alancing Ramp: n Excellent way to enhanced the Retention, Stability and Function of Denture. Nikhil harat bbad, Rajeev Srivastava, Umesh Palekar, Vivek Choukse,kshay Dave bstract: Prosthodontic rehabilitation aims at restoring the patient to a state of normal function, health and optimum esthetics. Numerous factors come together during various phases of complete denture construction. One such factor, the position of artificial teeth, is dependent to a large extent on the state, morphology and position of the denture area existing in the patient's mouth. alanced occlusion in dentures implies occlusal contacts that contribute to equilibrium of the denture bases on their respective ridges. alanced occlusion makes possible the greatest possible use of masticating power so that food may be properly prepared for digestion. Masticatory efficiency was statistically better in patients provided with complete dentures fabricated with lingualized occlusion than dentures with bilateral balanced occlusion. alancing ramps provide a tripodization of the denture bases. s a patient moves the mandible from centric relation to protrusive or lateral positions, there is smooth contact anteriorly on the teeth and posteriorly on the ramps. In this article a simple technique for providing bilateral balancing contacts in semi-anatomic dentures has been presented using balancing ramp. Keywords: alanced occlusion, Complete dentures, Occlusal concepts, alancing ramp Introduction: There has been search for the ideal denture occlusion in an effort to find out the tooth forms which provides esthetic, stability, and masticatory efficiency without compromising the health of underlying hard and soft tissues of the edentulous arch. The main aim of clinician is to fulfill these objectives, regardless of posterior tooth form selected. Dr.Nikhil harat bbad: PG Student Dr.Rajeev Srivastava: Professor & Guide. Dr.Umesh Palekar: HOD & Professor Dr.Vivek Choukse: Professor Dr.kshay Dave: PG Student Modern Dental College & Research Centre alanced occlusion is one of the neglected steps in the construction of complete dentures. alanced occlusion makes possible the greatest possible use of masticating power so that food may be properly prepared for digestion. The balancing contacts give improved horizontal stability to the dentures. This article discuss the treatment to built alancing ramps in the region of the retromolar pads of the mandibular denture have greatly simplified the procedure of balancing the occlusion. alancing ramp: alanced Occlusion is defined as the bilateral, simultaneous, anterior, and posterior NJDSR. Volume 1, Number 5, 2017 Page 52
occlusal contact of teeth in centric and eccentric positions. alanced occlusion in complete dentures is unique, as it does not occur with natural teeth 1,2,3. Masticatory efficiency in complete denture wearers is approximately 80% lower than in people with natural dentition. Other factors that affect chewing ability include bone resorption, reduced sensory perceptions, motor impairment and arrangement of teeth. 4,5. Usually, anatomic teeth are used to arrange teeth in balanced occlusion. Semi anatomic teeth and Nonanatomical teeth can be used with balancing ramps. Sears in 1949 advocated a balancing ramp to obtain bilateral balance 6,7. Indication: 1. In class 2 occlusion in which Patient complaint of discomfort of intercuspal interferences, diminished retention, tissue irritation, and clicking teeth. 2. To Stabilize the existent denture. alancing ramps provide a tripodization of the denture bases. Case Report: 70-year-old male patient, reported to the Department of Prosthodontics, Crown and ridge and Implantology (Institute of dental sciences) with a chief complaint of completely edentulous maxillary and mandibular arch and discomfort of intercuspal interferences, diminished retention, tissue irritation, and clicking teeth with his old denture. Intraoral examination revealed medium palatal vault, high frenal attachment on buccal side bilaterally and class 1 relation tongue was seen. Saliva was of medium consistency and patient was cooperative and philosophical according to House classification. Preliminary impression of the edentulous maxilla and mandibular arch was made with impression compound. The peripheral tracing procedures were completed tray with green stick impression compound and the secondary impression was made with zinc oxide eugenol impression material. Master cast was made with dental stone type III and heat cured record base was fabricated for maxillary and mandibular arch. Occlusal rim was fabricated using hard modeling wax. Facebow record was obtained. Tentative Centric relation record was obtained by Nick nd Notch method and found that class 2 occlusion was obtained. To confirm and verify the centric relation using Extra-oral Gothic arch Tracing The condylar guidances was set with a Protrusive record obtained using plaster material which help to programmed the articulator (Fig:1). The horizontal guidance (ennett angle) was set with Hanau s formula (Hanau Engineering Co. Inc., uffalo, N.Y.), or it can be set for maximum movement. NJDSR. Volume 1, Number 5, 2017 Page 53
