![• Balancing and working contacts should occur only on
the maxillary lingual cusps.[This helps to reduce
lateral movement of the lower denture by placing
occlusal forces more lingual to and toward the center
of the mandibular teeth].
• Protrusive balancing contacts should occur only
between the maxillary lingual cusps and the lower
teeth](https://image.slidesharecdn.com/balancedocclusionjc-200718071213/85/Balanced-occlusion-different-concepts-28-320.jpg)
![Technique 1:
Upper cast –facebow
Lower cast-were aligned and fixed to articulator[Hanau
H2]in centric relation position
Horizontal and lateral condylar guidance were
individualised by following the individual centric and
protrusive relation records.](https://image.slidesharecdn.com/balancedocclusionjc-200718071213/85/Balanced-occlusion-different-concepts-31-320.jpg)
![ Technique 2:
Casts were mounted on articulator using average
values.
This tech. was specific for this type of
articulator[stratos 100]-avoid facebow.
Lower cast was fixed-by horizontal guide plane
Teeth arrangement-Bio Functional prosthetic system
with 2D template](https://image.slidesharecdn.com/balancedocclusionjc-200718071213/85/Balanced-occlusion-different-concepts-32-320.jpg)
Balanced occlusion-different concepts
- 1. BALANCED OCCLUSION Presented by: Dr. Srishti Relan I MDS
- 2. Introduction Occlusion: Is defined as any contact between the incising or masticating surfaces of the maxillary and mandibular teeth. -GPT Balanced occlusion: “The simultaneous contact of opposing upper and lower teeth in centric relation position and a continuous smooth bilateral gliding from this position to any eccentric position with in normal range of mandibular function” - GPT
- 3. Bonwill in 1864, who has been called “the father of anatomic (balanced) three point contact occlusion”’ Sheppard stated that, “Enter bolus, Exit balance” According to this statement, the balancing contact is absent when food enters the oral cavity
- 4. Brewer and Hudson (1961) reported the importance of balanced occlusion. He stated that on an average, a normal individual makes masticatory tooth contact only for 10 minutes in one full day compared to 4 hours of total tooth contact during other functions. So, for these 4 hours of tooth contact, balanced occlusion is important to maintain the stability of the denture.
- 5. Importance of Balanced occlusion Improved stability of denture No interference of cusp during mastication Preservation of ridges by better distribution of forces Absence of occlusal balance will result in leverage of the denture during mandibular movement.
- 6. Requisites For Occlusal Scheme • 4 Incisors INSCIAL • Canine &post. teeth on the moving side WORKING • Canine &post. on the non- working side BALANCING
- 7. Characteristic Requirements Of Balanced Occlusion All the teeth of the working side (Central incisor to second molar) should glide evenly against the opposing teeth. No single tooth should produce any interference or disocclusion of the other teeth. There should be contacts in the balancing side, but they should not interfere with the smooth gliding movements of the working side. There should be simultaneous contact during protrusion
- 8. Types of Balanced occlusion Unilateral balanced occlusion Bilateral balanced occlusion Protrusive balanced occlusion Lateral balanced occlusion
- 9. Unilateral balanced occlusion: Seen on occlusal surfaces of teeth on one side when they occlude simultaneously with a smooth, uninterrupted glide NOT followed in complete denture construction – FPD
- 10. Bilateral balanced occlusion Seen when simultaneous contact occurs on both sides in centric and eccentric positions. helps to distribute the occlusal load evenly across the arch and therefore helps to improve stability of the denture during centric, eccentric or parafunctional movements. For minimal occlusal balance, there should be at least three points of contact on the occlusal plane. More the number of contacts, better the balance. Bilateral balanced occlusion can be protrusive or lateral balance
- 11. Protrusive balanced occlusion: This type of balanced occlusion is present when mandible moves in a forward direction and the occlusal contacts are smooth and simultaneous anteriorly and posteriorly. There should be at least three points of contact in the occlusal plane. Two of these should be located posteriorly and one should be located in the anterior region. This is absent in natural dentition.
- 12. Lateral balanced occlusion In lateral balanced there will be a minimal simultaneous three point contact (one anterior, two posterior) present during lateral moment of the mandible. Lateral balanced occlusion is absent in normal dentition.
- 13. Principles Of Balanced Occlusion • Narrower & smaller the ridge and wider the teeth the poorer the balance • Farther the teeth from the ridge ,poorer the balance • Arranging the teeth buccally will lead to poor balanced occlusion. • If the teeth are set outside the ridge the denture may elevate on one side during tooth contact. Hence, C.D should be designed – forces of occlusion are centered anteroposteriorly in the denture
- 14. Rudolph L.Hanau (1926)- He proposed nine factors that govern the articulation of artificial teeth. - Laws of BALANCED articulation. 1. Horizontal condylar inclination 2. Compensating curve 3. Protrusive incisal guidance 4. Plane of orientation 5. Bucco lingual inclination of tooth axis 6. Sagittal condylar pathway 7. Sagittal incisal guidance 8. Tooth alignment 9. Relative cusp height
- 15. Condylar guidance Incisal guidance Orientation of the plane of occlusion or occlusal plane. Cuspal angulation Compensating curves. Hanau later condensed these nine factors and formulated five factors, which are commonly known . Hanau’s quint
- 16. There should be a balance within these five factors. The incisal and condylar guidances --- increase posterior tooth separation COUNTERACTED TO OBTAIN BALANCED OCCLUSION. The other three factors ---- decrease the posterior tooth separation
- 17. This article discusses treatment with nonanatomic teeth arranged on a flat plane with the use of balancing ramps
- 18. Nonanatomic teeth have no cusp inclines; therefore balancing contacts must be obtained by other means. One method is to arrange teeth (maxillary and mandibular)to a flat plane with no overbite (vertical overlap). The plane can be positioned to prevent disturbing protrusive interferences, but it may compromise phonetics and esthetics
- 19. Another method is to incline the mandibular second molar to provide contact with the maxillary denture in all excursions. The maxillary second molars are similarly inclined but left out of centric contact. The inclined second molars provide balancing contacts in protrusive movements but may lack balancing contacts in lateral excursions. An improvement on the inclined molar technique is the use of customized balancing ramps placed posterior to the most distal mandibular molars
- 20. Balancing ramps provide a tripodization of the denture bases. As 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. The balancing contacts give improved horizontal stability to the dentures. Esthetics and phonetics are greatly enhanced because there is more freedom in placing the anterior teeth.
