ARRANGEMENT OF POSTERIOR TEETH ACCORDING TO DIFFERENT THEORIES OF OCCLUSION/ oral surgery courses

ARRANGEMENT OF POSTERIORARRANGEMENT OF POSTERIOR
TEETH ACCORDING TO DIFFERENTTEETH ACCORDING TO DIFFERENT
THEORIES OF OCCLUSIONTHEORIES OF OCCLUSION
INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com

CONTENTS
Introduction
History of the development of posterior tooth form.
Evaluation of occlusal forms
Occlusal schemes used in complete denture
Anatomic and non anatomic teeth
Theories and concepts of occlusion
Lingualized occlusion
Selection and arrangement of posterior teeth
Monoplane arrangement of posterior teeth
Posterior teeth arrangement of Class II patients
Posterior teeth arrangement of Class III patients
Review of literature
Summary & conclusion
References

INTRODUCTION
Knowledge of anatomy, physiology,
pathology and biomechanics….
The form of the arch or to satisfy the laws
of leverage, it requires the knowledge of
biology…..
“University of Buffalo School of Dentistry”

History of the development of the
posterior tooth form
Hundreds of years ago teeth were carved from
stone, wood, ivory and metal.
The early design of the 19th
century were seldom
based on scientific approaches that considered the
movements of the mandible guided by TMJ and
incisal guidance.
In 1913 Dr. Alfred Gysi of Switzerland carved the
first anatomic porcelain tooth. Marketed by
Dentist supply company and were called Trubyte.
Gysi called them normal bite teeth.

In 1927 Gysi also introduced
the cross-bite teeth.
In 1928 Victor Sears
introduced channel teeth.
After 10 years Sears
introduced platform teeth.
In 1929 Hall introduced a
nonanatomic form he called
inverted cusp teeth.www.indiandentalacademy.com

Myerson shortly introduced Truecusp teeth which had no
cuspal inclination, flat occlusal surface with cutting blades and
crushing tables incorporated in the occlusal carving.
Avery in 1930 introduced the
Scissor bite teeth.

In 1935 French designed
and the universal dental
company marketed a
severely modified teeth.
The maxillary tooth was
similar to Sears but with
very shallow buccolingual
inclines to reduce the
lateral thrust.
In 1936 McGreene
marketed a tooth which he
called the curved cusp
posterior tooth.

In 1937 Max Pleasure
proposed to modify the
lower posterior teeth
occlusal surfaces to a
reverse curve by tilting
the tooth buccally.
John Vincent in 1942
introduced a change in
materials by using metal
inserts in resin posteriors.

Sosin in 1961 replaced
maxillary second bicuspid and
first & second molars with
cleat shaped vitallium forms
called cross-blades.
Levin modified this scheme
by reducing the size of the
cross-blade to the maxillary
lingual cusp.

Non-anatomic or cuspless teeth
In 1929 Hall was the first to design cuspless teeth
he called inverted cusp tooth.
Myerson also design cuspless posterior teeth
called True-cusp. It had a series of transverse
buccal lingual ridges with sluice ways between
them.

In 1934 Nelson described
teeth he called chopping
blocks, which were flat
occlusal surfaces with
numerous ridges.
In 1939 Swenson designed
a posterior tooth called
nonlock. These were
essentially flat teeth with
Sluice ways for shredding
and allowing food to clear
the occlusal table.

In 1946 Hardy designed a metal
insert upper and lower posterior
which he called Vitallium
occlusal. Marketed by Austenal
Company and are still in use.
In 1951 Myerson Tooth
Corporation introduced the first
cross-linked acrylic teeth in a
flat occlusal scheme called the
Shear cusp tooth.
“The modern acrylic
tooth era begin”.

In 1952 Coe Masticators
designed by Cook.
In 1957 Bader introduced cutter
bar scheme by opposing upper
porcelain cuspless teeth with a
metal cutting bar replacing 2nd
premolar, 1st
& 2nd
molar.

