Concepts of occlusion in prosthodontics: A literature review,

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1 Review Article Concepts of occlusion in prosthodontics: A literture review, prt II V. Rngrjn, P. B. Yogesh, B. Gjpthi, M. Mohmed Irhim, R. Gnesh Kumr, Murli Krthik Deprtment of Prosthodontics, Sri Venkteswr Dentl College nd Hospitl, Chenni, Tmil Ndu, Indi Astrct This series of rticles descries out concepts of occlusion in the complete denture, fixed prtil denture, nd implnts. This rticle discusses out the evolution of different concepts of nonlnced occlusion nd occlusl schemes in complete denture occlusion. Key Words: Articultion, lnced occlusion, nonlnced occlusion Address for correspondence: Dr. P. B. Yogesh, Deprtment of Prosthodontics, Sri Venkteswr Dentl College nd Hospitl, Thlmur, Chenni, Tmil Ndu, Indi. E mil: yogu_mds@yhoo.com Received: 07 th June, 2015, Accepted: 14 th June, 2015 INTRODUCTION In continution with concepts of occlusion in prosthodontics prt I where concepts developed to chieve lnced rticultion were descried, now the different concepts developed to ttin the non lnced occlusion re descried with their merits nd demerits. [1] Nonlnced rticultion [1] Vrious concepts proposed to ttin nonlnced rticultion. Those re: Pound s concept [1] Mxillry posterior teeth should hve shrp pltl cusps which should occlude with opposing widened centrl fosse of the mndiulr posterior teeth to eliminte the deflective occlusl contcts in processed dentures nd the teeth should hve gold occlusl inlys to mintin verticl dimension t occlusion. Accurte retentive denture ses re requirement in this concept. Quick Response Code: Access this rticle online Wesite: ips.org In centric occlusion, the occlusl contct forces re directed towrd the ridges [Figure 1]. In the right lterl position, the uccl cusps on the working side re out of contct nd the occlusl contct forces re directed towrd the lingul side of the lower ridge. There is tendency of shifting of denture ses on the lncing side [Figure 1]. Aull s concept [1] Fetures Artificil mxillry posterior should hve 33 cusp form teeth with full gold occlusl surfce Anterior teeth rrnged to meet the requirements of phonetic vlues Chrcteristic of this concept is recording pntogrphic trcing nd trnsferring it to rticultor to eliminte deflective contcts in the posterior rrngement Accurte retentive denture ses re requirement in this concept. In centric occlusion, the contct forces re directed towrd This is n open ccess rticle distriuted under the terms of the Cretive Commons Attriution NonCommercil ShreAlike 3.0 License, which llows others to remix, twek, nd uild upon the work non commercilly, s long s the uthor is credited nd the new cretions re licensed under the identicl terms. For reprints contct: reprints@medknow.com DOI: / How to cite this rticle: Rngrjn V, Yogesh PB, Gjpthi B, Irhim MM, Kumr RG, Krthik M. Concepts of occlusion in prosthodontics: A literture review, prt II. J Indin Prosthodont Soc 2016;16: The Journl of Indin Prosthodontic Society Pulished y Wolters Kluwer - Medknow

2 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II the ridges [Figure 2]. In the right lterl position, the cnine guidnce disocclude the posterior teeth [Figure 2]. Hrdy s concept [1] Fetures Nonntomic mxillry nd mndiulr posterior teeth re rrnged in flt plne with minimum overite Mstictory forces re directed towrd the ridge ilterlly in centric occlusion [Figure 3]. In right lterl position, only the uccl cusps on the working side contct if the pth of the condyle is not prllel to the occlusl plne. Tilting of the ses my result if extreme gliding contcts re mde [Figure 3]. Ser s concept [1] Fetures Occlusl pivots were introduced y Ser s Pivot s plce the mndile in equilirium y mintining the occlusl lod in the molr regions Occlusl contct forces re lso reduced in the nterior region of the residul ridges. In centric occlusion, occlusl contct forces re directed towrd the ridges. Pivoting in the posterior region of flt occlusl plne hs een used to reduce temporomndiulr joint symptoms [Figure 4]. In