Download - Setting Posterior Teeth
Setting Posterior TeethSetting Posterior Teeth
Set for FunctionSet for Function
Philosophies of Denture OcclusionPhilosophies of Denture Occlusion
Many philosophies of arranging denture occlusion
No definitive scientific studies prove one occlusal scheme clearly superior
Many philosophies of arranging denture occlusion
No definitive scientific studies prove one occlusal scheme clearly superior
Rationale for Dalhousie ApproachRationale for Dalhousie Approach
Principals to choose an occlusal scheme Based on clinical experience Dalhousie: two occlusal schemes :
• Lingualized Occlusion• Monoplane Occlusion
Principals to choose an occlusal scheme Based on clinical experience Dalhousie: two occlusal schemes :
• Lingualized Occlusion• Monoplane Occlusion
Occlusal SchemesAttempts to Stabilize DenturesOcclusal Schemes
Attempts to Stabilize Dentures
Lingualized Occlusion: Contacts on centered on mandibular ridge minimizes movement
Monoplane Occlusion: Lack of cusps minimizes lateral forces on denture
Lingualized Occlusion: Contacts on centered on mandibular ridge minimizes movement
Monoplane Occlusion: Lack of cusps minimizes lateral forces on denture
Based on the UCLA/IVOCLAR/ACP Series Based on the UCLA/IVOCLAR/ACP Series
Lingualized OcclusionLingualized OcclusionLingualized OcclusionLingualized Occlusion
Centric contacts are maxillary lingual cusp to central fossa / marginal ridge
Centric contacts are maxillary lingual cusp to central fossa / marginal ridge
Lingualized Occlusion
Lingualized Occlusion
Anatomic teeth used in maxilla Better esthetics than
Monoplane Shallow cusped mandibular
teeth Forces centered over
mandibular ridge
Anatomic teeth used in maxilla Better esthetics than
Monoplane Shallow cusped mandibular
teeth Forces centered over
mandibular ridge
Lingualized OcclusionLingualized Occlusion
No overbite May or may not have balancing
contacts in excursions Anterior teeth - must make at
least grazing contacts in excursions
No overbite May or may not have balancing
contacts in excursions Anterior teeth - must make at
least grazing contacts in excursions
Lingualized OcclusionLingualized Occlusion
Maxillary anatomic (33°) Mandibular Teeth
Steep Condylar Guidance Shallow cusped (Anatoline)
Shallow Condylar Guidance Non-anatomic (Portrait 0°)
Maxillary anatomic (33°) Mandibular Teeth
Steep Condylar Guidance Shallow cusped (Anatoline)
Shallow Condylar Guidance Non-anatomic (Portrait 0°)
Denture Occlusion OptionsDenture Occlusion Options
AnatomicAnatomic
Semi-anatomicSemi-anatomic
Lingualized (lingual contact)
Lingualized (lingual contact)
Non-anatomic (balancing ramp)Non-anatomic (balancing ramp)
Non-anatomicNon-anatomic
Set mandibular premolars & Set mandibular premolars & 11stst molar : molar :
• Level with occl plane Level with occl plane •Centered over ridge Centered over ridge
Set mandibular premolars & Set mandibular premolars & 11stst molar : molar :
• Level with occl plane Level with occl plane •Centered over ridge Centered over ridge
Occlusal planeOcclusal planeOcclusal planeOcclusal plane
Line indicating the crest of the ridgeLine indicating the crest of the ridgeLine indicating the crest of the ridgeLine indicating the crest of the ridge
Balanced Lingualized Occlusion
Balanced Lingualized Occlusion
Maxillary anatomic opposing Mandibular shallow cusp
Maxillary anatomic opposing Mandibular shallow cusp
If using a lingualized posterior If using a lingualized posterior tooth form (Dentsply Anatoline) tooth form (Dentsply Anatoline)
• little or no Curve of Wilsonlittle or no Curve of Wilson• lingual and buccal cusps of lingual and buccal cusps of
level with plane of occlusion level with plane of occlusion
If using a lingualized posterior If using a lingualized posterior tooth form (Dentsply Anatoline) tooth form (Dentsply Anatoline)
• little or no Curve of Wilsonlittle or no Curve of Wilson• lingual and buccal cusps of lingual and buccal cusps of
level with plane of occlusion level with plane of occlusion
