Lingualized

1. Lingualized Occlusion For Removable
Prosthodontics
Presented by:
Dr. Mujtaba Ashraf
MDS II
Becker CM, Swoope CC, Guckes AD
J Prosthet Dent 1977;38:601-8
Journal Club Presentation
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2. Introduction
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3. The literature is filled with discussions of the
various types of occlusal forms and posterior tooth
arrangements.
The search for the ideal denture occlusion has
been going on for almost two centuries in an effort
to find the tooth form which provides maximum
denture stability and masticatory efficiency
without compromising the health of the underlying
bone.
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4. Prof. Alfred Gysi was first to design
and patent “Cross-Bite Posterior
Teeth” in 1927 . Each maxillary
tooth featured a single, linear cusp
that fit into shallow mandibular
depression. So the Concept of
lingualized occlusion was
introduced by A. Gysi in 1927.
Maxillary posterior teeth featured single,
linear cusps that fit into shallow mandibular
depressions.
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5. Today, the available occlusal forms can be
classified into three major groups :
• anatomic- 30 degree cusps,
• semianatomic- 20 degree cusps,
• nonanatomic or cuspless- 0 degree cusps
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6. Advantages of various cusp forms suggested in the literature
Cusp Form Advantages
Anatomic
occlusion
• Penetrates food more easily
• Resists the rotation of denture bases through cusp
interdigitation
• Provides better esthetics
• Acts as a guide for proper jaw closure
Non-anatomic
occlusion
• Does not lock the mandible in one position
• Permits the use of less time consuming
techniques
• Minimizes horizontal stress because of the
absence of inclined planes
• Adapts easily to Classes II and III jaw relations
• More easily adjusted after changes in vertical and
horizontal relations
• Easier to arrange in crossbite19 July
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7. Cusp Form Disadvantages
Anatomic
occlusion
• More occlusal disharmony during settling and
difficult to correct by adjustment
• Precise jaw closure and base stability required for
interdigitation
• Increased horizontal forces
• Difficult to adapt to abnormal jaw relationships
Non-anatomic
occlusion
• Poor esthetics
• Decreased masticatory efficiency
• More difficult to obtain balanced occlusion
• Psychological
Disadvantages of various cusp forms suggested in the literature
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8. LlNGUALlZED OCCLUSION
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9. Lingualized occlusion is an attempt to maintain the
esthetic and food-penetration advantages of the
anatomic form while maintaining the mechanical
freedom of the non-anatomic form.
The lingualized concept utilizes anatomic teeth for the
maxillary denture and modified non-anatomic or
semi-anatomic teeth for the mandibular denture
Lingualized occlusion should not be confused with
placement of the mandibular teeth lingual to the ridge
crest, as suggested by several authors. 19 July
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10. Lingualized Occlusion has been defined as “a form
of denture occlusion that articulates the maxillary
lingual cusps with the mandibular occlusal surfaces
in centric, working, and nonworking mandibular
positions. GPT-9
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11. EVOLUTION
 Gysi was first to report the biomechanical advantages of
lingualized tooth forms (1927).
 The basic concepts of lingualized occlusion were first
suggested by Payne (1941).
 Pound discussed a similar occlusal concept and used the term
“lingualized occlusion” (1973).
 Ortman, Murrell, Becker, and Kelly provided additional
support for this occlusal concept (1977).
Parr GR, Loft GH. The occlusal spectrum and complete dentures. Compend Contin Educ Dent 1982; 3:241-50
Parr GR, Ivanhoe JR. Lingualized occlusion:an occlusion for all reasons. Dent Clin North Am 1996;40:103-12
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12.  Gysi designed and patented
“Cross-Bite Posterior Teeth” in
1927.
 Each maxillary tooth featured a
single, linear cusp that fit into a
shallow mandibular depression.
 These teeth were reasonably
esthetic, easy to arrange, and
encouraged vertical force
transmission via their mortar-
and-pestle anatomy.
Gysi’s Cross-bite Posterior Teeth
Gysi A. Special teeth for cross-bite cases.Dent Digest 1927;33:167-71
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13.  By 1935, Dr. FA French had patented
his “Modified Posterior Teeth”.
 The maxillary teeth featured shallow
fossae, while the mandibular teeth
displayed narrow, planar occlusal
surfaces.
French FA. The problem of building satisfactory dentures. J Prosthet Dent 1954;4:769-81
Dr. French’s Modified Posterior Teeth
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14. PAYNE’S CONCEPT
 This changed in 1941, when
Dr. SH Payne introduced a
more cogent form of
lingualized occlusion.
 According to Payne’ article,
a mortar-and-pestle
arrangement was created via
judicious recontouring of
30-degree teeth.
Payne SH. A posterior set-up to meet individual requirements. Dent Digest 1941;47:20-2
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15.  The maxillary lingual
cusps maintained
contact with the
mandibular teeth in
eccentric movements.
 In contrast, the
maxillary buccal cusps
did no contact to the
opposing teeth during
mandibular movements.
Payne SH. A posterior set-up to meet individual requirements. Dent Digest1941;47:20-2
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16. POUND’S CONCEPT
 Pound also championed
lingualized occlusion in his articles
and presentations.
 Pound used maxillary teeth having
cusp angles greater than 30
degrees in conjunction with
mandibular teeth having cusp
angles of 20 degrees or less.
 He carefully reshaped mandibular
fossae to produce cross-arch
balance.
