • OCCLUDE = to close
• Term “occlusion” – Latin word “occlusio”
• Occlusion is an important factor which governs the retention
and stability of the complete denture
INTRODUCTION
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• “The static relationship between the incising or
masticating surfaces of the maxillary or mandibular
teeth or tooth analogues“ GPT 9
4. • The first description of the occlusal relationships of the
teeth was made by Edward angle in 1809
INTRODUCTION
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5. • The first description of the occlusal relationships of the
teeth was made by Edward angle in 1809
INTRODUCTION
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6. • Centric occlusion – The occlusion of opposing teeth when
the mandible is in centric relation. This may or maynot
coincide with the maximal intercuspal position (GPT 9)
• Eccentric occlusion – An occlusion other than centric
occlusion (GPT 9)
• Maximum intercuspation – Complete intercuspation of
opposing teeth independent of condylar positions
TERMINOLOGY
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7. • Excursive movement – Movement occuring when mandible
moves away from maximum intercuspation ( GPT 8 )
• Balancing side or non working side – The side of mandible
which moves towards median line during lateral excursions
• Balanced occlusion: - bilateral, simultaneous, anterior and
posterior occlusal contact of teeth in centric and eccentric
positions
TERMINOLOGY
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8. • Ideal occlusion
– perfect interdigitation of upper and lower teeth
-- Is a result of developmental process consisting of jaw
growth, tooth formation and erruption
• Occlusal development – 4 developmental periods
- Neo-natal upto 6 months after birth
- Primary dentition 6 months to 6 years
- Mixed dentition period 6 years to 12 years
- Permanent dentition 12 years onwards
DEVELOPMENT OF DENTAL OCCLUSION
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9. • Only the mandibular arch moves !!!
• Working [laterotrusive] side – The side that the mandible moves
towards
• Non working [mediotrusive, balancing] –The side opposite to
which mandible moves
• Protrusion – Moving the mandible forward in an anterior-
posterior plane
• Retrusion – Moving the mandible backwards in an anterior-
posterior plane
MANDIBULAR MOVEMENTS
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11. Pure hinge movement as a result of
the condyles rotating in the lower
compartment of TMJ within a 10-
13degree arc which creates a 20-25
mm separation of the anterior teeth.
MANDIBULAR MOVEMENTS
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Maximum opening is reached when
the capsular ligaments prevent
further movement at the condyles.
Maximum opening is in the range of
40 to 60 mm as measured between
the incisal edges of the maxillary and
mandibular teeth. Translational
movement occurs in the upper
compartment
Up and down motion of mandible
- combination of two movements
12. • Protrusive movement
Mandible slides forward so that maxillary and mandibular
teeth are in end-to-end relation.
MANDIBULAR MOVEMENTS
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Ideally the anterior segment
of mandible travel a path
guided by the contacts
between the anterior teeth,
with complete disocclusion
of posterior teeth
13. • LATERAL EXCURSION
The condyle on nonworking side will arc forward and
medially. The condyle on the working side will shift
laterally and slightly posteriorly.
MANDIBULAR MOVEMENTS
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14. • BENNET MOVEMENT
During lateral excursion. The bodily shift of mandible in
the direction of working side was first described by
BENNETT.
The angle formed in the horizontal plane between the
pathway of the nonworking condyle and the sagital plane
is called the BENNET ANGLE
MANDIBULAR MOVEMENTS
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20. Arise from fundamental differences in :
• Sensory feedback mechanism
• Derivation of
– Retention
– Stability
– Support
• Reaction of supporting structures to masticatory
forces
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DIFFERENCES BETWEEN NATURAL AND COMPLETE DENTURE
OCCLUSION
23. DIFFERENCES BETWEEN NATURAL AND COMPLETE DENTURE
OCCLUSION
NATURAL DENTITION
Retained by PDL
Units move
independently
Malocclusion
effects are not
immediate
“DENTURE” DENTITION
Mobile bases on
mucosa
Teeth move as a unit
Malocclusion affects
the entire base
immediately
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24. NATURAL DENTITION
Non-vertical forces
affect only the teeth
involved. Usually well
tolerated
Incising doesn’t affect
posteriors
Bilateral balance is
rare
“DENTURE” DENTITION
Non-vertical forces
affect all the teeth and
is traumatic
Incising affects all teeth
attached to the base
Bilateral balance is
desired for base stability
DIFFERENCES BETWEEN NATURAL AND COMPLETE DENTURE
OCCLUSION
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25. IDEAL REQUIREMENTS OF COMPLETE DENTURE OCCLUSION
[ WINKLER ]
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• Stability of the denture when mandible is in both centric and
eccentric relations
• Balanced occlusal contacts bilaterally for eccentric contacts
26. IDEAL REQUIREMENTS OF COMPLETE DENTURE OCCLUSION
[ WINKLER ]
• Should have a surface that direct the forces of occlusion
vertically.
