Balanced occlusion / dental implant courses by Indian dental academy

BALANCED OCCLUSION AND ITS IMPORTANCE
IN COMPLETE DENTURE FABRICATION
INDIAN DENTAL ACADEMY
Leader in Continuing Dental Education
www.indiandentalacademy.com

ContentsContents
 Introduction
 Definitions
 Requirements of complete denture occlusion
 Concepts of occlusion (ie spectrum of occlusion and
complete dentures)
 Balanced occlusion: Definition
Pre-Requisites
Pro and Cons

 Parameters to success of occlusal balance
 Types
 Hanaus Law of articulation
 Steps
 Contacts in balanced occlusion: Selective grinding
 Balancing Ramps
 Review of literature
 Summary & conclusion
 References

INTRODUCTION

“A judicious selection and use of teeth is
necessary to obtain stable occlusion in
harmony with the function and the state
of the supporting structures”

Definitions:Definitions:
Occlusion:
Is defined as any contact between the incising or
masticating surfaces of the maxillary and mandibular
teeth.-GPT
According to Heartwell this is a static position and the
jaws can be in either centric or eccentric relation.
Every time the teeth contact there is a resultant force
which may vary in magnitude and direction.

Dental Articulation:
The static and dynamic contact relationship
between the occlusal surfaces of the teeth
during function.-GPT
Centric Occlusion:
Refers to the relationship of the mandible to
the maxilla, when the teeth are in maximum
occlusal contact, irrespective of the position or
alignment of the condyle disk assemblies. This
is also referred to as the acquired position of
the mandible or the maximum interocclusal
position. (MIOP).www.indiandentalacademy.com

“When the intercuspation of the teeth is in
harmony with both correctly positioned
and aligned condyle-disk assemblies,
centric relation and centric occlusion are
the same. This is the goal of occlusal
treatment.”

Requirements of complete denture occlusion:
-Stability of occlusion at centric relation position and in an
area forward and lateral to it.
-Balanced occlusal contacts bilaterally for all eccentric
mandibular movements.
-Unlocking the cusps mesio-distally to allow for gradual but
inevitable settling of the bases due to tissue deformation and
bone resorption.
-Control of the horizontal force by buccolingual cusp height
reduction according to residual ridge resistance form and
interarch distance.

-Functional lever balance by favourable tooth-ridge crest
position.
-Cutting, penetrating, and shearing efficiency of occlusal
surfaces.
-Anterior incisal clearance during all posterior masticatory
function and bruxing activity.
-Minimum occlusal contact areas for reduced pressure in
comminuting food (lingual contact occlusion).
-Sharp ridges or cusps and generous sluiceways to shred food
with the minimum of force necessary.

Requirements for balancing occlusal unitsRequirements for balancing occlusal units::
-They should contact on the 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 a smooth gliding contacts for lateral and
protrusive excursions.

Axioms for Artificial occlusion: (Sears)
1. The smaller the area of occlusal surface acting on
food the smaller will be the crushing force on food
transmitted to the supporting structures.
2. Vertical force applied to an inclined occlusal surface
causes non vertical force on the denture base.
3. Vertical force applied to a denture base supported by
yielding tissue causes the base to teeter when the
force is not centered on the base.
4. Vertical force applied outside to the ridge crest
creates tipping force on the base.
5. Vertical forces applied to inclined supporting tissues
will cause non-vertical forces on the denture base.www.indiandentalacademy.com

The occlusal spectrum and complete dentures:The occlusal spectrum and complete dentures:
occlusal schemes in use today:
-Balanced occlusion: -Non-balanced occlusion
Anatomic Spherical occlusion
Semianatomic Organic occlusion
Non-anatomic Transiographics
Lingualised Lingualised

