Balanced occlusion

1. BALANCED OCCLUSION
Presented by,
Dr. vasavamba D S
Guided by
Dr.Veena mam’m

2. CONTENTS
•Introduction
•Definitions
• Concepts of occlusion
•Factors affecting occlusion
•Requirements of complete denture occlusion
•Objectives of balanced occlusion
•Various concepts proposed to attain balanced occlusion
•Procedure
•Teeth arrangement
•Occlusal errors
•Conclusion
•References

3. Introduction
 After the loss of natural teeth, there is a need for fabrication of artificial
prosthesis that restores the lost tissues
 Such prosthesis should not only aid in function and aesthetic but also restores
neuromuscular co-ordination and harmony of the oro-facial musculature.
 Fabrication of such prosthesis can be done either by using conventional method
or by a specialized technique called bilaterally balanced occlusion.

4.  Teeth, whether natural or artificial are not immobile, so occlusion
can never be considered a purely static relationship.
 Artificial occlusion undergoes even more apparent movement
since the teeth move as a group and on a common base because of
the nature of underlying supporting structures.
 To overcome such problems, accommodation should be made in
artificial occlusion.

5. Balanced Occlusion:
“ The simultaneous contacting of maxillary and mandibular teeth on right and left and
in the posterior and anterior occlusal areas in centric and eccentric positions. ”-
HEARTWELL
“ 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
• Hanau used the term articulation to define the contacting of teeth as the mandible
moved to and from centric relation and eccentric relation.
• This is dynamic movement

6. CONCEPTS OF COMPLETE DENTURE OCCLUSION
STATIC CONCEPT :
The static relations in occlusion include centric occlusion, protrusive occlusion, right and
left lateral occlusion. All of these relations must be balanced with the simultaneous
contacts of all the teeth on both sides of the arch at their very first contact.
DYNAMIC CONCEPT :
The dynamic concept of occlusion is primarily concerned with opening and closing
movements involved in mastication
Occlusal rehabilitation in complete denture fall into four occlusal concepts
• Unbalanced articulation
• Balanced articulation
• Linear or monoplane articulation
• Lingualized articulation.

7. REVIEW OF COMPLETE DENTURE
OCCLUSION
A.) BONWILL’S THEORY OF OCCLUSION (1858)
“Theory of equilateral triangle”
“ Teeth move in relation to each other as guided by the condylar
controls and the incisal point “.

8. B.) CONICALTHEORY OF OCCLUSION BY HALL in 1915
“ Conical theory of occlusion proposed that the lower teeth move over the surfaces of upper teeth
as over the surface of cone with generating angle of 45° “
&
“ Central axis of cone tipped at a 45° angle to occlusal plane ”

9. C.) SPHERICALTHEORY OF OCCLUSION BY MONSON IN 1918
“The spherical theory shows that the lower teeth moving over the surfaces of upper teeth as over the
surfaces of the sphere
With diameter of 8 inches ”.
“The centre of the sphere is located at GLABELLA and the surface of the sphere passes through the glenoid
fossa along the
Articulating eminence or concentric with them”.

10. REQUIREMENTS OF COMPLETE DENTURE OCCLUSION
STATIC POSITION DYNAMIC POSITION
• There should be Anterior incisal clearance during
all posterior masticatory function .
Acc to winkler, 2mm overjet and 0.5mm overbite.
Acc to boucher both overjet and overbite should
be approx 1.5mm
•Balanced occlusal contacts bilaterally for eccentric
mandibular movements.
( protrusive and lateral movements)
•Stability of occlusion in centric relation position and
in an area forward and lateral to it.
• Control of horizontal forces by bucco-lingual
cusp height reduction according to residual ridge
resistance form and inter-arch distance.
• Functional lever balance by favorable tooth-to-
ridge crest position.
•Minimum occlusal contact areas
•Cutting, penetrating, and shearing efficiency of
occlusal surfaces.
•Sharp ridges or cusps and generous sluice

11. -:The requirements can be easily applied by dividing into 3 basic units :-
INCISING
WORKING
BALANCING
Acc.To WINKLER
Essentials of complete dentures, by SHELDONWINKLER 3rd edition.