1967 Frush described linear occlusal concept
maxillary and mandibular flat with a single
mesiodistal ridge usually on the lower.
In a condensed history of development of the
posterior artificial tooth forms such as this, it is
apparent that the underlying quest was for
masticatory efficiency with control of both vertical
and horizontal forces so that their function would
be as innocuous as possible in highly
compromised edentulous mouth.

Evaluation of occlusal forms
There have been many investigations evaluate
the effectiveness of the various types of
posterior occlusal forms.
Two main factors are involved
1. Masticatory efficiency
2. Forces directed to the ridges
Two different methods have been used to
determine which of the forms had the highest
comminuting efficiency.
1. Comparison of different types of teeth in the
same denture wearer.
2. Comparison of chewing efficiency in a large
sample of denture wearers with various types of
teeth. www.indiandentalacademy.com

Occlusal schemes used in complete
denture
The natural tooth form with its cusp inclines
usually functions in harmony with its opposing
tooth.
This harmony in contact is monitored by the tooth
contacts of incisal guidance, cuspid guidance and
group function of posteriors with proprioceptive
information to the neuromuscular system to give
efficient and harmonious function.
Artificial posterior teeth have been evaluated as
units opposing each other, which is in contrast to
the consideration of individual tooth form.

Many types of posterior teeth have been
designed to needs of various philosophies
of complete denture occlusion. These can
be divided into two main groups –
The anatomic teeth
The nonanatomic or semianatomic

Anatomic teeth
The cuspal forms designed by nature are ideally
shaped to function in harmony with the
temporomandibular joint and the muscles of
mastication to shear and grind food with the least
effort.
Indication:
Where good ridge exists
With younger people
Advantages
They imitate nature
Esthetically appealing
Very efficient
Provide efficient occlusal balance
Can be made to confirm to mandibular movements

Disadvantages
It is mandatory to use an adjustable articulator
Eccentric records must be made for articulator
adjustments.
Mesiodistal inter locking will not be permit settling of
the bases without horizontal forces developing.
Harmonious balanced occlusion is lost when settling
occurs.
The bases need prompt and frequent refitting to keep
the occlusion stable and balanced.
The presence of cusp generates more horizontal forces
during function resulting in resorption of the ridge
tissue. www.indiandentalacademy.com

Non-anatomic or Semi-anatomic teeth
They are defined as “a tooth which is designed on
mechanical basis rather than anatomic basis,
having a flat or nearly flat occlusal surface”.
The major objective of special occlusal form is to
prevent the destruction of tissues and to preserve
the integrity of the supporting ridges.

Indications for the use of flat teeth given by
Payne.
Where ridges are flat, rendering dentures more
susceptible to horizontal stress.
In old age where the ridges are flat
When the vertical dimension is great which
would cause tipping forces to develop.
If a maximum of vertical force and a minimum of
horizontal stress is desired.

Advantages of using non-anatomic teeth
Versatility of use, hence their employment in Class I and
Class II jaw relationships.
Permitting closure of the jaws over a broad contact area.
Creating minimal horizontal pressure.
Allowing construction of dentures with a simple technique
and articulator.
Where the neuromuscular controls are so uncoordinated that
jaw relation records are not repeatable, the cusp from tooth
cannot be balanced. Monoplane teeth are less damaging
than cusp teeth.
In case of diabetic patients where the underlying bone is
vulnerable to damage less stress is transmitted by the use of
monoplane teeth. www.indiandentalacademy.com

Disadvantages of using non-anatomic teeth
Their anatomic form is esthetically inferior to that of
cusped teeth.
Some patients complain of an inability to penetrate food
effectively, which renders the dentures mechanically
inefficient.
They probably require the application of force in a nearly
horizontal direction of jaw movement to shear food; this
results in lateral forces against the residual ridges.
Shanhan suggests that the general rule, should be
“High cusps for the young and low or flat cusps for
the aging” be the criteria of tooth selection.