Anatomic (Balanced)
Occlusion
Semi-anatomic
(balanced)
Lingualized Occlusion
Non-anatomic (balanced)
Neutrocentric
Occlusion
Advantages Disadvantages
1. Better Esthetics
2. Ease of Penetration (Decreased
vertical stress)
3. Denture stability during
parafunctional movements
1. Less esthetic
2. Poor penetration (Feel dull,
increased vertical forces on ridge)
3. Encourage lateral chewing
component.
Disadvantages Advantages
1. Precise records, Exact mountings
required.
2. Greater lateral forces on inclines
(more bone deformation)
3. Results short level
4. Harder to adjust
1. Simpler technique, less precise
records.
2. Decreased lateral forces
3. Faster to adjust (sandpaper)
4. Permits area of closure
5. Good for class II and III jaw
relations.
6. Good stability, forces centralized
and neutralized.www.indiandentalacademy.com

Balanced Occlusion:Balanced Occlusion:
It is defined as “The simultaneous contacting of the maxillary
and the mandibular teeth on the right and left side and in
the posterior and anterior occlusal areas in centric and
eccentric positions, developed to lessen or limit the tipping
or rotating of the denture base in relation to the supporting
structures.-GPT

-When forces act on a body in such a way that no
motion results, there is balance or equilibrium.
-A stable base is the ultimate goal. Total stability is
not possible because of the yielding nature of the
supporting structures.
Following axioms should be considered:
1. The wider and larger the ridge and closure the
teeth are to the ridge, the greater the lever balance.
2. Conversely, the smaller and narrower the ridge
and the farther the teeth are placed from the ridge
the poorer the lever balance.

3.The wider the ridge and the narrower the teeth, the greater
the balance.
4.Conversely, the narrower the ridge and wider the teeth the
poorer the balance.
5.The more lingual the teeth are placed in relation to the
ridge the better the balance.
6.The more buccal the teeth are placed to the ridge crest, the
poorer the balance.
7.The more centered the force of occlusion anterior-
posteriorly, the greater the stability of the base.

Balanced occlusion involves a definite arrangement of tooth
contacts in harmony with the mandibular movements.
If the positions, dimensions and occlusal surfaces of the teeth
are such that during functional jaw movements; mandibular
cusp blades contact maxillary cusp blades throughout the
dentures, those dentures can perform their masticatory
function most effectively, and their occlusion can be termed
as balanced occlusion….

Pre-Requisites for balancing:
1.Mandibular posterior teeth must be set so that occlusal
surfaces are horizontal.
2.Plane of occlusion must have a proper orientation.
3.A compensating curve must be set.
4.Teeth must be modified so that there are no interlocking
transverse ridges.

Pros and Cons –Bilateral Balanced Occlusion:
“Enter bolus, exit balance” has cast suspicion as to
whether smooth, gliding, non-interfering, bilateral
tooth contacts are possible. It implies that occlusal
balance is impossible during mastication.
Brewer and Hudson (1961) have shown that complete
denture teeth do contact at times during
mastication.

Pros:
1.The contact varies in frequency with different foods and
different persons. If this contact is interruptive and deflective;
and not bilateral, the denture base will not be stable. Hence,
bilateral balanced contacts during the terminal arc of closure
help to seat the denture in a stable position.
2.Also bilateral balanced occlusion is important during
activities such as swallowing saliva, closing to reseat the
dentures, and the bruxing of the teeth during times of stress.
3.Patient with a balanced design do not upset the normal static,
stable and retentive qualities of their dentures.
4.In bilateral balance the bases are stable during bruxing
activity and they are tight when the patient separate the teeth.

Cons:
There are some possible disadvantages of bilateral balanced
articulation:
1.It may tend to encourage lateral and protrusive grinding,
although this habit may be confined to those people who are
subjected to irrelevant muscle activity.
2..It is difficult to achieve in mouths where an increased vertical
incisor overlap is indicated, and is better to retain the vertical
overlap, than to sacrifice it in order to achieve articular
balance.
3.A semi-adjustable or fully adjustable articulator is required.

Parameters to success of occlusal balance:
1.Accurate record of relation of maxilla to T.M.J. (which is
registration of 3 dimensional spatial relation of maxilla to
T.M.J. to maintain biological soundness of the joint.)
2.Optimal relation of condyles.
3.Bilateral muscle balance of horizontal movers of the
mandible.
4.Eccentric relation record of functional protrusion of the
mandible.