right lterl position, only the working side pivot will contct if the pth of the condyle on the lncing side is not prllel to the occlusl plne [Figure 4]. Kurth s concept [1] Fetures Artificil posterior teeth rrnged incorporting the reverse lterl curve This concept utilizes posterior tooth locks in series of four teeth which were rrnged on flt occlusl plne with reverse lterl curve nd posterior rmp. In centric occlusion, the contct forces re directed towrd the lingul side of the lower ridge [Figure 5]. In the right lterl position, the occlusl contct forces directed towrd the ridges on the working side [Figure 5]. Lingulized rticultion [2,3] In 1927, Gysi introduced the concept of lingulized rticultion. In 1941, Pyne reported on Frmer s posterior setup tht used 30 cusp teeth tht were selectively reshped to fulfill the concept of lingulized rticultion nd meet the individul requirements of edentulous ptients. In effect, the occlusion is lingulized y the elimintion of contcts on the uccl cusps nd y the nteroposterior rrngement of lower posterior teeth so tht their lingul surfces re on or within the lingul side of tringle from the mesil re of the lower cuspid to the sides of the retromolr pd. [2] Lingulized occlusion is developed to mintin the food penetrtion dvntges of the ntomic form while mintining the mechnicl freedom of the nonntomic form. The lingulized concept utilizes ntomic teeth for the mxillry denture nd modified nonntomic or semi ntomic teeth for the mndiulr denture. [3] Antomic posterior occlusl rrngements hve the mndiulr uccl cusps occluding in the mxillry centrl fosse nd the mxillry pltl cusps occluding in the mndiulr centrl fosse [Figure 6].With lingulized occlusions, only the upper lingul cusps occlude in the mndiulr centrl foss. The Figure 1: () Pound s concept: In centric occlusion. () Pound s concept: Right lterl position Figure 2: () Aull s concept: In centric occlusion. () Aull s concept: In right lterl position Figure 3: Hrdy s concept: In centric occlusion. () Hrdy s concept: In right lterl position Figure 4: () Ser s concept: In centric occlusion. () Ser s concept: In right lterl position The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1 9

3 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II mxillry posterior teeth re rotted slightly to void ll contct of the uccl cusps [Figure 6]. If the horizontl overlp is 3 4 mm etween the nterior teeth, lnced occlusion cn e chieved efore nterior tooth contct t mximum intercusption. Estheticlly verticl overlp of the teeth cn e incresed [Figure 7]. When little horizontl overlp etween the nterior teeth is cceptle, then the verticl overlp must e reduced to zero to ttin lnced occlusion [Figure 8]. Protrusive movement is possile while mintining lnced occlusion with miniml verticl overlp of the nterior teeth [Figure 9]. In left lterl excursive movements, only the mxillry pltl cusps mke contct. Selective grinding of the mxillry uccl cusps my e needed to crete clernce etween the mxillry nd mndiulr uccl cusps [Figure 10]. Indictions High priority on esthetics ut nonntomic occlusl scheme is indicted Severe residul ridge resorption Clss II jw reltionship Fly supporting tissue When complete denture opposes removle prtil denture. The need for ilterl lnced occlusion is sed on more fvorle stress distriution during prfunctionl hits. Nocturnl occlusl prfunction cn e eliminted y removl of the dentures while sleeping, ut there is still Figure 5: Kurth s concept: In centric occlusion. () Kurth s concept: In right lterl position Figure 6: () Norml occlusion nd () lingulized occlusion Figure 7: Overjet: 3 4 mm Figure 8: Overjet: mm Figure 9: Lingulized lnced occlusion: Protrusion Figure 10: Lingulized lnced occlusion: Lterl excursion 10 The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1