Factors influencing function of
anatomic and non-anatomic teeth
I. Efficiency: it has been defined as the ability to
produce results. This is applicable to denture
functions the aim of mastication being the
comminution of food.
Factors influencing efficiency
a. Type of patient
b. Condition of the mucosa and bony ridge
c. Type of denture
d. The biting force
e. The character of food and size of the bolus
f. The arrangement of the teeth

II. Directional forces: Forces on dentures must be in
a direction which will give the greatest stability.
This is accomplished by
a. The form of the tooth
b. Placement of the tooth
c. The arrangement of the tooth

III. Horizontal stress: When a vertical forces is applied
to an inclined plane nonvertical forces or horizontal
stresses appear. Schuyler maintains that the inclination
of the eminentia articularis portion of the mandibular
fossa along with the incisal guidance and not the tooth
forms governs horizontal stress.
IV. Stability: It is the ability of the denture to remain in
position during masticatory and non-masticatory
movements.

Theories and concepts of occlusion
Keeping in mind the 2 kinds of occlusion one
which is provided by nature, that normal occlusion
and one which is man made that is artificial
occlusion and the different kind of posterior teeth
marketed.
The concept of occlusion for complete dentures
fall into two broad categories –
Non balanced occlusion
Balanced occlusion

Non-balanced occlusion
Non balanced occlusion is an arrangement of teeth
with form or purpose. The occlusal form of the
teeth will be decided by the type of occlusion to be
developed.
The arrangement of teeth according to the
spherical theory, organic occlusion, monoplane
may be classified as non-balanced occlusion.
De Van’s concept of neutrocentric occlusion
also falls under this category.

Proponents of non-balanced occlusion emphasis
that:
The character of the supporting foundation makes
it almost impossible to harmonise teeth
arrangement with mandibular movements in the
eccentric relation to the maxilla and maintain
harmony.
The contacting of the teeth during masticatory and
non-masticatory mandibular movements takes
place when the mandible is in centric relation to
the maxillae.

The artificial teeth should not contact. When the
mandible is in eccentric relation to the maxillae,
for when the jaws are eccentrically related to the
teeth contact, horizontal and torquing destructive
forces are directed to the support.
When the jaws are in centric relation and the
contact of the teeth produces no discomfort to the
supporting tissues or the joints, the patient is
encouraged to make similar maxillomandibular
relations repeatedly.

Spherical theory of occlusion
This was given by Monson and the concept was
derived from an idea by Vonspee.
Positioning of teeth with anterioposterior and
medio-lateral inclines in harmony with a spherical
surface. Some times referred to as having Monson
curve.

This form of occlusion tends to magnify the
stresses created, because the forces delivered
somewhat at right angles to the occlusal surface
are of butting action.
The forces against the lower denture are not only
exerted, such a direction as to tip it, but will drive
it to one side against the poorly formed and
sensitive tissues of the mylohyoid ridge.

The effect of Bonwills equilateral
triangle theory
According to study by Finn Tengs, Christensen
variations in the size of Bonwills triangle
influence the cusp angulation for complete
dentures.

Christensen’s angle decreases with an increase of
Bonwill’s triangle.
Christensen’s angle is directly proportional to the
cusp angulation.
γ1
γ2
Sine γ1
Sine γ2
½ L1L2
a1
½ L1L2
a2
a2
a1
= = =
γ1
γ2
a2
a1
=

Organic occlusion
It is that concept where in any jaw movement away
from centric occlusion will result in separation of all
posterior teeth.
The ridge and groove directions of the posterior teeth
are determined as result of the movements of the
condyles. The cusp height, fossa depth of posterior
teeth and the proper concavity at the lingual surfaces
of the maxillary anterior teeth are determined as a
result of mandibular movements.
The aim of this occlusion is to relate the occlusal
elements of teeth so that the teeth will be in harmony
with the muscles and joints in function.

In organic occlusion three phases of
mutually interdependent protection are
present.
The posterior teeth should protect the anterior
in the centric occlusal position.
The maxillary incisors should have vertical
overlap sufficient to provide separation of, the
posterior teeth when the incisors are in edge to
edge contact.
In lateral mandibular position outside the
masticatory movements, the cuspids should
prevent contact of all other teeth.