Figure 1: Plaster record for programming the semi adjustable articulator Steps for ramp construction: The method of constructing balancing ramps is quite simple. The length, width, and height of the ramps was determined. During this procedure, the ramps was built up in wax as far distally and buccally as the last molar of the upper denture will travel in protrusive and lateral excursions. Two millimeters of wax was added to the distal and buccal surfaces of the ramps to allow for polishing and trimming. Then, the dentures was processed in acrylic resin and polished. Release the centric locks on the articulator. ssume an edge-toedge position of the opposing anterior teeth. The upper member was sequentially moved down the ramp to centric relation to give the ramp its basic shape. Figure 2: alancing Ramp Constructed () alancing Ramp are built up in wax.() asic shape achieved on Ramp Reheat the wax and move the upper member through lateral border excursions. Reheat the wax and perform intermediate excursions. Evaluate the balancing contacts to ensure contact in all excursions, and add wax as necessary. Deflasking of the denture was done. Do not adjust the balancing ramps during the laboratory remount. Evaluate the occlusion and carry out all excursions of the mandible in patients mouth (Fig: 3&4) Figure 3: Working side contact on () Right and () on Left side NJDSR. Volume 1, Number 5, 2017 Page 54
Figure 4: Protrusive contact Evaluate the balancing ramps at the patient articulator clinical remount and adjust as necessary to ensure smooth balancing contacts without interferences (Fig:5). C D Figure 5: Upper 2 nd molar resting on the alancing ramp () Right side and () Left side when protrusive movement is performed t the insertion of the dentures, a final check of the occlusion in all excursions of the mandible was made and extra oral postoperative photographs were taken (Fig:6) Discussion: Figure 6: Preoperative () Frontal Profile and () lateral view, Postoperative (C) Frontal Profile and (D) Lateral View ilateral balanced occlusion is obtained by using balancing ramps. alancing ramps are added to counteract Christiansen s phenomenon 10,11,12,13. ccording to Nimmo, Kratochvil F there are Two prevailing theories pertain to NJDSR. Volume 1, Number 5, 2017 Page 55
balanced occlusion for complete dentures: (1) balanced occlusion in centric relation only, and (2) balanced occlusion in centric relation and lateral excursions. They mention the modification of balancing ramps which can be incorporated at the insertion appointment 8. Nepola SR constructed balancing ramp by creating Occlusal cavities are prepared in the ramps. They used amalgam material for constructing the ramp. The shiny streaks in the amalgam ramps represent the paths followed by the upper last molars during protrusive and lateral jaw movements 9. dvantages of balancing ramp: 1)Improvement in the masticatory efficiency,2)retention of denture is improved,3)stability is improved Conclusion: Complete edentulism not only hampers the mastication, esthetics, but also affects the psychological well being of the patient. Every edentulous patient is unique. Success of complete denture treatment depends greatly on clear understanding of the possibilities and the limitations of various factors. Through this article author describe balancing ramps which help to increase retention and stability alancing ramps can be an indispensable factor in obtaining ilateral balanced occlusion. References: 1. Savitha K C, Shantaraj S. Occlusal schemes for complete dentures - a review article. UJOD 2013;3(1):67-71. 2. Prasad K, Prasad R, ardia & Prasad. Enhancing stability : a review of vvvarious occlusal schemes in complete denture prosthesis NUJHS 2013;3(2):105-112. 3. Prasad K, Prasad R, Prasad D & Jason N. Concepts of arrangement of artifical teeth, selective grinding and balanced occlusion in complete denture prosthodontics. NUJHS 2012;2(1):54-60. 4. Rangarajan, et al. Concepts of occlusion in prosthodontics: literature review, part I. JIPS 2016;15(2):201-205. 5. Pokorny P, Weins J, Litvak H.Occlusion for fixed prosthodontics: historical perspective of the gnathological influence. J Prosthet Dent 2008;99:299-313. 6. Winkler S. Essentials of Complete Denture Prosthodontics. 2nd ed. Delhi: ITs Publishers; 2000. 7. oucher CO. Prosthodontic Treatment for Edentulous Patients. 9th ed. Delhi: CS Publishers; 1990. p. 119. 8. Nimmo, Kratochvil F.alancing ramps in nonanatomic complete denture occlusion. J Prosthet Dent 1985;53(3):431-433. 9. Nepola SR. alancing ramps in prosthetic occlusion. J Prostht Dent 1957;8(5):776-780. 10. hmed R, Muneer M, Hakeem S. Masticatory efficiency between balanced and lingualized occlusion in complete denture wearers. Pakistan Oral & Dental Journal 2013;33(1):200-207. 11. Chaudhari S, Dange S,Khalekar S.iometric Denture Space Enhanced With alanced Occlusion: Remedy for Severely Resorbed Mandibular Ridges.IOSR 2015;14(5):42-46 12. Rao C et al.inclined plane effect and leverage perspectives of stable dentures-an overview. nnals of Prosthodontics & Restorative Dentistry.2016:2(3):63-68. 13. oswell J. Practical occlusion in relation to complete dentures. J Prostht Dent 1951;1(3):303-312. Corresponding uthor Dr. Nikhil harat bbad PG Student Dept Of Prosthodontics, Crown nd ridge nd Implantology Modern Dental College & Research Center, Indore (M.P) Email ID :- dr.nikhilabbad@gmail.com NJDSR. Volume 1, Number 5, 2017 Page 56