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• Minimal areas of contact for reduced force on ridges during
mastication
• Functional lever balance should be obtained by vertical tooth to
ridge crest relationship
27. IDEAL REQUIREMENTS OF COMPLETE DENTURE OCCLUSION
[ WINKLER ]
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• Cutting and shearing efficiency of occlusal surface
• Incisal clearance during posterior functions
28. • Mastication of food with natural teeth is usually found to
be 5 - 175lb.
• According to various studies masticatory force in
Complete denture - molar and bicuspid region-22-24lb
Incisor region-9 lb
• Forces on teeth (CD) during swallowing are 41% of
normal teeth. Swallowing occurs 1000 times/day.
FORCES OF MASTICATION
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29. • 2 categories-
• Balanced occlusion
• Nonbalanced occlusion.
• But as overall, various types of CD occlusion are
• Balanced occlusion
• Lingualized occlusion
• Monoplane occlusion
• Organic occlusion
• Lineal occlusion
• Linear occlusion
• Physiologically generated occlusion
• Neutrocentric occlusion.
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32. Gysi concept ( 1934 )
• Suggested arranging 33 degree anatomic teeth
• Inclination of 33° to the cuspal inclines harmonize them
with the condylar inclination of 33° to the horizontal. In
lateral mandibular movements, cusps contact bilaterally to
enhance the stability of the dentures.
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Concepts of complete denture occlusion
33. • In centric occlusion, the masticatory forces directed toward
the ridges [Figure a]
• In a right lateral position, the occlusal contact forces are
directed away from the ridges. In extreme working lateral
position, contacts on both cusps incline, contact force are
also directed outside the ridges [Figure b].
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Concepts of complete denture occlusion
34. • FRENCH CONCEPT
• He proposed lowering the mandibular occlusal plane to
increase the stability of dentures along with balanced
occlusion.
• Maxillary first premolars – 5 degree
• Maxillary second premolars – 10 degree
• Maxillary molars – 15 degree
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Concepts of complete denture occlusion
35. • SEAR’S CONCEPT
• Proposed balanced occlusion for non anatomical teeth using
posterior balancing ramps or an occlusal plane which curves
antroposteriorly and laterally.
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Concepts of complete denture occlusion
36. • Pleasure concept
Dr. Max Pleasure presented an occlusal scheme called the "pleasure curve,“
•In order to increase the stability of denture
•A reverse curve is used in the bicuspid area for
lever balance,
•A flat scheme of occlusion is set in the first molar
area, and
•A spherical scheme set in the second molar area by
raising the buccal incline to provide for a balancing
contact in lateral position.
•The distal of the second molar can also be
elevated to produce a compensating curve for
protrusive balance
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Concepts of complete denture occlusion
37. • Boucher concept
• There are three 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.
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Concepts of complete denture occlusion
38. • Hanau's Quint
• In 1925, Rudolph L. Hanau presented a discussion paper
entitled, “Articulation: Defined, analyzed, and formulated”
• He mathematically charted the nine factors
governing the articulation – Hanau’s Laws of
Articulation
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Concepts of complete denture occlusion
40. Later these were condensed to five factors called
Hanau’s quint
Thielemann subsequently simplified Hanau's factors in
a formula for balanced articulation.