Lineal occlusion concepts for complete
dentures
A straight line of points or knife-edge contacts on
artificial teeth in one arch occluding with flat
nonanatomic teeth in the opposing arch has been
suggested as a means of reducing unfavourable
occlusal forces and simplifying occlusal adjustments
in complete dentures.
A line of occlusal contacts in one dental arch
opposing a flat occlusal table in the other dental arch
has the potential of creating the smallest lateral
component of force against the denture bases.

No change in the location of the contact during
lateral movements. Therefore, the direction of
force in that dental arch remains fairly constant.

Tooth positioning for lineal occlusion
The anterior teeth are arranged with no
vertical ovelap to prevent interference
in lateral and protrusive mandibular
movements.
The posterior landmark is usually the
top 1/3rd
of retromolar pad. The
occlusal plane should be kept as high
posteriorly as practical to aid in
developing protrusive balancing
contact with a flat plane of occlusion.
The lower posterior teeth are set first
and centered over the crest of the
residual ridge.

The buccal line of contacts should be set in a
straight line anterioposteriorly.
The lingual part of the mandibular posterior teeth
is positioned approximately 0.5mm below a plane
contacting the right and left lines of contact.
The maxillary posterior teeth are arranged against
the mandibular posterior teeth so that the line of
contacts of the lower teeth is centered
buccolingually. The flat occlusal surfaces of the
maxillary posterior teeth should be parallel to a
cross-arch horizontal plane.

Lingualized Occlusion
It is an attempt to maintain the
aesthetic and food penetration
advantages of the anatomic form
while maintaining the mechanical
freedom, of the nonanatomic form.
The lingualized concept utilizes
anatomic teeth for the maxillary
denture and modified nonanatomic
teeth for the mandibular denture.
The basic concepts were first
suggested by Payne. Pound
discussed a similar concept and used
the term “lingualized occlusion”.

Rationale for lingualized integration
Four factors are universal to all edentulous
patients during occlusal rehabilitation.
Maximum intercuspation must occur at the centric jaw
relation position.
An absence of deflective occlusal contacts or tooth
interferences must be observed between opposing teeth.
The arrangement and articulation of artificial tooth
forms must provide enough cusp height to permit
selective occlusal reshaping to achieve an absence of
interferences.
A natural and pleasing appearance must be achievable
with the tooth arrangement.

Indication for lingualized occlusion
It is particularly helpful when the patient places
high priority on aesthetics but a nonanatomical
occlusal scheme is indicated by oral conditions
such as severe alveolar resorption, a class II jaw
relationship, or displaceable supporting tissues.

Principles of lingualized occlusion
Anatomic posterior teeth are used for the
maxillary denture. Tooth forms with prominent
lingual cusps are helpful.
Nonanatomic or semianatomic teeth are used for
the mandibular denture.
A modification of the mandibular posterior teeth is
accomplished by selective grinding which is
always regardless of specific tooth or material.

Maxillary lingual cusps should contact mandibular
teeth in centric occlusion. The mandibular buccal
cusps should not contact the upper teeth in centric
occlusion.
Balancing and working contacts should occur only
on the maxillary lingual cusps.
Protrusive balancing contacts should occur only
between the maxillary lingual cusps and the lower
teeth.

The molds for lingualized articulation
Lingualized articulation is based on the maxillary
lingual cusp functioning as the main supporting
cusps in harmony with the occlusal surfaces of the
lower teeth.
The maxillary teeth are usually more anatomic in
appearance with greater cusp height.

Occlusal morphology of
the mandibular teeth is
usually uncomplicated and
provides the opportunity
for interdigitation of the
lingual cusps of the
maxillary teeth.
Depending on the mold
selected, some tooth forms
may require, some minor
reshaping and refinement
more common in
mandibular teeth.

