1. 16. Occlusal Schemes - Lingualized
Occlusion
John Beumer III, DDS, MS
and
Michael Hamada DDS
Division of Advanced Prosthodontics,
Biomaterials and Hospital Dentistry
UCLA School of Dentistry
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2. 13c. Occlusal Schemes

3. Lingualized Occlusion
Balanced occlusion

4. Lingualized Occlusion
Zero
setting
Protrusive
insert
Protrusive inserts
Begin by positioning the appropriate protrusive insert, and
check to ensure that the incisal guide pin is set at zero and
in contact with the incisal guide table.

5. Setting Maxillary Anterior Denture Teeth

6. Clinical Determinants of Anterior Tooth
Placement
Clinically determined by
• Phonetics
• Esthetics
• Lip support

7. Lip Support
The amount
required is
determined by
The need for lip both the wax rim
support from the and the trial
teeth and denture denture.
flange varies
depending upon the
degree of ridge
resorption.

8. Functional Phonetic Determinants of
Anterior Tooth Position
 Clinically determined by
“F” and “V” position “S” position
 Utilizing
• Wax Occlusion Rims
• Wax Trial Denture Set-up

9. Functional Phonetic Determinants of
Anterior Tooth Position
 Note the relationship between the
“F” and “V” position

10. Functional Phonetic Determinants of
Anterior Tooth Position
 Note the maxillary to mandibular
“S” position
The mandible travels down and forward to create a small
space between the maxillary and mandibular incisors during
the production of sibilant sounds.

11. Esthetic Determinants of Anterior Tooth Placement
A typical esthetic display of the maxillary
anterior teeth. The central incisors are aligned
with the midline and the laterals and cuspids
are elevated off the occlusal plane.

12. Materials and Preparation
 Setting the Maxillary Anterior Denture Teeth

13. Cast Landmarks
Mark the casts indicating midline, crest of the ridge, and the midpoint of
the retromolar pad. These landmarks will be used to check your denture
setup.
Maxilla Mandible
Midline Ridge
Anterior land Retromolar pad
Incisive papilla

14. Cast Landmarks - Maxilla
Anterior land
Incisive
papilla
Midline

15. Cast Landmarks -Mandible
Midpoint of
retromolar pad
Mark on land
Land
indicating the
midpoint of the
Lines indicating the
retromolar pad
crest of the ridge

16. Setting the Anterior Teeth
When the wax rim is ideally contoured and mounted and the lower cast
mounted on the on the articulator with a centric relation record, the plane
The three landmarks used to determine the plane of occlusion are:
The midpoint of the retromolar pads bilaterally as previously marked on the
mandibular cast.
The incisal edge of the maxillary central incisors

17. Setting the Anterior Teeth
Mark indicating
midpoint of the
retromolar pad
To set the remaining maxillary
anterior teeth a clear glass or
plastic slab is positioned on
the mandibular record base to
represent the plane of
occlusion.

18. Setting the Maxillary Central Incisors
Soften some baseplate wax and attach the other
central incisor to the ridge lap portion of the maxillary
central incisors and attach it to the record base

19. Setting the Maxillary Central Incisors
The mesial of each tooth should be on the midline
(arrow) and the incisal edge should be parallel to and
in contact with the occlusal plane.

20. Setting the Maxillary Central Incisors
Viewed from the facial perspective, the maxillary
central incisor is placed so that the long axis shows a
slight distal inclination to the perpendicular.

21. Setting the Maxillary Central Incisors
Inner edge
of the land
When viewed from profile the cervical
aspect of the tooth should be slightly
depressed. Note that the incisal 2/3 of Occlusal
the central incisors are perpendicular to plane
the plane of occlusion
In this particular patient, appropriate lip support was achieved by placing
the labial surface of the central incisors on a curve coinciding with the
inner edge of the land of the cast (red line). This may vary, and in many
patients the incisors project more anteriorly, particularly in those with
severe resorption of the premaxilla.

22. Setting the Maxillary Lateral Incisors
The maxillary lateral incisor is should be positioned with a
slight distal inclination and is usually ½ to 1 mm above the
plane of occlusion.

23. Setting the Maxillary Lateral Incisors
When viewed in profile
note that the lateral
incisor is positioned with
a slight distal inclination Note again that the lateral
in relationship with the incisor is positioned slightly
central incisor. above the plane of occlusion.

24. Setting the Maxillary Lateral Incisors
When viewed from the occlusal, the incisors should follow
the same curvature as the internal aspect of the land.

25. Setting the Maxillary Cuspids
When viewed in profile the cuspid has a slight distal inclination
from the perpendicular and the incisal tip touches the occlusal
plane (arrow).

26. Setting the Maxillary Cuspids
“Toed-in” Position
Note how the cervical and incisal edges of the cuspid are
aligned vertically (yellow line). The facial surface of the
cuspid however, is canted inward and appears “toed in” (red
line) due to the prominence of the cervical area of the tooth
(yellow arrow).

27. Setting the Maxillary Cuspids
The cuspid has two planes on
the labial surface – a mesial
plane (yellow line) and a distal
plane (red line). When viewed
from the anterior only the mesial
plane should be visible.

28. Setting the Maxillary Cuspids
When viewed from the
occlusal the anterior teeth
follow the curvature of the
internal portion of the land.

29. Setting the Maxillary Cuspids
Note the inclination of the anterior teeth.

30. Setting Mandibular Anterior Teeth
Determinants of Mandibular Anterior Tooth
Position
• Phonetics
• Jaw relations
• Occlusal schemes with bilateral balance

31. Setting Mandibular Anterior Teeth
Patients with skeletal Class I relationships
• Vertical overlap (1-2 mm)**
• Horizontal overlap (1-2 mm)*
• No contact is centric occlusion
* When using occlusal schemes
with bilateral balance, the amount
of vertical and horizontal overlap
will vary depending on condylar ** It is generally advisable
inclination, occlusal plane to keep the vertical overlap
orientation and esthetic needs. to a minimum in complete
dentures.