12. • These units should be SHARP.
• They should NOT CONTACT during mastication.
• They should have FLAT INCISAL GUIDANCE
considering esthetics and phonetics.
• They should have HORIZONTAL OVERLAP.
About 1-2mm.
Vertical overlap should be about 0.5mm
• They should CONTACT ONLY DURING
PROTRUSIVE INCISING FUNCTION.
FOR INCISING UNITS
Essentials of complete dentures, by SHELDONWINKLER 3rd edition.

13. • They should be efficient in cutting and grinding.
• They should have decreased bucco-lingual width.
They should be over the ridge crest in the masticating area for
lever balance.
• They should have a surface to receive and transmit the force of
occlusion essentially vertically.
• They should Centre the workload near the anteroposterior
centre of the denture.
• They should present a plane of occlusion as parallel as possible
to the mean foundation plane.
FOR WORKING UNITS

14. • They should contact on the second molars when the
incising units contact in function.
• They should contact at the end of the chewing cycle
when the working units contact.
• They should have smooth gliding contacts for lateral
and protrusive excursions .
FOR BALANCING UNITS
Essentials of complete dentures, by SHELDONWINKLER 3rd edition.

15. 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

16. OBJECTIVES OF BALANCED OCCLUSION
1.) WIDER & LARGER the ridge + CLOSER the teeth are to the ridge = GREATER the LEVER balance.
NARROWER & SMALLER the ridge + teeth FARTHER from the ridge = POOR LEVER balance.
2.) WIDER the ridge & NARROWER the teeth = GREATER the balance.
NARROWER the ridge & WIDER the teeth = POOR the balance.

17. 3.) More LINGUAL the teeth placed in relation to ridge = GREATER is the balance.
More BUCCAL the teeth placed in relation to ridge = POOR is the balance.
4.) The more CENTERED the force of occlusion ANTERO-POSTERIORLY greater the
stability of denture base.

18. This is present when occlusal surfaces of teeth on one side occlude
simultaneously, as a group, with a smooth uninterrupted glide.
1). UNILATERAL OCCLUSAL BALANCE
TYPES OF BALANCE

19. Prime 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.

20. This is present when simultaneous contact occurs on both the sides in centric and
eccentric positions.
2). BILATERAL OCCLUSAL BALANCE

21. Usually seen during the protrusion of the mandible.
3) PROTRUSIVE OCCLUSAL BALANCE
This is present when mandible moves essentially forward and occlusal contacts are smooth
and simultaneous in the posterior both on right and left sides and on anterior teeth.
This requires minimum 3 point contact on each side & one anteriorly.

22. MECHANICS OF BALANCED OCCLUSION

23. LAWS OF PROTRUSIVE OCCLUSION
Protrusive occlusion has a few primary worldwide accepted stomatognathic system components which should
be considered before developing balanced occlusion.
Hanau’s study was a pioneer exploration of this subject & referred to as,
HANAU’S LAW OF ARTICULATION

24. Then he wisely combined the original 9 factors & reduced them to 5.
few words have been changed for clarity and convenience.
• INCLINATIONOFTHE CONDYLARGUIDANCE
• INCLINATIONOFTHE INCISALGUIDANCE
• ORIENTATION OFTHE OCCLUSAL PLANE
• INCLINATION OFTHE CUSPS
• PROMINENCEOFTHE COMPENSATINGCURVES

25. INCLINATION OF CONDYLAR GUIDANCE
• Condylar guidance is a guiding influence which is furnished
to the condyles of the mandible by theTEMPORO - MAND.
articulation during eccentric jaw movements.
HANAU stated it as a definite factor ( anatomical conception)
“ with this statement there is ready accord that it is the one
factor that edentulous patient presents and can no way be
modified by the operator “.