Advantages of lingalized occlusion
Most of the advantages attributed to both the
anatomic and nonanatomic forms are retained.
Cusp form is more natural in appearance
compared to nonanatomic tooth form.
Good penetration of the food bolus is possible.
Bilateral mechanical balanced occlusion is readily
obtained for a region around centric relation.
Vertical forces are centralized on the mandibular
teeth.

Lingualized occlusion with cutter bars
The use of posterior teeth with metal blades has
been advocated by numerous authors. The
procedure usually recommended is to place the
metal-bladed teeth on the maxillary denture and
porcelain nonanatomic teeth on the mandibular
denture.
Lingualized occlusion provides a useful
combination of several occlusal concepts. Many
advantages of anatomic and nonanatomic
occlusions are retained. Adjustments to
compensate for minor changes in vertical and
centric relation is readily accomplished.

Monoplane occlusion
There has been increasing
references to non-anatomic
occlusion in the current dental
literature. Many authors have
inferred that a non-anatomic
tooth may be occlusion of
choice for given situations.
Jone’s, De Van’s and others
have discussed the relation of
non-anatomic teeth to the
preservation of structures of
the basal seat. www.indiandentalacademy.com

The indications for use of non-anatomic
teeth
Flat ridges
Knife edge ridge
Large interridge space
Milling type of chewing pattern with broad
excursions
Improper neuromuscular coordination.

Arrangement of monoplane posteriors in a flat
linear type of occlusion
Place the maxillary premolar and molars with their
long axis right angles to the occlusal plane. The
buccal and lingual cusps should touch the plane.
A straight edge may be used to align the lingual
cusp of all four posteriors to a straight line, when
this is done a proper buccal contour results.
Follow the same procedure in placing the posterior
on the opposite side.

Then occlude the mandibular
teeth to the maxillary teeth
there should be approximately
1.5mm of buccal by the
maxillary teeth.
The maxillary and mandibular
teeth don’t have to be
interdigitated they may be set
end to end.
For denture stability to be
increased by eliminating
cuspal inclines, and
minimizing lateral shifting of
the denture bases, the teeth
must be set in a flat,
monoplane arrangement.www.indiandentalacademy.com

Selection of posterior teeth
Shade
Buccolingual width
Mesiodistal width
Vertical height of the facial surface of posterior
teeth.
Types of posterior teeth according to material and
cusp inclines.

Guides to arrangement
of posterior teeth
Tentative arch form of
posterior teeth
Tentative buccolingual
position of posterior teeth
Leverage and posterior tooth
position
Orientation of occlusal plane

Surveying the mandibular cast
Compensatory curves

Arranging 33° anatomic maxillary
posterior teeth
Place the maxillary first premolar with its long axis at right
angles to the occlusal plane. Then place the buccal and
lingual cusps on the plane.
Place the maxillary second premolar in like manner. Align
the facial surfaces of the premolar and the canine with a
straight edge.
Have the mesiobuccal and mesiolingual cusps of the
maxillary first molar touch the occlusal plane. Raise the
distolingual cusp approximately 0.5mm from the occlusal
plane.

Raise all cusps of the second molar from the lower
occlusal plane after the positioning and angulation
of the first molar.
Follow the same procedure in placing the posterior
teeth on opposite side.
Articulation of the mandibular first molar:
Mandibular first molar is the key to in articulation.

Lingually the mesiolingual
cusp of the upper first is seated
in the central fossa of the lower
and the mesiolingual cusp of
the lower first molar fills the
embrasure between the upper
second premolar and first
molar.
The mesiobuccal inclined
plane of the lower second
molar contacts the marginal
ridge of the distobuccal cusp of
upper first molar in centric
occlusion. www.indiandentalacademy.com

The lower second premolars buccal cusps rest
between the upper first and second premolar. The
tip of the buccal cusp contact the mesial marginal
ridge of the upper second premolar in centric
occlusion shows its lingual cusp between the
upper first and second premolars.
In centric occlusion the lower first premolar is
positioned with the tip of the buccal cusp in
contact with the mesial marginal ridge of the
upper first premolar the distobuccal slope of the
lower first premolar contact and glides over the
mesiobuccal slope of the premolar in working
occlusion.