4 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II the prolem of prfunction during dy time. Usully, the desired rnge of lingulized lnced occlusion cn e chieved efore the nterior teeth mke contct. Anterior tooth position does not compromise the efforts to chieve ilterl lnced occlusion within the suggested rnge, nd the teeth cn e rrnged to meet esthetic nd phonetic requirements. In situtions where the nterior teeth would contct efore chieving the desired rnge of ilterl lnced occlusion, the verticl overlp of the nterior teeth cn e reduced to pproch n incisl guidnce of zero. In oth situtions, slight compensting occlusl curve will e necessry to chieve continuous posterior contcts nterior to centric reltion. [3] Advntges [3] Both the ntomic nd nonntomic forms re retined Cusp form is more esthetic compred to nonntomic tooth form Good penetrtion of the food olus is possile Bilterl lnced occlusion cn e otined for region round centric reltion Verticl forces re centrlized on the mndiulr teeth. Orgnic occlusion [4] In this concept, the nterior teeth re rrnged ccording to the requirements of esthetics nd phonetics. Extreme verticl overlps producing cuspid guidnce re frequently used, resulting in disocclusion of the posterior teeth wy from centric occlusion. Chrcteristic of this concept is the use of pntogrphic trcings nd the trnsfer of these recordings to n instrument to eliminte ll potentil deflective contcts in the rrngement of posterior teeth. This occlusion is sed on the muscles nd joint determines the mndiulr position without tooth guidnce nd tht the teeth in the function should lwys e pssive to the prts of the mndiulr movements. In orgnic occlusion The posterior teeth should protect the nterior teeth in the centric occlusion position The mxillry incisors should hve sufficient verticl overlp to provide seprtion of the posterior teeth when the incisors re in edge to edge reltion In lterl mndiulr position outside the mstictory movements, the cuspids should prevent contcts on ll other teeth. Monoplne rticultion [2,5] Jones dvocted monoplne rticultion in In this concept, nonntomic occlusl scheme is used with few specific modifictions. The mount of horizontl overlp is determined y the jw reltionships. The mxillry posterior teeth re rrnged first, nd the occlusl plne must fulfill certin requirements. The occlusl plne should evenly divide the spce etween the upper nd lower ridges The occlusl plne should e prllel to the men denture se foundtion Finlly, the plne should fll t the junction of the upper nd middle thirds of the retromolr pds. Disdvntges Flt premolrs my pper less esthetic Reported s less efficient in chewing tests Anterior esthetics needs more overjet nd no overite. Neutrocentric concept [2,4,6] In 1954, De vn formlized guidelines for using flt teeth in his Neutrocentric concepts, which stted flt occlusl surfces should hve: Flt plnes in ll directions with no inclintion t ll in respect to the underlying denture foundtion Blnce ws considered undesirle, s the resulting inclines would crete instility of the dentures. Thus, the teeth re not inclined to form compenstory curves. In mediolterl direction, the teeth re set with no medil nd lterl inclintion. Thus, the concept of occlusion elimintes ny nteroposterior or mediolterl inclines of the teeth nd directs the forces of occlusion to the posterior teeth. The occlusl plne is prllel to the men plne of the denture foundtion. This concept ws crried out y limiting the mesiodistl extent of the occlusl tle to void rrnging the teeth over the lower molr slope inherent in the posterior portion of the residul ridge. To direct the forces towrd the center of support nd to reduce the functionl forces, the uccolingul width of the teeth is reduced nd the numer of teeth is lso reduced to direct the forces in the molr nd icuspid re of support nd to refrin from plcing tooth on the ridge incline. If the teeth re rrnged in ny other mnner thn descried ove, excessive pressure or pin is cused due to lterl interferences. There re five elements in this occlusl scheme: Position Proportion Pitch Form Numer. The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1 11