26. COMPONENTS OF CONDYLAR GUIDANCE
HORIZONTAL CONDYLARGUIDANCE LATERAL CONDYLARGUIDANCE

27. • INCREASE IN CONDYLAR GUIDANCE ∝ JAW SEPERATION, during
protrusion.
• All the other factors should be modified to compensate the effects of this
factor.
• For example,
In patients with STEEPCONDYLAR GUIDANCE, the INCISAL
GUIDANCE should be decreased to reduce the amount of jaw separation
produced during protrusion.

29. INCISAL GUIDANCE
• Defined as “The influence of the contacting surfaces of the mandibular and
maxillary anterior teeth on mandibular movements”.

30. RELATION BETWEEN HORIZONTAL ANDVERTICAL OVERLAP
• LESSERTHE HORIZONTAL OVERLAP = GREATERTHEVERTICAL OVERLAP
• GREATERTHE HORIZONTAL OVERLAP = LESSERTHEVERTICAL OVERLAP
• In complete dentures, the incisal guide angles should be as flat as possible keeping in
mind the aesthetics and phonetics.

31. • “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.
• Parallel to camper’s line & tilting of the plane >10° is not advisable
ORIENTATION OF OCCLUSAL PLANE

32. COMPENSATINGCURVES
•The antero-posterior curving and the medio-lateral curving within the alignment of
the occluding surfaces and incisal edges of artificial teeth that is used to develop
balanced occlusion. (GPT-9)
•It is determined by the inclination of the posterior teeth and their vertical
relationship to the occlusal plane.
The curves that assist in producing balanced occlusion are
•Antero-posterior curve – run in antero-posterior direction
•Medio-lateral curves – run in a lateral direction from one side of the arch to the
other

33. CURVE OF SPEE
“The anatomic curve established by the occlusal alignment of the teeth, as projected onto
the median plane, beginning with the cusp tip of the mandibular canine and following the
buccal cusp tips of the premolar and molar teeth, continuing through the anterior border of
the mandibular ramus, ending with the anterior most portion of the mandibular condyle.”-
GPT 9

34. CURVE OF MONSON
“The curve of occlusion in which each cusp and incisal edge touches to a segment of the
sphere of 8 INCHES diameter with its center at glabella”-GPT
Runs across the palatal & buccal cusps of maxillary molars .

35. CURVE OFWILSON
“In the mandibular arch, that curve, as viewed in the frontal plane, which is concave
above and contacts the buccal and lingual cusps of the mandibular molars;
In the maxillary arch, that curve, as viewed in the frontal plane, which is convex below
and contacts the lingual and buccal cusps of the maxillary molars.The facial and lingual
cusp tips on both sides of the dental arch form the curve.” -GPT

36. PLEASURE CURVE
“A helicoid curve of occlusion that, when viewed in the frontal plane, conforms to
curve that is convex from the superior view, except for the last molars which
reverse that pattern .”-GPT
“Pleasure curve“ in which the posterior teeth are set with
buccal tilt providing total lever balance during function.
• Buccal tilt (reverse curve) is given at the premolars,
• No tilt or flat occlusal surface at first molars and
• A lingual tilt (Monson curve) to second molars.
This scheme is especially beneficial for patients with
class II jaw relation.

37. CUSPAL ANGULATION
“Angle made by the average slope of a cusp with the Cuspal plane measured
mesiodistally or buccolingually ”.
It is an important factor that modify the effect of plane of occlusion & the
compensating curves

38. In shallow bite
Cuspal angle should be
reduced to balance the incisal
guidance.
In Deep bite cases
Cuspal angle should be
increased to balance the
incisal guidance.