Arrangement of posterior teeth in
abnormal jaw relations
Maxillary protrusion and wider upper arch
In this situation the lower crest of the ridge in the posterior
region is lingual to the upper residual ridge. So it may give
considerable difficult in the placement of upper and lower
teeth in their correct occlusal relationship.
In such instances if the upper arch is wider than the lower
and the upper teeth are placed on the crest of the ridge,
they will make inadequate occlusal contact with the
correctly placed lower teeth.

Various methods of correction may be
employed
Is the discrepancy is very slight, the upper
teeth are moved slightly in a palatal direction
to provide a working occlusal contact with the
lower teeth.
The lower posterior teeth are correctly on the
crest of the ridge and the upper teeth are then
set so that they occlude well with the lower
teeth. The buccal contours are built on the
upper teeth in wax which is later replaced by
tooth-colored acrylic resin.
The upper posterior teeth are arranged first to
meet the requirements of esthetics. The lower
teeth are kept on the crest of the ridge.
In order to establish a functional occlusal
contact, waxed is added on the palatal aspect
of the upper posterior teeth which is later
replaced by tooth colored acrylic resin.www.indiandentalacademy.com

Arrangement of posterior teeth in
mandibular protrusion
In cases of extreme protrusion, a
negative or reverse horizontal labial
overlap is used.
Use large lower tooth mold than upper teeth.
Use slight overlapping in upper anterior
teeth is acceptable.
Upper posterior teeth can be set slightly
buccal to crest of upper ridge.
Non anatomic teeth may be used which
allow freedom in their buccolingual
placement.
Cross arch arrangement can be done by
using upper teeth on lower denture and
lower teeth on upper denture. The right
upper teeth are placed on lower left side and
vice versa.

Review of Literature
Ben L. Faber (1992) conducted a study to assess
the effect on mandibular arch width when
mandibular posterior teeth are set according to
anatomic reference points versus a physiologic
approach. A survey of U.S. dental schools was
also conducted to determine the guidelines used in
positioning mandibular posterior teeth in each
school.
He observed for the entire study population, the
physiologic measurements exceeded the anatomic
measurements by an average of 2.72mm.

He concluded that positioning mandibular
posterior teeth according to a physiologic method
results in a more buccal position of the teeth
compared with the anatomic method of placing the
teeth with the central fossa of the teeth over the
crest of the ridge.

Honorato Villa (1959) described a technique for arranging
posterior teeth according to the elliptical principle.
He suggested that all of the guiding paths for tooth
arrangement are related to the cranium and all of the
moving points that determine the paths are related to the
mandible. Therefore when the posterior teeth are arranged
the paths or cusp inclines must be determined by moving
points in the lower member of the articulator.

He said that the position of posterior teeth are
determined by several factors.
Height of the occlusal plane
Inclination of the protrusive inclines in harmony with
the inclination of the condylar and incisal guides
The direction of the working side lateral path, in
harmony with the gothic arch guidance and the
balancing side lateral condyle paths
The inclination of the working-side incline, in harmony
with the path of the condyle on the working side and
vertical displacement of the incisal guide pin in lateral
movement.
A path tracer was designed which not only traces
the paths that will determine the exact position of
each posterior tooth but also brings out the
deficiencies in incorrectly designed posterior
teeth. www.indiandentalacademy.com

Julian B. Woelfel, Judson C. Hickey and Morgan L.
Allison (1962) employed several methods to study jaw
movement during mastication: photography of the pathway
of a beam of light attached to the mandible,
kinematographic procedure, graphic and stroboscopic
methods, serial profile radiography, motion pictures of
beads fastened to the incisor teeth, cineradiography and
motion picture of the movements of plastic casts attached
outside the mouth alongside the natural teeth.