Second molar elevated by ~ 15Second molar elevated by ~ 15° from the occlusal ° from the occlusal planeplaneSecond molar elevated by ~ 15Second molar elevated by ~ 15° from the occlusal ° from the occlusal planeplane
15 degrees15 degrees15 degrees15 degrees
Max. lingual cusps Max. lingual cusps contact central contact central fossae/marginal ridgefossae/marginal ridge
~ 1mm space ~ 1mm space between buccal between buccal cuspscusps
Max. lingual cusps Max. lingual cusps contact central contact central fossae/marginal ridgefossae/marginal ridge
~ 1mm space ~ 1mm space between buccal between buccal cuspscusps
Maxillary lingual cusps firmly contact bilaterally simultaneously
Maxillary lingual cusps firmly contact bilaterally simultaneously
Verify centric Verify centric No max. buccal cusp contacts in: No max. buccal cusp contacts in:
• • Centric Centric • • Lateral excursions Lateral excursions
Verify centric Verify centric No max. buccal cusp contacts in: No max. buccal cusp contacts in:
• • Centric Centric • • Lateral excursions Lateral excursions
Centric PositionCentric PositionCentric PositionCentric Position
Verify excursive contactsVerify excursive contacts
Anterior teeth are in contact Anterior teeth are in contact during lateral excursions during lateral excursions
Verify excursive contactsVerify excursive contacts
Anterior teeth are in contact Anterior teeth are in contact during lateral excursions during lateral excursions
Working ExcursionsWorking ExcursionsWorking ExcursionsWorking Excursions
Note the Note the balancing contactsbalancing contactsNote the Note the balancing contactsbalancing contacts
Balancing ExcursionsBalancing Excursions
Effect of Mandible Moving Downward During Excursions
Effect of Mandible Moving Downward During Excursions
QuickTime™ and aMotion JPEG OpenDML decompressor
are needed to see this picture.
Maintaining Balancing Contacts
Maintaining Balancing Contacts
Change occlusal plane angle Increase compensating curves Increase cusp angles
Change occlusal plane angle Increase compensating curves Increase cusp angles
Achieving BalanceAchieving Balance
• Condylar angulation Recorded with protrusive record
• Cusp angle Selected by dentist
• Condylar angulation Recorded with protrusive record
• Cusp angle Selected by dentist
Achieving BalanceAchieving Balance
• Occlusal Plane Determined by dentist with wax rims
• Curve of Spee & Curve of Wilson Controlled by inclination of teeth
• Occlusal Plane Determined by dentist with wax rims
• Curve of Spee & Curve of Wilson Controlled by inclination of teeth
Checking for BalanceChecking for Balance
Feels Feels SmooSmoooooooooothth in in excursions excursions
- Fingers on Maxillary Canines- Fingers on Maxillary Canines- On Articulator- On Articulator
Feels Feels SmooSmoooooooooothth in in excursions excursions
- Fingers on Maxillary Canines- Fingers on Maxillary Canines- On Articulator- On Articulator
Assessing BalanceAssessing Balance
• Jumps or bumps are due to cusp tips moving over other cusp tips, inclines, marginal ridges
• Jumps or bumps are due to cusp tips moving over other cusp tips, inclines, marginal ridges
Occlusal RefinementOcclusal Adjustment, Selective Grinding
Occlusal RefinementOcclusal Adjustment, Selective Grinding
Set teeth as close to: Maximum intercuspation Balance
All setups will need some adjustment
Set teeth as close to: Maximum intercuspation Balance
All setups will need some adjustment
‘IIF’ Rule‘IIF’ Rule
a
Inner Inclines (inside of cusp)Outer Inclines(outside of cusp)
B LBL
WorkingContacts
a
Inner Inclines (inside of cusp)Outer Inclines(outside of cusp)
B LBL
WorkingContactsIIF you have contacts on the Inner Inclines of Functional cusps they are balancing contactsIIF you have contacts on the Inner Inclines of Functional cusps they are balancing contacts
Find the Balancing Contact
Find the Balancing Contact
Find the Balancing Contact
Find the Balancing Contact
What type of Contact?What type of Contact?
What type of Contact?What type of Contact?
What type of Contacts?What type of Contacts?
What type of Contact?What type of Contact?