41. VARIOUS CONCEPTS PROPOSEDTO ATTAIN BALANCED OCCLUSION
GYSI’S CONCEPT (1914)
In 1914, 33° Cuspal form was introduced by “Gysi”. He gave an inclination of 33° to the cuspal inclines to
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.
In centric occlusion, the masticatory
forces directed toward the ridges
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 .

42. According to the concept, the occlusal surface of the mandibular posterior teeth had been reduced to increase
the stability of the dentures.
The maxillary posterior teeth have slight lingual occlusal inclines of 5° for first premolar, 10° for second
premolar, and 15° for first and second molars, so that a balanced occlusion could be developed laterally as well
as antero-posteriorly by the arrangement of teeth on a curved occlusal plane.
In centric occlusion, half of width of mandibular
posterior teeth helps to direct the masticatory
forces in a buccal direction to the mandibular
residual ridge
In a right lateral position, the occlusal contact forces are
directed toward the ridges on the working side and
away from the ridges on the balancing side
FRENCH CONCEPT

43. SEARS CONCEPT (1922)
• Sears in 1922 with his chewing members and in 1927 with channel teeth (both were
nonanatomic teeth) developed a balanced occlusion by a curved occlusal plane antero-
posteriorly and laterally or with the use of a second molar ramp.
• In centric occlusion, nonanatomic teeth will exert contact forces toward the ridges.
• In the right lateral position, the occlusal contact forces directed toward the ridge on the
working side and toward the buccal side of the ridge on the balancing side

44. FRUSH CONCEPT
• In 1967, Frush gave the "Linear occlusal concept," which employed an arbitrary articulator balance,
followed by intraoral corrections to obtain balance.
• A single mesiodistal ridge on the lower posterior teeth contacted a flat occlusal surface of the upper
posterior teeth set at an angle to the horizontal.
• The intention was to eliminate deflective occlusal contacts and increased stability.
• In centric occlusion, contact forces directed toward the ridges according to the linear occlusal concept
• In a right lateral position, the contact forces toward the ridge on the working side and slightly toward
the buccal side of the lower ridge on the balancing side at a given inclination of 6°

45. TRAPOZZANO’s CONCEPT
• He eliminated 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.
Trapozzano reviewed Hanau's five factors and decided that only three factors were actually
concerned in obtaining balanced occlusion.

46. BOUCHER’s CONCEPT
CARL O BOUCHER analysedTRAPOZZANO’s work and in doing so he stated his own concept and ideas.
This can be stated as,
There are three factors of BALANCED OCCLUSION
1. ORIENTATIONOF OCCLUSAL PLANE
2. INCISALGUIDANCE
3. CONDYLARGUIDANCE
• The angulation of certain cuspal is more important than height perse.
• COMPENSATORYCURVES are more important as it help in increasing the effective cusp height
without changing the the tooth form
• Both CUSP HEIGHTS and COMPENSATORYCURVES are means for solving the problems imposed
by CHRITENSONS’s PHENOMENON
• The occlusal plane should be located according to the aesthetic appearance and intraoral soft tissue anatomy
instead of locating according to LEVERAGE or MECHANICAL REQUIREMENTS

47. STEPS IN ATTAINING BALANCED OCCLUSION
Making the Preliminary Impression
Border Moulding and Final Impressions
Preparation of maxillary and mandibular occlusal rims
Jaw relation recording to be done.
(vertical, horizontal , centric)
The record base is centered over the face-bow fork
Place the maxillary base with the attached face-bow fork into the patient's
mouth.
Instruct the patient to hold the maxillary record base in place with his or her
fingers/thumb probably and make the face-bow transfer record.

48. ARTICULATOR PREPARATION
Adjust the protrusive inclination of both Condylar Guidance
Adjust the Bennett Angles of both Condylar Guidance
Attach the face-bow fork to the lower member of the articulator.
Seat the maxillary cast (securely) in the face-bow fork record.
The mounting should be smoothed and neatly finished.