32. Setting Mandibular Anterior Teeth
Why horizontal and vertical overlap?
1. We desire to minimize the forces
applied to the mandibular and
maxillary anterior ridges in centric
occlusion.
2. Create the appropriate
relationship of the maxillary and
mandibular anterior teeth during
the production of sibilant speech
sounds.

33. Setting Mandibular Anterior Teeth
Magnitude of horizontal overlap?
In Class II patients the mandible tends
to travel farther anteriorly in function
than the typical Class I patient and
consequently more horizontal overlap
is necessary to allow for this Class I Class II
In contrast Class III patients often demonstrate little or no
anterior movement of the mandible during function.
Consequently, little or no horizontal overlap is developed
in the set up.
Class III

34. Setting Mandibular Anterior Teeth
“S” position
As noted previously, during the production of sibilant sounds
the mandible travels down and forward and a space of about
1 mm is created between the maxillary and mandibular
incisors.

35. Setting the Mandibular Central Incisors
In most patients the labial
surface of the mandibular
incisors should be roughly
perpendicular to the occlusal
plane.
Occlusal plane

36. Setting the Mandibular Central Incisors
Vertical
Horizontal
overlap
overlap
1 mm
1.5 mm
In the setup shown here, the initial vertical overlap chosen was
1.0 mm and the amount of horizontal overlap was 1.5 mm.

37. Setting the Mandibular Central Incisors
Horizontal
overlap
1 mm Horizontal
overlap
1.5 mm
Horizontal overlap is measured from the tip of the maxillary central incisor to
the labial surface of the mandibular central incisor.

38. Setting the Mandibular Central Incisors
Incisal
The incisal angle varies angle
depending on the
magnitude of the vertical Vertical
and horizontal overlap,
the arrangement of the
overlap
occlusal plane and the
condylar inclination. It is
generally advisable to
keep the incisal angle to Occlusal
a minimum in complete
dentures. plane

39. Setting the Lateral Incisors and Cuspids
Position the remaining mandibular anterior teeth. The
lateral incisors should be placed similar in angulation and
position to the central incisors. Note that the cuspids are
towed out at the cervical. The vertical overlap can be easily
appreciated from frontal perspective.

40. Setting the Lateral Incisors and Cuspids
The vertical overlap should be
1.0 mm throughout the
anterior region at this stage of
the setup.
Occlusal
plane
Note that the cuspid is slightly
inclined to the distal whereas
the lateral incisor is relatively
vertical.

41. Setting the Lateral Incisors and Cuspids
The horizontal overlap should be consistent throughout the
anterior region. At this stage it should be about 1.5 mm.

42. Setting the Lateral Incisors and Cuspids
From the anterior perspective the angulation of the
mandibular anterior teeth should be as indicated. Note
that the cervical of the cuspids are in the towed out
position.

43. Setting the Anterior Teeth
The anterior teeth have now been
positioned. The final positions will be
determined during the trial denture
appointment.

44. Setting the Mandibular Posteriors
Set the mandibular
premolars and the 1st molar.
Occlusal plane Make sure these teeth are
on plane and on ridge. Use
the marks on your cast to
help you visualize the
occlusal plane and crest of
the ridge.
Line indicating the
crest of the ridge

45. Setting the Mandibular Posteriors
When using this
lingualized posterior
tooth form (Ivoclar
Ortholingual) there
should be little or no
curve of Wilson. In this
set up both the lingual
and buccal cusp tips of
the premolars and the 1st
molar were on the plane
of occlusion.

46. Setting the Mandibular Posteriors
15 degrees
Position the 2nd molar. The curve of Spee is created by
slightly elevating the distal half of the 1st molar and by
elevating the the 2nd molar by about 15 degrees up from
the occlusal plane.

47. Setting the Mandibular Posteriors
Both sides have now been set. Before setting the maxillary
posterior teeth make sure the posterior mandibular teeth are
centered over the ridges and on plane.

48. Setting the Maxillary Posteriors
Position the maxillary
posterior teeth. There
should be about a 1mm
space between the
lingual inclines of the
buccal cusps of the
maxillary teeth and the
the buccal slopes of the
buccal cusps of the
mandibular teeth.

49. Setting the Maxillary Posteriors
The lingual cusp tips
should be in contact
with the central fossae
of the opposing
mandibular teeth.
However, as opposed
to anatomic teeth set to
bilateral balance, they
need not be arranged
in a cusp – embrasure
relation ship.

50. Setting the Maxillary Posteriors
 All of the maxillary teeth have been positioned. Note
that the maxillary lingual cusps all firmly contact the
central fossae of the mandibular teeth.

51. Completed Denture Setup
Verify centric and make adjustments as necessary. The lingual cusps of the
maxillary posterior teeth must rest in the central fossa of the opposing mandibular
teeth. There should be no buccal cusp contacts of posterior teeth in centric or in
lateral excursion.

52. Lingualized Occlusion
Verify working, balancing
and protrusive. Make
adjustments as necessary.
This is the working position.
Note that the anterior teeth
are in contact during lateral
excursions. If adjustments
are necessary to achieve
appropriate contact they
should be done at this
stage.

53. Lingualized Occlusion
Verify working, balancing and protrusive. Make adjustments
as necessary. This is the balancing position.

54. Lingualized Occlusion
Protrusive
Develop protrusive contacts as shown. Light contact of
the anterior teeth in protrusion enhances stability. Note
the contacts in the 2nd molar region.

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