[K × I]/[OP × C × OK].
Where, K = Condyle guidance.
I = Incisal guidance.
C = Cusp height inclinations.
OP = Inclination of the occlusal plane.
OK = Curvature of the occlusal surfaces.
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42. • Trapozzano concept
• Trapozzano reviewed Hanau's five factors
• Only three factors were actually concerned in obtaining
balanced occlusion.
• E liminated the plane of orientation since its location is highly
variable within the available inner ridge space. He also
suggested that the occlusal plane can be located at various
heights to favor a weaker ridge
• Trapozzano stated, no need for a compensating curve, as it is
obsolete since the cuspal angulation will produce a balanced
occlusion.
Concepts of complete denture occlusion
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43. Balanced Occlusion is defined as the bilateral,
simultaneous, anterior, and posterior occlusal
contact of teeth in centric and eccentric positions.
BALANCED OCCLUSION
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44. IMPORTANCE
• It enhances stability of denture
• If balance is not present, the bases could shift, tip or torque
on their foundations during the eccentric movements and
cause inflammation leading to accelerated bone resorption.
• Equal contact of all posterior teeth [centric occlusion]
in centric relation is essential for the health of mucosa
BALANCED OCCLUSION
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46. FACTORS INFLUENCING BALANCED OCCLUSION
• Inclination of condylar path
• Incisal guidance
• Orientation of the plane of occlusion
• Cuspal angulation
• Compensating curve
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47. INCISAL GUIDANCE
• This is defined as, “The influence of the contacting surface of the
mandibular and maxillary anterior teeth on mandibular
movements”.
• It is determined by the dentist and customized for the patient
during anterior try-in.
• The angle formed by this protrusive path to the horizontal plane is
called as the protrusive incisal path inclination or the incisal guide
angle.
• The incisal guidance has more influence on posterior teeth than
condylar guidance.
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50. CONDYLAR GUIDANCE
• IT IS THE POST END CONTROLLING FACTOR.
• More the condylar guidance more will be the cuspal height
• Condylar pathway depends on bone contour of T.M.J.,
muscles of mastication, ligaments of T.M.J. and
neuromuscular control of the patient.
• Average condylar guidance is about 25-30 degree.
• It is obtained by movement of protrusive registration
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52. Path of condylar inclination
• The interocclusal records are transferred to the articualtor
and then accomodated to glide freely into position
• Mechanics :
Increase in condylar
guidance will increase the
jaw separation during
protrusion. It is constant. So
in patients with steep
condylar guidance, incisal
guidance is decreased to
prevent posterior jaw
separation
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53. PLANE OF OCCLUSION
• It is purely geometrical factor.
• This plane is assumed to pass through
3 dental landmarks - central incisal
point and summit of mesio-buccal
cusp of last molar on either side.
• It is parallel to Ala- tragus line.
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55. CUSPAL INCLINATION
• The angle formed by the slope of mesio- buccal cusp
to horizontal plane is defined as cuspal inclination.
• According to that there are 3 types of posterior teeth.
• a) 00 posterior teeth.
• b) 200 posterior teeth.
• c) 330 posterior teeth.
• If the condylar guidance is steep, higher cuspal height
tooth are used to gain in balanced occlusion.
• Effective cuspal angle can either be increased or
decreased by mesial or distal tilt of tooth.
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57. • In shallow bite cases – cuspal angle should be reduced to
balance the incisal guiance
• In deep bite cases with steep inisal guidance, the jaw
separation is more during protrusion. Teeth with high
cuspal inclines are used in such cases.
• Occlusal reshaping is done after teeth arrangement to
produce balanced occlusion
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58. COMPENSATING CURVES
• It is determined by the inclination of the posterior teeth
and their vertical relationship to the occlusal plane.
• There are two types of compensating curves namely:
Anteroposterior curves
Lateral curves
• Curve of Spee, Wilson’s curve and Monson’s curve are
associated with natural dentition.
• In complete dentures compensating curves similar to
these curves should be incorporated to produce
balanced occlusion.