49. MOUNTING MANDIBULAR CAST
seat the mandibular cast in the bite rim
The centric interocclusal relation record is then carefully
seated between the indexed occlusal surfaces of the upper
and lower occlusal rims
Complete the mounting
Adjustment of lateral condylar guidance (bennett angle),
hanau formula
L= H/8 + 12

50. ARRANGEMENT OF 33° ANATOMIC TEETH IN
BALANCED OCCLUSION

51. Upper anterior teeth
Central Incisor
 The incisal edge should be parallel and on the occlusal plane
 Labial long axis should be 90º to the occlusal plane
 Proximal long axis should be 8º to the vertical axis with the
neck of tooth nearest the alveolar ridge.
Lateral incisor
• Incisal edge should be parallel to occlusal plane but 1mm above
• Labial long axis should be 10º
• Proximal long axis should be 12º with its neck slightly nearer to the
ridge than central incisor.
Canine
• Only the cusp tip should contact the occlusal plane
• Labial long axis is parallel to central line
• Proximal long axis should be parallel , thus there is slight prominence
of neck of tooth.

52. Lower anterior teeth
Central incisor
• The incisal edge should be 1-2 mm above occlusal plane
• Labial long axis is parallel to the vertical plane
• Proximal long axis exhibits 5º labial inclination.
Lateral incisor
• Incisal edge corresponds to the central incisor
• Labial long axis should be parallel to vertical plane
• Labial inclination is less than the central incisor
Canine
• Incisal edge should ne 1mm higher than central and lateral
• Labial long axis is inclined towards the midline
• Proximal long axis is parallel to the vertical plane.

53. Upper posterior teeth
1st premolar
• The apex of the buccal cusp should contact the occlusal plane
• The buccal long axis should be parallel to the vertical plane
• Palatal cusp should be 0.5 mm above the occlusal plane.
2nd premolar
Similar to 1st premolar except that the palatal cusp contacts the occlusal plane
1st molar
• Both buccal and proximal long axis will exhibits deviation of 5º to the vertical plane
• Mesiobuccal cusp is 0.5mm above
• Mesiopalatal cusp contacts occlusal plane
• Distobuccal cusp is above 1mm
• Distopalatal cusp is 0.5 mm above
2nd molar
• Both buccal and proximal axis has deviation of 15º
• Mesiobuccal cusp is 1.5 mm above
• Mesiopalatal cusp 1mm above
• Distobuccal cusp is 2mm above
• Distopalatal cusp is 1.5mm above

54. Canine relation Molar relation

55. Class II Jaw Relations
•The anterior teeth do not provide the protection and guidance normally provided by
horizontal and vertical overlap.
•The posterior teeth bear the full force of occlusion.
•Protrusive movement is the dominant and the most used movement
Principles of teeth arrangement-
•The mandibular anteriors are placed with increased overjet of 5–6 mm and overbite
of 2 mm
•Due to retruded position of the mandibular ridge with less space for teeth,
one premolar is removed in the mandibular arch while all the teeth are arranged in the
maxillary arch .

56. Class III Jaw Relations
•There is lack of anterior guidance and the added width and length of
the mandible.
•The same principles of teeth arrangement is followed, with slight
modifications.
•the overjet which is eliminated (edge-to-edge bite) and the overbite
which is also minimized.
•In order to provide space for the maxillary posterior teeth, usually one
premolar is trimmed mesiodistally or removed from the maxillary arch

57. • If marks show on lower cusp inclines, gently grind the inclines to eliminate
deflective contacts.
• If there are any upper lingual cusps out of contact, the nonoccluding maxillary
teeth are repositioned by moving the lingual cusps down into contact
• Only the lower central fossae or marginal ridges should be ground, not the
upper lingual cusps.
STATIC
CENTRIC
CONTACTS
• Grind the marked premature balancing contacts, heavily marked working side
contacts, or both, on the lower teeth.
• Do not grind the upper lingual cusps.
• There should be no upper buccal cusp contact in any excursion.
WORKING
AND
BALANCING
CONTACT
• If anterior interference occurs, either move or grind the lower offending
anterior tooth slightly or increase the distal incline on the lower second
molar by increasing the compensating curve.
PROTRUSIVE
BALANCE

58. Working side:
The mandibular buccal cusp ridges makes 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 mesio-buccal & lingual cusp ridges of the mandibular teeth
contact the distobuccal & lingual cusp ridges of the maxillary
teeth.