Types of Balanced Occlusion:
Balance may be: Unilateral, bilateral, or protrusive.
Unilateral lever balance:
This is present when there is equilibrium of base on its
supporting structures when a bolus of food is interposed
between teeth on one side and space exists between teeth on
the opposite side…

Unilateral occlusal balance:
This is present when occlusal surfaces of the teeth on one side
articulate simultaneously with smooth uninterrupted glide.

Bilateral occlusal balance:
-This is present when there is
equilibrium on both sides of
denture due to simultaneous
contact of teeth in centric and
eccentric occlusion.
-It requires a minimum of three
contacts. The more the contacts
the more assured the balance.

Protrusive occlusal balance:
-This is present when the mandible moves essentially forward
and occlusal contacts are smooth and simultaneously in
posterior region both on right and left sides as well as anterior
teeth.
-It requires a minimum of three contacts, one on each side
posteriorly and one anteriorly

-The tooth size and position in relation to the ridge size and
shape.
-The extent of denture base coverage.
-Occlusal balance with stable contacts at the retruded border
position and in an area anterior to it.
-Right and left eccentric occlusal balance by simultaneous
contacts at the limit of functional and parafunctional activity.
-Intermediate occlusal balance for all positions between centric
occlusion and all other functional or parafunctional excursions
to the right and left and protrusive.

‘Rudolph L.Hanau’ proposed nine factors that govern
the articulation of artificial teeth.
-Laws of articulation.
-Hanaus Quint

Hanau’s QuintHanau’s Quint

Trapozzano’s Concept:Trapozzano’s Concept:

Bouchers concept:
Occlusal plane be located exactly as it was when the natural
teeth were present.
States that:
-There are 3 fixed factors :
1. The orientation of the occlusal plane, the incisal guidance,
and the condylar guidance.
2. The angulation of the cusp is more important than the
height of the cusp.
3. The compensating curve enables one to increase the effective
height of the cusps without changing the form of the teeth.

Lotto’s concept:
“Related the laws of occlusion, by relating them to the
posterior separation which is a result of the guiding
factors”……

Authors Concept:Authors Concept:

Condylar guidance:Condylar guidance:
“The condylar path should be
determined on the patient
and set on the instrument so
that the patients TMJ is in
harmony with the occlusion
as programmed on the
articulator”.

Incisal guidance:Incisal guidance:
This is defined as “The
influence of the
contacting surfaces of
the mandibular and
maxillary anterior teeth
on mandibular
movements”-GPT.

Plane of occlusion:Plane of occlusion:
It is defined as “An imaginary
surface which is related
anatomically to the cranium
and which theoretically
touches the incisal edges of the
incisors and the tips of the
occluding surfaces of the
posterior teeth. It is not a
plane in the true sense of the
word but represents the mean
curvature of the surface”.-
GPT

Compensating curve:Compensating curve:
It is defined as “The anteroposterior and lateral curvatures in
the alignment of the occluding surfaces and incisal edges of
artificial teeth which are used to develop balanced occlusion”.-
GPT
Determined by the inclination of the posterior teeth and their
vertical relationship to occlusal plane so that occlusal surface
results in a curve that is in harmony with the movement of the
mandible as guided by the condylar path.

Inclination of the cusps:Inclination of the cusps:
These are important determinants, as they modify the effect of
plane of occlusion and the compensating curve.
The mesiodistal cusp heights that interdigitate and lock the
occlusion so that resorption of the teeth due to settling of the
bases cannot take place.
To prevent this, it is advocated that mesiodistal cusp heights be
eliminated in anatomic type teeth.
The cusp of teeth modify the plane of occlusion and
compensating curve

Steps involved in balancing:Steps involved in balancing:
-The teeth have to be inclined to develop a balanced occlusion.
-The upper and lower incisal units meet only when the
mandibular teeth are protruded and protrusive balancing unit
functions only when upper and lower units contact.
-To develop a balanced occlusion one needs an adjustable
articulator which should:
-Receive a face-bow transfer.
-Adjust to individual inter condylar guidance.
-Have an adjustable incisal guide table.