Assess ContactsAssess Contacts Centric Stops Excursions
Centric Stops Excursions
Non-Balanced Lingualized Occlusion
Non-Balanced Lingualized Occlusion
Maxillary anatomic opposing mandibular non-anatomic
Maxillary anatomic opposing mandibular non-anatomic
Mortar & pestle occlusion without maxillary Mortar & pestle occlusion without maxillary buccal cusp contactbuccal cusp contact
Mortar & pestle occlusion without maxillary Mortar & pestle occlusion without maxillary buccal cusp contactbuccal cusp contact
Lack of mandibular cusp angles and no Lack of mandibular cusp angles and no attempt to balance the occlusionattempt to balance the occlusion
Lack of mandibular cusp angles and no Lack of mandibular cusp angles and no attempt to balance the occlusionattempt to balance the occlusion
No compensating curvesNo compensating curvesNo overbiteNo overbite
No compensating curvesNo compensating curvesNo overbiteNo overbite
No overbiteNo overbite
Magnitude of OverjetMagnitude of OverjetMagnitude of OverjetMagnitude of Overjet
More for Class II More for Class II patients patients
More for Class II More for Class II patients patients
Class IClass I Class IIClass II
Magnitude of Horizontal OverlapMagnitude of Horizontal Overlap
Class III patients
Little or no overjet
Class III patients
Little or no overjet
Class IIIClass III
Setting the posterior teethSetting the posterior teeth • Teeth should end prior to the ascending Teeth should end prior to the ascending
ramus ramus
Setting the posterior teethSetting the posterior teeth • Teeth should end prior to the ascending Teeth should end prior to the ascending
ramus ramus
• Maxillary lingual cusps contact central groove/marginal ridge of the opposing teeth
• Maxillary lingual cusps contact central groove/marginal ridge of the opposing teeth
The horizontal overlap
should be ideal and
should be sufficient to
prevent biting of the cheek
and corner of the mouth
The horizontal overlap
should be ideal and
should be sufficient to
prevent biting of the cheek
and corner of the mouth Horizontal Horizontal
overlapoverlapHorizontal Horizontal
overlapoverlap
• All maxillary teeth, with the exception of the lateral incisors and cuspids, should be on the plane of
occlusion
• All maxillary teeth, with the exception of the lateral incisors and cuspids, should be on the plane of
occlusion
Monoplane OcclusionMonoplane Occlusion
Monoplane OcclusionMonoplane Occlusion
Cuspless teeth (0°) on a flat plane with 1.5-2.0 mm overjet
No cusp to fossa relationship No anterior contacts in
centric position
Cuspless teeth (0°) on a flat plane with 1.5-2.0 mm overjet
No cusp to fossa relationship No anterior contacts in
centric position
Monoplane OcclusionMonoplane Occlusion
Eliminate cusps lateral forces reduced improves stability
Simplifies tooth arrangement
Eliminate cusps lateral forces reduced improves stability
Simplifies tooth arrangement
Monoplane OcclusionMonoplane Occlusion
No overbite (would cause tilting)
Overjet of 2 mm is used to create an illusion of overbite
No overbite (would cause tilting)
Overjet of 2 mm is used to create an illusion of overbite
Monoplane OcclusionMonoplane Occlusion
Excursions - may or may not contact on balancing sides
Depends on condylar inclination and other aspects of the tooth arrangement
Excursions - may or may not contact on balancing sides
Depends on condylar inclination and other aspects of the tooth arrangement
Monoplane OcclusionMonoplane Occlusion
Anterior teeth make contact in excursions
Modifications have been proposed to minimize the tilting potential: Balancing ramps Compensating curves
Anterior teeth make contact in excursions
Modifications have been proposed to minimize the tilting potential: Balancing ramps Compensating curves
Monoplane Occlusionwithout condylar influence
Monoplane Occlusionwithout condylar influence
Monoplane OcclusionMonoplane Occlusion
Monoplane OcclusionMonoplane OcclusionAdvantages• Technically easier to achieve• Use when:
– Difficulty obtaining repeatable centric records (muscle incoordination)
– Skeletal malocclusion (Class II, III)– Severe residual ridge resorption
– Reduces horizontal forces
Advantages• Technically easier to achieve• Use when:
– Difficulty obtaining repeatable centric records (muscle incoordination)
– Skeletal malocclusion (Class II, III)– Severe residual ridge resorption
– Reduces horizontal forces
Monoplane Occlusion
Monoplane Occlusion
Disadvantages• Poorer appearance• Can be unstable if condylar
guidance is steep (posterior teeth separate, leaving only the anteriors in contact)
Disadvantages• Poorer appearance• Can be unstable if condylar
guidance is steep (posterior teeth separate, leaving only the anteriors in contact)
Monoplane Occlusion
Monoplane Occlusion
Clinical remount on an articulator Practice doing a clinical remount
Clinical remount on an articulator Practice doing a clinical remount
Adjusting Monoplane Occlusion
Adjusting Monoplane Occlusion
Main adjustment is flat If heavy prematurity near
fossa, slightly shallow fossa
Main adjustment is flat If heavy prematurity near
fossa, slightly shallow fossa