Objectives of this investigations were
To observe the chewing patterns of the
edentulous subjects.
To determine if alterations in the posterior tooth
form affected the chewing patterns
To test the effect of posterior tooth forms on
denture stability.
To obtain information on tooth contacts during
mastication

They concluded –
The masticatory cycles remained relatively constant in
size and did not increase in speed as the chewing
progressed to prepare the food for swallowing.
The many irregularities seen in the chewing cycles are
natural random variations.
The occlusal form is a factor in the stability of dentures
during mastication when the ridge conditions are not
favourable.
Opposing tooth contacts during mastication were
numerous. Thus the forms of the posterior teeth should
be in harmony with the guiding factors of mandibular
motion.

Julian B. Woelfel, Chester M. Winter and
Takayashi Igarashi (1976) conducted a five year
cephalometric study of mandibular ridge resorption
with different posterior occlusal forms. Three groups
of patients were selected,
one group of patient flat-cusped rational posterior teeth
were used.
Second group, semianatomic 20° posterior teeth were set
with a buccolingual reverse curve.
Third group of patient given anatomic 33° posterior teeth.
Each occlusion is arranged on the articulator to
provide bilaterally, balanced eccentric contacts.
The average age of patient was 49 years at the
beginning of the study and the average for years
edentulous was 3 years longer in the upper arch than
in the lower arch.

They concluded that contrary to the popular and
frequently expressed opinion that denture patients
are more comfortable and will require less post
insertion care if flat cuspid teeth are used. Here the
non anatomic group of patients needed the most
adjustments for sore spots and the most alterations
on the lower denture bases when compared to the
anatomic group.

Summary & Conclusion
At present the choice of a posterior tooth form or arrangement
for complete dentures is an empirical procedure. Little or no
supporting research is available to the profession relative to the
overall effect on the esthetics, function and long term
maintenance of the supporting tissues. Professionals document
clinical experiences in a very subjective manner and their
conclusions often conflict.
What is necessary is the development of esthetic sense by the
observation of natural dentition in function so as to be able to
create dentures that are living and not just mere artifacts.
The dental profession should continue its studies and research
efforts to provide more chewing efficiency for the most
deserving of all dental cripples “the edentulous patient”.

References
Sheldon Winkler: Essential of complete denture
prosthodontics, 2nd
Edition.
Zarb Bolender: Prosthodontic treatment for edentulous
patients, 12th
edition.
John J. Sherry: Complete denture prosthodontics, 3rd
edition.
Rudd and Marrow: Dental laboratory procedures-complete
denture, Vol.1, 2nd
edition.
Brein R. Lang: Dental clinics of North America, July 2004.
Hamish Thomson: Occlusion, 2nd
edition.
Finn Tengs Christensen: Effect of Bonwill’s triangle on
complete dentures. JPD 9: 791; 1959.

Harold Ortman: Role of occlusion in preservation and
prevention in complete denture prosthodontics, JPD 1971.
Arthur R. Roraff: Arranging artificial teeth according to
anatomic landmarks, JPD 38: 120; 1977.
Donald G. Grones: Lineal occlusal concepts for complete
dentures, JPD 32: 122; 1974.
B.K. Goyal, K. Bhargava: Arrangement of artificial teeth in
abnormal jaw relation – Maxillary protrusion and wider upper
arch, JPD 32: 107; 1974.
Julian V. Walpel, Christer M Winter: 5 years cephalometric
study of mandibular ridge resorption with different posterior
occlusal forms, JPD, 36: 602; 1976.
Honarato Villa A.: Technique for arranging posterior teeth, JPD
9: 803; 1959.
Honarato Villa A.: Adaptability of posterior teeth, JPD 9: 810;

Julian B. Woelfel, Judson C. Hickey: Effect of posterior
tooth form on jaw and denture movement. JPD 12: 922;
1962.
Ben L. Faber: Comparison of an anatomic versus
physiologic method of posterior tooth placement for
complete dentures, JPD 67; 410: 1992.
M.A. Pleasure: Anatomic versus nonanatomic teeth, JPD 3:
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