5 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II Position Arrnge the teeth in centrl position in reference to the foundtion s the tongue will llow, in order to provide greter stility for the denture. He felt this ws the most importnt fctor nd tht off ridge contct for the purpose of lnce creted more prolems. is the lest esthetic s there is no incisl overlp nd no posterior cusps Moving the teeth lingully nd ltering their verticl position my not e comptile with the tongue, lip, nd cheek function. This is offsetted y nrrowing of the tooth width The flt nture of teeth results in impired mstiction. Proportion De vn reduced tooth width to 40% to correct tooth proportion. Reduced width of the rtificil teeth reduces the verticl stresses on the ridge. In ddition, horizontl stresses were lso reduced due to the friction etween opposing surfces ws decresed. Forces were centrlized without encrochment on the tongue spce. Pitch Tooth pitch (inclintion, tilt) ws corrected y plcing the occlusl plne prllel to the underlying ridges nd midwy etween them. This positioning directed forces perpendiculr to the men osseous foundtion plne. There ws no compensting curve nd no incisl guidnce. Ptients were educted not to incise or protrude. Form Tooth form ws modified using flt teeth with no deflecting inclines. This rrngement reduced destructive lterl forces nd to direct the mstictory forces perpendiculr to the support. All contcts were in single plne with no projections ove or elow the plne to interfere with the mndiulr movements. Numer The posterior teeth were reduced in numer from 8 to 6. This decresed the mgnitude of the occlusl force nd centrlized it to the second premolr nd first molr re. Advntges of neutrocentric occlusion This technique is simple nd requires less precise records. Therefore, it is idel for ptient who hs resored frile ridges with moile tissue By removing inclines, the lterl forces which re destructive to the residul ridges re reduced Teeth rrnged with neutrocentric occlusl scheme re esier to djust Becuse the neutrocentric technique provides n re of closure nd does not lock the mndile into single position Also the centric occlusion centric reltion discrepncy introduced y the denture settling would tend to e less destructive ecuse of the unlocked nture of the occlusion Neutrocentric occlusion is especilly indicted in clss II (retrognthic), clss III (Prognthic), nd crossite cses. Disdvntges of neutrocentric occlusion The gretest criticism of this occlusl scheme is tht it Physiologiclly generted occlusion [7] Mehringer developed physiologiclly generted occlusion to hrmonize complete denture occlusion, neuromusculr system, nd the temporomndiulr joint. The complete denture friction is preceded till try in nd processing of only mxillry denture is done. After it is polished, 20 conicl disc is ttched to the pltl region of the mxillry denture. The lower denture se is ttched with plexiglss followed y friction of plster (1/3 tlc nd 2/3 plster) nd ttching centrl ering device exctly fitting into the upper conicl disc. The ptient is sked to mke chewing nd swllowing movements, which creted functionlly generted pths. Then pply seprting medium to otin mxillry stone cst of generted pths. Lower teeth re rrnged ccording to mxillry cst of generted pth. Two point contcts on working side re eliminted nd converted to one point contct, this increses stility nd trnsmit forces on lingul cusps only. Linel occlusion [8] A line of occlusl contcts in one dentl rch opposing flt occlusl tle in the other dentl rch hs the potentil of creting the smllest lterl component of force ginst the denture ses. Since the re of contct is miniml, the frictionl resistnce is reduced. Furthermore, in the dentl rch with the line of occlusl contcts, there is no chnge in the loction of the contct during lterl movements. Therefore, the direction of force in tht dentl rch remins firly constnt. Locting the line of occlusl contcts The liner ridge of occlusl contcts my e locted in either of the dentl rches The decision s to whether to locte the ridge of contcts in the mxillry or mndiulr rch depends on the fctors of denture stility nd esthetics. COMBINATIONS OF OCCLUSAL FORMS USED FOR LINEAL OCCLUSION Mxillry nonntomic porcelin teeth; mndiulr porcelin linel teeth Lest occlusl wer Recommended for young, helthy ptients with good residul ridges 12 The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1