Pound E. Utilizing speech to simplify a personalize denture service. J Prosthet Den1970;24:586-600
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17.  Pound ensured that maxillary
buccal cusps did not contact
mandibular teeth during
eccentric mandibular
movements.
 He accomplished this by
reducing the facial surfaces of
the mandibular posterior teeth
rather than elevating the buccal
cusps of the maxillary teeth.
Though the method for eliminating maxillary buccal contact was
dissimilar, the mechanical results were nearly identical to those described
by Payne.
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18. OBJECTIVE
In a lingualized occlusion scheme, the objective is the
elimination of buccal cusp contacts in order to
alleviate lateral stresses or lateral dislodging forces.
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19.  The lingual cusps of the upper posteriors make contact in
centric relation in the central fossae of the lower
posteriors.
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20. The buccal cusps are out of
contact; however the lingual cusps
are in contact in centric, working
and balancing movements.
For this reason, all the stresses
created during working and
balancing motions are of a
downward nature, thus creating
stability.
Working Side
Balancing Side
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21. INDICATIONS FOR LINGUALIZED OCCLUSION
• Lingualized occlusion can be used in most denture
combinations.
• It is particularly helpful when the patient places high
priority on esthetics but non-anatomic occlusal
scheme is indicated because oral conditions such as
severe alveolar resorption, a Class II jaw relationship,
or displaceable supporting tissue.
• If the non anatomic occlusal scheme is used, esthetics
in the premolar region are compromised. With
Lingualized occlusion, the esthetic result is greatly
improved while still maintaining the advantages of a
non-anatomic system.
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22. A monoplane occlusal scheme limits esthetic results in the
premolar region.
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23. A lingualized occlusion provides improved esthetics in
the premolar region. 19 July
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24. Lingualized occlusion also can be used
effectively when a complete denture opposes a
removable partial denture.
Patients having parafunctional habits, so that
reduced amount of horizontal forces are
transmitted to supporting tissues.
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25. Implant-supported overdentures to eliminate lateral
forces that can rock abutments loose over time.
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26. PRINCIPLES
1. Anatomic posterior (30 or 33 degree) teeth are used for
the maxillary denture.
 Tooth forms with prominent lingual cusps are helpful.
2. Non-anatomic or semi-anatomic teeth are used for the
mandibular denture.
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27.  Either a shallow or flat cusp form is used.
 A narrow occlusal table is preferred when severe
resorption of the residual ridges has occurred.
3. Maxillary lingual cusps should contact mandibular
teeth in centric occlusion.
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28. Modification of the mandibular posterior teeth is
accomplished by selective grinding which is
always necessary regardless of specific tooth or
material.
Selective grinding smooth the central fossae of the
mandibular teeth, lowers marginal ridges, and
forms slight buccal and lingual inclines
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29.  The mandibular buccal cusps
should not contact the upper
teeth in centric occlusion, as
is customary with usual
anatomic tooth placement.
 It is helpful to slightly rotate
the maxillary posterior teeth
buccally to allow for slight
clearance of the buccal cusps
in the working position and
to reduce the need for
extensive grinding 19 July
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30. 4. Balancing and working contacts should occur only on the
maxillary lingual cusps.
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31. Working Side Balancing Side
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32. Reduction of antero-posterior interferences on the
mandibular teeth may be necessary in order to
provide a range of balanced occlusion in the
protrusive position.
Selective grinding for should be done
only on the mandibular teeth so that
lateral balancing contacts and the
vertical dimension of occlusion are not
changed.
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33. A wide variety of cusped and non-cusped tooth
forms may be used to create arrangements that may
be considered to be lingualized occlusion.
Generally, maxillary teeth with cusp angles of ≥30
degrees are opposed by mandibular teeth displaying
cusp angles of ≤20 degrees.
Some of the most popular combinations include 30-
to 33-degree cusp designs for maxillary teeth and 0-
degree cusp designs for mandibular teeth.
BalancingWorking
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34. Advantages of Lingualized Occlusion
 Most of the advantages attributed to both the anatomic
and non-anatomic forms are retained.
 Cusp form is more natural in appearance compared to
non-anatomic 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.
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35. Summary
 Lingualized occlusion provides a useful combination
of several occlusal concepts.
 Many advantages of anatomic and non-anatomic
occlusions are retained. Adjustment to compensate for
minor changes in vertical and centric relation is
readily accomplished.
 Satisfactory occlusion is easily obtained, and balanced
occlusion can be accomplished.
 The lingualized occlusal concept is not a panacea, and
all other procedures still must be carefully executed.
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36. References
 1. Sears, V. H. : Chewing Members, J. PROSTHET. DENT. 1: 761-
763, 1951. (Historical reprint of an original paper presented in 1922.)
 2. Hall, R. E.: The Inverted Cusp Tooth, J. Am. Dent. Assoc. 18:
2366-2368, 1931.
 3. Hardy, I. R.: The Development in the Occlusal Patterns of
Artificial Teeth, J. PROSTHET. DENT. 1: 14-28, 1951.
 4. Sears, V. H.: Thirty Years of Non Anatomic Teeth, J. PROSTHET.
DENT. 3: 596-617, 1953.
 5. Rapp, R.: The Occlusion and Occlusal Patterns of Artificial
Posterior Teeth, J. PROSTHET. DENT. 4: 461-480, 1954.
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