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60. Anteroposterior compensating curve
• Curve of Spee – Anatomic curvature of the occlusal
alignment of teeth beginning at the tip of lower canine and
following the buccal cusps to the anterior border of the
ramus
• Described by Graf Von Spee
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61. • COMPENSATING CURVE OF
MONSON
The curve of occlusion in which
each cusp and incisal edge
touches to a segment of the
sphere of 8” in diameter with its
center at glabella.
Runs across the palatal and
buccal cusps of maxillary
molars.
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62. • WILSON’S CURVE
• Concave upwards
• Follows the arrangement of
mandibular posteriors
• To avoid interference in lateral
movements
Lateral compensating curves
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63. • REVERSE CURVE
• Convex upwards in transeverse cross section
• Confined to mandibular premolar teeth
• Improve stability of denture
• Modified by Max Pleasure to form Pleasure curve
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64. • Pleasure concept
Dr. Max Pleasure presented an occlusal scheme called the "pleasure curve,“
•In order to increase the stability of denture
•A reverse curve is used in the bicuspid area for
lever balance,
•A flat scheme of occlusion is set in the first molar
area, and
•A spherical scheme set in the second molar area by
raising the buccal incline to provide for a balancing
contact in lateral position.
•The distal of the second molar can also be
elevated to produce a compensating curve for
protrusive balance
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Concepts of complete denture occlusion
66. • Unilateral balanced occlusion
Seen on occlusal surfaces of teeth on one side when they
occlude simultaneously with a smooth uninterrupted glide.
This is not followed during complete denture fabrication. It
is more pertained to fixed partial dentures.
Balanced occlusion
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67. • Bilateral balanced occlusion
Seen when simultaneous contact occurs on both sides in centric
and eccentric positions.
Helps to distribute occlusal load evenly across the arch and thus
improve stability of denture
For minimal occlusal balance, there should be atleast three
points of contact on the occlusal plane
Balanced occlusion
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68. • Protrusive balanced occlusion
This is present when mandible
moves in a forward direction and
the occlusal contacts are smooth
and simultaneous anteriorly and
posteriorly.
There should be atleast three
points of contact in the occlusal
plane – two points posteriorly and
one anteriorly.
Absent in natural dentition
Balanced occlusion
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69. • Lateral balanced occlusion
Minimum three point contact
during lateral movement of
mandible.
Absent in natural dentition
Balanced occlusion
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71. • A type of nonbalanced occlusion where posterior teeth have
masticatory surfaces that lack any cusp height.
MONOPLANE OCCLUSION
• 00 teeth
• Articulator-a simple articulator that can maintain VD, posses
incisal guide pin-do not need any complex movements.
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72. • Advantages: -
• More adaptable to class II and III malocclusions.
• Used more easily when variations in the width of upper and
lower jaws indicate a cross bite set-up.
• 00 teeth provide freedom in mandibular movement.
• 00 teeth –occlude in more than one position. Centric relation
is not that critical.
• It is simple, less time-consuming technique and efficient for
longer duration.
• They accommodate better, to inevitable negative changes in
ridge height that occurs with aging.
MONOPLANE OCCLUSION
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73. • Alfered Gysi (1927)
• Payne in 1941, Pound and Murrel (1973) - also advocated this
concept of occlusion.
• Anatomic teeth for the maxillary denture
Modified non-anatomic or semi-anatomic teeth for the
mandibular denture.
• Esthetic and food penetration advantages of the anatomic
form
Mechanical freedom of the non-anatomic form.
LINGUALIZED OCCLUSION
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74. • Principles of lingualized occlusion: -
– Maxillary teeth-
anatomic teeth (30-330) with
prominent lingual cusps.
– Mandibualr teeth-
non-anatomic with narrow occlusal
table.
– Maxillary lingual cusp should contact
mandibualr teeth in occlusion.
maxillary buccal cups are trimmed to
decrease interference.
– Balancing and working contacts
should occur only on upper lingual
cusp with in 2-3 mm excursive
movements.
LINGUALIZED OCCLUSION
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75. • Indications:-
– Severe ridge resorption,.