59. • The right and left excursions for the completed unilateral setup are then checked.
• There should be working and balancing contacts that are in harmony with the guidance of condylar
inclination and incisal guidance.
Ideally in this occlusal scheme there should be ,
• 5WORKING CUSP CONTACTS.
• 5 BALANCING CUSPCONTACTS.
• NO MAXILLARY BUCCAL CUSPCONTACTS.

61. REMOUNTING OF PROCESSED DENTURES
REMOUNT PROCEDURE :
Any method used to relate restorations to an articulator for analysis
and/or to assist in development of a plan for occlusal equilibration or
reshaping - GPT9
•The purpose of the laboratory remount is to correct errors in occlusion
that have occurred during processing, to return the dentures to the
correct vertical dimension of occlusion and to restore centric contacts
and bilateral balanced occlusion.
•Clinical remounting is a procedure where by occlusal adjustment is
carried-out on the articulator after remounting the dentures with new
records obtained from the patient.

62. Occlusal Errors
1. Change in state of health ofTMJ
2. Inaccurate maxillomandibular relation record
3. Errors in transfer of records to the articulator
4. Ill-fitting temporary record bases, failure to use facebow
5. Changing the vertical dimension on the articulator
6. Incorrect arrangement of teeth.

63. The occlusal errors resulted after processing was corrected by selective
grinding procedure.
Occlusal reshaping or selective grinding
Any change in the occlusion intended to alter the occlusal surfaces of the
teeth or restorations to change their form;
syn, Occlusal adjustment, selective grinding

64. The Sequence for correction of occlusal errors followed was:
(i) Restore centric occlusion,
(ii) Correct working and balancing occlusion,
(iii) Correct protrusive occlusion.
Initially contact between heels was check to ensure that increase in
vertical dimension is not due to overlying thick denture base resin in
these areas.

65. Working side Occlusal Errors and their Correction : BULL RULE
It’s a rule that the centric holding cusps are not grinded.
If interferences exists in the working side reduce in accordance with BULL RULE
BULL: acronym for Buccal of the Upper, Lingual of the Lower
L
B

66. Non-working side Occlusal Errors and their Correction
The contact on the non–working side is so intense that teeth on the working side are
out of contact.
Correction- pathways are ground over the mandibular buccal cusp in order to reduce
the incline of the part of the cusp that prevents tooth contacts on the working side.
Each interfering cusp is preserved as much as possible.
Grinding is not performed on the lingual cusps that can be included in this contact.

67. Protrusive Contacts and their Correction : DUML RULE
If the anterior teeth have heavy contact with no contact on the posterior teeth.
Correction: Grind the labial surface of the lower anterior and the palatal surface of
the upper anterior.
If heavy posterior contact exists with no anterior contact
Correction: reduce the distal inclines of the maxillary cusps and the mesial inclines
of the mandibular cusps.(DUML RULE)

68. CONCLUSION

70. •The complete denture prosthodontics is the most difficult and skill requiring area to
bring out the best rehabilitation in an edentulous patient.
•Regardless of one’s belief about the superiority of a particular form of occlusion; the
anatomical, mechanical, physiologic and esthetic limits presented by the patient should
determine the choice of the occlusal scheme.
•A physiological consideration like interocclusal distance, centric relation is mandatory for
the success of the denture.
•As classically told by Heartwell
BALANCING AN OCCLUSION IS LIKE CONVERTING “THE STUMBLING
PROSE INTO POETRY”

71. REFRENCES

73. THANK YOU