-To adjust the articulator requires:
-A centric relation relation record.
-Eccentric protrusive record.
-Right and left lateral relation records are desirable if the
articulator is capable of accepting the records.
-If the articulator will not receive the lateral records (Hanau
type) then lateral condylar guidance is calculated as:
L = H/8 + 12

Selective grinding for centric contacts:Selective grinding for centric contacts:
-After the complete arrangement of teeth, place an articulating
paper and tap the articulator.
Only the lower central fossa or marginal ridges should be
ground not the upper lingual cusps.
-If any upper buccal cusps or inclines are in contact, they
should be ground out of contact.
“The final result should be upper lingual cusp in common lower
central fossa”.

Selective grinding for working and balancingSelective grinding for working and balancing
contacts:contacts:
There should be working and balancing contacts that are in
harmony with guidance of condylar inclination and incisal
guidance.
If the mandible moves to left, the upper left lingual cusps
should contact lower left lingual cusps (on working side) and
the upper right lingual cusps contact lower buccal cusps
(balancing side).
‘If any prematurity exist, selective grinding is done’.

-“BULL Principle”
-In anterior teeth, lingual of upper and labial surface of lower
teeth is grinded to eliminate any interference.
-Final result should be smooth gliding lateral excursion with
five working and five balancing contacts.
-The multiple contacts should be smooth, uniform and in
harmony with the TMJ’s and the neuro-muscular activity.

Balancing ramps in non-anatomic complete dentureBalancing ramps in non-anatomic complete denture
occlusionocclusion::
-Non anatomic teeth have no cusp inclines.
-flat plane with no overbite.
-Inclined molar technique
-Improvement of above technique , by using balancing ramps.
Two techniques.
-Tripodization of the dentures

Review of Literature

Finn Tengs Christensen (1960) described the importance of
balanced occlusion in arrangement of teeth. He stressed the
introduction of compensating curves for achieving balance.
-In order to achieve balance, the compensating curve must be
in harmony with other factors.
-This is determined by ‘Thielmanns’ formula of occlusion
which is expressed as: KI
OP.C.O.K.
-By means of compensating curves, complete antagonist contact
during protrusive movements can be obtained with lower cusp
angulation.
-’So the orientation in one factor influences the other’.www.indiandentalacademy.com

Vincent R. Trappozano(1960) carried out tests to check the
efficiency of balanced and non-balanced occlusion.
-He selected few patients depending on inter-ridge space,
intelligence and experience of wearing dentures and on basis of
type of residual ridge. Patients were from 55 years to 70 years.
-All had worn dentures with 23degrees posterior teeth in
balanced occlusion.
- Comparative chewing tests of occlusal efficiency were made
with carrots and freshly roasted peanuts.
-These were selected as test foods because they don’t readily
disintegrate into fine particles.www.indiandentalacademy.com

-The number of strokes made upto time of deglutition were
counted and averaged.
-The average was noted for each patient and this was the
number of strokes permitted.
-A 100 mesh screen was used as sieve to study the size of
remaining particles and weight changes in test materials after
mastication by the patient.
-Out of 12 patients examined, 9 patients had greater efficiency
of chewing with balanced occlusion.
- In 3, efficiency was greater with non balanced occlusion when
carrots were chewed. When peanuts were chewed no difference
was noticed.

Honorato Villa(1962) recommended a technique for the use of
non-anatomic posterior teeth. He used the incisal guidance for
attaining balanced occlusion.
-The lower bicuspids were placed first on lower occlusal rims.
The two bicuspids represent the central transverse axis.
-When cusps are placed against a flat plane, there will be
balancing contacts only in working position and not in
protrusive and balancing positions.

-A groove is made in upper denture where the lower cusp will
occlude, inorder to overcome the difficulty and this makes the
balanced occlusion possible in protrusive and lateral occlusion.
-The logistic behind this arrangement is that balancing incline
requires less inclinations when it is placed on upper first
bicuspid instead of second molar because of anterior position of
bicuspid.