6 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II Adequte interrch spce for porcelin teeth required Exhiits occlusl dishrmonies in erlier thn occlusion formed with other mterils. (centric reltion recorded t verticl dimension t rest with inch verticl clernce). The nterior verticl overlp is sent to provide noninterception in eccentric movements. Mxillry plstic teeth (modified); mndiulr plstic linel teeth This comintion of posterior teeth is the esiest to fricte nd djust Disdvntge susceptiility of the teeth to wer As wer occurs flt occlusion Contrindicted hevy occlusl wer (ruxism nd rsive diets) nd for young ptients with good ridges Advntgeous for ptients with dly resored residul ridges nd poor muscle function nd who need tretment dentures ecuse of rpid deteriorting or chnging ridges. Mxillry nonntomic plstic teeth; mndiulr porcelin linel teeth This comintion should wer less thn does the ll plstic comintion The porcelin teeth in occlusl contct will wer very little nd tend to mintin linel occlusion longer thn do plstic teeth More self djusting s mouth chnges occur s compred to ll porcelin comintion. Mxillry Antomic Porcelin Teeth; Mndiulr Nonntomic Plstic Teeth When esthetics is of more concern The mxillry denture is estheticlly equivlent to norml cuspl contours in the premolr nd molr regions. Tooth positioning for linel occlusions Anterior No verticl overlp to prevent interference in excursive movements Mndiulr incisors estlish the nterior end of the occlusl plne The posterior lndmrk is usully the top one third of retromolr pd Occlusl plne should e kept s high posteriorly s prcticl to id in developing protrusive lncing contcts with flt plne of occlusion. Liner occlusion [9] The occlusl rrngement of rtificil teeth, s viewed in the horizontl plne, wherein the mstictory surfces of the mndiulr posterior rtificil teeth hve stright, long, nrrow occlusl form resemling tht of line, usully rticulting with opposing monoplne teeth. Teeth re rrnged on flt plne, which extends from the tip of mxillry centrl incisors to the top of the retromolr ppill. The 2 3 mm of interocclusl clernce is not needed The posterior teeth used re nonntomic with mndiulr lde form of teeth. They exhiit ilterl fulcrum of protrusive stility on protrusion lde form of mndiulr second molr contcts mxillry first premolr ilterlly nd prevent nterior rottionl contct. DISCUSSION In 1976, Koym, In, nd Yokoym conducted study on denture werer preference nd mstictory efficiency for lnced, orgnic (cuspid protected), nd lingulized occlusions in three complete denture ptients. Mstictory efficiency ws highest for the lingulized occlusion, next highest for the lnced occlusion, nd lowest for the cuspid protected occlusion. The differences in efficiency etween lingulized nd lnced occlusions nd lso etween lingulized nd cuspid protected occlusions were significnt. [10,11] Woelfel, Mickey, nd Allison, in 1962, tested ntomic (33 ), modified ntomic (20 ), nd nonntomic (0 ) teeth to determine the influence of occlusl form on the jw movements during chewing nd the denture movement on its foundtion. The shpe of the mstictory cycle s shown with cinephotogrphy ws not influenced gretly y occlusl form. The closures in ll three types of teeth were in close proximity to the posterior order movement. Where the ridges of the sujects were good, the denture se movement ws miniml nd pproximtely the sme for the three types of teeth, ut where the ridge ws poor, there ws lest movement with nonntomic teeth. [10] In 1976, Woelfel nd Winter studied three groups of denture werers over 5 8 yer period. There were 15 sujects in ech group wering ntomic (33 ), modified ntomic (20 ), nd nonntomic (0 ) teeth. The gretest one loss nd closure of the occlusl verticl dimension were oserved in the group of denture werers with nonntomic posterior teeth nd the lest in the group wering ntomic posterior teeth. The nonntomic group lso needed the most djustments