– Class II jaw relation
– Highly displaceable tissue
– When complete denture opposing a removable partial denture
LINGUALIZED OCCLUSION
•Advantages:-
1) Advantages of both anatomic and nonanatomic teeth
are made use of.
2) Cusp form- increases esthetics.
3) Good chewing ability.
4) Bilateral balance
Vertical forces are centralized on mandibualr teeth.
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LINGUALIZED OCCLUSION
76. • Proposed by Pound
• Maxillary posterior teeth - anatomic teeth with large, blunt
lingual cusp.
• Mandibualr posterior teeth – 00 teeth, large marginal ridge
areas, very shallow grooves and sluice ways.
• Mandibualr posterior teeth are arranged as monoplane with
all central fossa in same line (a flat block posterior teeth can
be used). Maxillary teeth are arranged perpendicular to
occlusal plane, buccal cusps raised (1mm) and lingual cusps
set on central fossa.
NONBALANCED LINGUALIZED OCCLUSION
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77. Indications: -
• Severely resorbed ridges/ flabby ridges.
• Poor oral dexterity
• Who are not able to adjust to intricate occlusal patterns.
• Patients who receive transitional / immediate dentures, and
insist on unlocked occlusal scheme that is easy top adjust at
the time of insertion.
• Patients who show poor accuracy of oral records (jaw
relation)
• If patients who do not accept monoplane occlusion for
esthetic reasons
NONBALANCED LINGUALIZED OCCLUSION
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79. REVIEW OF LITERATURE
• Gibbs CH, Mahan PE, Lundeen HC, Brehnan K, Walsh EK,
Holbrook WB. Occlusal forces during chewing and
swallowing as measured by sound transmission. J Prosthet
Dent. 1981;46:443–9. [PubMed]
• Gibbs et al. showed that the average closing force during
mastication of complete denture wearers is only 11.7
pounds. The force necessary to masticate food can vary
from 5 to 175 pounds with natural teeth. The comparison
between natural and artificial teeth shows that complete
denture wearers can exert only from 10% to 15% of the
force of a patient with good natural teeth.
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80. • Clough h e (1983): - compared efficiency of lingualized
occlusion and monoplane occlusion in complete dentures.
• Two sets of dentures, one with lingualized occlusion and
the other with monoplane occlusion, were made for each
of 30 edentulous patients. 67% of patients preferred
lingualized occlusion done to improved masticatory
abilities, comfort, and esthetics.
REVIEW OF LITERATURE
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81. CONCLUSION
“Dentures are mechanical devices and are subjected to the
principle of physics (mechanics), that is the inclined plane and the
lever. The forces will operate whether or not we recognize them,
rather than let them operate uncontrolled, it is the responsibility of
the dentist to control them in order to enhance function, stability
and comfort” -Sheldon Winkler.
A thorough understanding of force management in complete
denture through selecting and delivering a correct occlusion
scheme is important for the long term success of denture.
The patients with complete dentures should follow a regular control
schedule at yearly intervals so that an acceptable fit and stable
occlusion can be maintained..
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82. REFERENCES
• Boucher : Prosthodontic treatment for edentulous patients.
• Shldon Winkler : Essentials Of Complete Denture Prosthetics, 2nd edition
• Dawson P. E. : Evaluation, Diagnosis, and treatment of occlusal problems
• Gibbs CH, Mahan PE, Lundeen HC, Brehnan K, Walsh EK, Holbrook WB. Occlusal
forces during chewing and swallowing as measured by sound transmission. J
Prosthet Dent. 1981;46:443–9. [PubMed]
• J. C. TU¨ RP*, C. S. GREENE† & J. R. STRUB‡ Dental occlusion: a critical reflection on
past, present and future concepts
• Rodney D. Phoenix, DDS, MS,a and Robert L. Engelmeier, DMD, MSb Lingualized
occlusion revisited
• Alex Milosevic Occlusion: Terms, Mandibular Movement and the Factors of
OcclusionDOI: 10.12968/denu.2003.30.7.359 · Source: PubMed
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