H.O. Beck (1973) grouped the balanced and non-
balanced occlusions into five categories each.
Non-balanced occlusions are:
a. Modified cusp teeth with upper lingual cusps
opposing widened lower fossa and a reduction of
buccal cusps of lower posterior teeth.
b. Cusp teeth arranged in typical occlusion with
disocclusion by cuspid guidance in eccentric positions.
c. Non-anatomic teeth arranged in flat occlusal plane
anteroposteriorly and laterally.
d. Non-anatomic teeth arranged high in second and
first molar regions.
e. Non-anatomic teeth arranged in flat plane anteriorly
but with reverse lateral curve.

Five balanced occlusions are:
a. Anatomic and semi-anatomic teeth arranged in classic
interdigitations.
b. Semi anatomic teeth with buccal reduction of lower posterior
teeth.
c. Non-anatomic teeth arranged on curves anteroposteriorly
and laterally.
d. Non-anatomic teeth arranged reverse curve laterally but with
second molar ramps for balancing contacts.
e. Semi-anatomic teeth with only a linear contact of lower
posterior teeth with upper occlusal surfaces balanced
anteroposteriorly and laterally.

‘Sir Willford Fish’ described a denture as having three
surfaces playing an independent role in the fit and stability
of dentures.
-The first two are impression and occlusal surfaces. The
third termed by Fish is the polished surface.
-It is the denture base material and teeth surfaces which
come in contact with the cheeks, lips and tongue.

L.G. Jordan (1978) described the Hanaus Quint while
describing the factors of balanced occlusion.
Hanau prepared a scientific summary of possible influence of
each of the factors of articulation on established tooth
arrangement and balanced occlusion.
He termed his statements as ‘Laws of Articulation’.
His statements were assembled into a condensed form in
Hanaus Quint
The Quint describes the changes to be carried out in factors
corresponding to changes in other factors.

SummarySummary
The nature of the supporting structures for the complete
dentures and the forces directed to them by the occlusion
creates a special biomechanical problem.
Balanced occlusion is one of the most important factors
which will favor the stability of the base; and help in
preservation of the supporting structures by reducing the
lateral forces.
“ Thereby signifying its importance in complete denture
fabrication.”

ConclusionConclusion
“Regardless of ones 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”.

References:References:
-Arthur N.: Balancing ramps in non-anatomic complete denture occlusion.
JPD,1985;53:431-433.
-Beck H.O.: Occlusion as related to complete removable prosthodontics.
JPD,1972;27:246-256.
-Becker C.M., Swoop P.C.: Lingualised occlusion for removable
prosthodontics.JPD,1977;38:601-608.
Bernard Levin: Reevaluation of Hanaus Laws of Articulation and the
Hanaus Quint. JPD,1978;39:254-258.
-Bolender-Zarb: Prosthodontic Treatment For Edentulous Patient,12th
Edition, 2004 Mosby.
-Dawson P.E.: Evaluation, diagnosis and treatment of occlusal problems,2nd
edition, 1989 Mosby.
Gregory R.P., Gerald H.L.: The Occlusal Spectrum and Complete
Dentures.
-Heartwell Charles M.:Sylabbus of complete dentures.www.indiandentalacademy.com

-Kydd W.L.: Comlete debture base deformation with varied
occlusal tooth form. JPD., 1959;6:714-718.
-Kurth L.E.: Balanced Occlusion. JPD’1954’4:150-167.
-Ramjford S. and Ash: Occlusion
-Sharry J.J.: Complete Denture Prosthodontics;1962 McGraw-
Hill Book Company.
Sheldon Winkler: Essentials of complate denture
prosthodontics2nd Edition;2000, Ishiyaku EurAmerica Inc.
U.S.A.
-Trappozano V.R.: An experimental study of the testing of
occlusal patterns on the same denture bases. JPD.;1952; 440-
457.

Thank you

Balanced occlusion / dental implant courses by Indian dental academy

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