over 5 yer period. [10,12] Hence, selection of prticulr concept of occlusion nd occlusl scheme in completely edentulous ptient depends on mxillry nd mndiulr jw reltion, residul lveolr ridge resorption, presence or sence of displcive tissues in denture foundtion res, neuromusculr control, ptient s mentl ttitude, nd esthetics demnds. It is importnt to explin our ptients tht tretment with removle complete dentures is not definitive tretment which needs frequent follow up to prevent the long term risks ssocited with consequences of wering complete dentures. The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1 13

7 Rngrjn, et l.: Concepts of occlusion in prosthodontics- A literture review, prt II CONCLUSION Complete denture occlusion is prt of the stomtognthic system nd not just merely rrnging of mxillry nd mndiulr teeth. The first nd foremost concern is out the helth nd the preservtion of the supporting structures. We need to consider ll the fctors such s iologic, physiologic, nd mechnicl tht fvor the stility of the denture se to void deflective or excessive forces trnsmitted to the underlying structures. Finncil support nd sponsorship Nil. Conflicts of interest There re no conflicts of interest. REFERENCES 1. Beck HO. Occlusion s relted to complete removle prosthodontics. J Prosthet Dent 1972;27: Lng BR. Complete denture occlusion. Dent Clin N Am 2004;48: Becker CM, Swoope CC, Guckes AD. Lingulized occlusion for removle prosthodontics. J Prosthet Dent 1977;38: Rhn AO, Hertwell CM. Textook of complete dentures. 5 th ed. Phildelphi: Le nd Feiger; Brudvik JS, Wormley JH. A method of developing monoplne occlusions. J ProsthetDent 1968;19: De Vn MM. The concept of neutrocentric occlusion s relted to denture stility. J Am Dent Assoc 1954;48: Mehringer JE. Physiologiclly generted occlusion. J Prosthet Dent 1973;30: Grons DG. Linel occlusion concepts for complete dentures. J Prosthet Dent 1974;32: Weinerg LA. Temporomndiulr joint function nd its effect on concepts of occlusion. J Prosthet Dent 1976;35: Winkler S. Essentils of complete denture prosthodontics. 2 nd ed. AITBs Pulishers, Delhi: Koym M, In S, Yokoym K. Quest for idel occlusl ptterns in complete dentures. J Prosthet Dent 1976;35: Woelfel JB, Winter CM, Igrshi T. Five yer cephlometric study of mndiulr ridge resorption with different posterior occlusl forms. Prt I denture construction nd initil comprison. J Prosthet Dent 1976;36: Author Help: Online sumission of the mnuscripts Articles cn e sumitted online from For online sumission, the rticles should e prepred in two files (first pge file nd rticle file). Imges should e sumitted seprtely. 1) First Pge File: Prepre the title pge, covering letter, cknowledgement etc. using word processor progrm. All informtion relted to your identity should e included here. Use text/rtf/doc/pdf files. Do not zip the files. 2) Article File: The min text of the rticle, eginning with the Astrct to References (including tles) should e in this file. Do not include ny informtion (such s cknowledgement, your nmes in pge heders etc.) in this file. Use text/rtf/doc/pdf files. Do not zip the files. Limit the file size to 1 MB. Do not incorporte imges in the file. If file size is lrge, grphs cn e sumitted seprtely s imges, without their eing incorported in the rticle file. This will reduce the size of the file. 3) Imges: Sumit good qulity color imges. Ech imge should e less thn 4096 k (4 MB) in size. The size of the imge cn e reduced y decresing the ctul height nd width of the imges (keep up to out 6 inches nd up to out 1800 x 1200 pixels). JPEG is the most suitle file formt. The imge qulity should e good enough to judge the scientific vlue of the imge. For the purpose of printing, lwys retin good qulity, high resolution imge. This high resolution imge should e sent to the editoril office t the time of sending revised rticle. 4) Legends: Legends for the figures/imges should e included t the end of the rticle file. 14 The Journl of Indin Prosthodontic Society Jn-Mr 2016 Vol 16 Issue 1

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