- 23. Modifications of the technique for use at clinical remount The balancing ramps can be incorporated at the insertion appointment in conjunction with the clinical remount. Roughen the denture base posterior to the most distal mandibular molar with a carbide bur. Mix autopolymerising resin -doughy stage it is added to the roughened surface. Perform all eccentric positions on the articulator whiIe the resin is still soft. The denture can be placed in a pressure pot to cure the resin. Refine and smooth the balancing ramps after curing is complete, and carefully evaluate the contacts in eccentric occlusion
- 24. Lingualized occlusion should not be confused with placement of the mandibular teeth lingual to the ridge crest, as suggested by several authors.
- 25. Lingualized occlusion is an attempt to maintain the esthetic and food-penetration advantages of the anatomic form while maintaining the mechanical freedom of the nonanatomic form. It is particularly helpful when the patient places high priority on esthetics but a nonanatomic occlusal scheme is indicated by oral conditions such as severe alveolar resorption, a Class II jaw relationship, or displaceable supporting tissue.
- 26. PRINCIPLES OF LINGUALIZED OCCLUSION Anatomic posterior (30 or 33 degree) teeth are used for the maxillary denture Nonanatomic or semianatomic teeth are used for the mandibular denture. Modification of the mandibular posterior teeth is accomplished by selective grinding -smooths the central fossae of the mandibular teeth, lowers marginal ridges, and forms slight buccal and lingual inclines .This creates a slight concavity in the occlusal surface.
- 27. Maxillary lingual cusps should contact mandibular teeth in centric occlusion. The mandibular buccal cusps should not contact the upper teeth in centric occlusion, 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.
- 28. • Balancing and working contacts should occur only on the maxillary lingual cusps.[This helps to reduce lateral movement of the lower denture by placing occlusal forces more lingual to and toward the center of the mandibular teeth]. • Protrusive balancing contacts should occur only between the maxillary lingual cusps and the lower teeth
- 29. ADVANTAGES OF LINGUALIZED OCCLUSION Most of the advantages attributed to both the anatomic and nonanatomic forms are retained. Cusp form is more natural in appearance compared to nonanatomic tooth form. Good penetration of the food bolus is possible Vertical forces are centralized on the mandibular teeth
- 30. Aim: compare complete dentures made by 2 techniques: with facebow and without facebow.
- 31. Technique 1: Upper cast –facebow Lower cast-were aligned and fixed to articulator[Hanau H2]in centric relation position Horizontal and lateral condylar guidance were individualised by following the individual centric and protrusive relation records.
- 32. Technique 2: Casts were mounted on articulator using average values. This tech. was specific for this type of articulator[stratos 100]-avoid facebow. Lower cast was fixed-by horizontal guide plane Teeth arrangement-Bio Functional prosthetic system with 2D template
- 33. Then the dentures were processed as usual Occlusal contacts of each pair were registered using articulating paper and kept for reference. Pt was given 1pair of denture asked to wear for 10 days and then recalled for questionnaire. After 10 days-other pair was inserted-pt recalled after10 days for questionnaire
- 34. Results concerning about the questionnaire and the number of contacts of group A and group B were statistically analysed .
- 37. The aim of this study was to assess the influence of balanced occlusal arrangement of artificial teeth on the decrease in reduction of edentulous alveolar ridge
- 38. Method: longitudinal study on 91 fully edentulous patients was conducted using their panoramic radiographs and parameters of vertical dimension of edentulous ridges.
- 39. Parameters: heights of edentulous ridges of corpuses of mandibles in the areas of mental foramen to the right side and to the left side, heights of the areas in which were roots of molars to the right and to the left side. Two control parameters : in the regions of distal edges of retromolar pads to the left and to the right side. These were measured in the control group and the experimental group
- 40. Article Concluded that This study confirmed the same level of edentulous residual ridge prior the therapy and after the therapy by acrylic complete dentures with balanced occlusion.
- 41. Conclusion Balanced Occlusion is a favoured occlusal design in setting artificial teeth in conventional complete dentures since it preserves edentulous ridge and influences the stability of dentures. Should be applied not only in setting of artificial teeth in conventional complete dentures, but also in construction of complete dentures on implants
- 42. References: Becker CM, Swoope CC, Guckes AD. Lingualized occlusion for removable prosthodontics. The Journal of prosthetic dentistry. 1977 Dec 1;38(6):601-8. Kumar M, D'souza DS. Comparative evaluation of two techniques in achieving balanced occlusion in complete dentures. Medical Journal Armed Forces India. 2010 Oct 1;66(4):362-6. Poštić SD. Influence of balanced occlusion in complete dentures on the decrease in the reduction of an edentulous ridge. Vojnosanitetski pregled. 2012;69(12):1055-60. Nimmo A, Kratochvil FJ. Balancing ramps in nonanatomic complete denture occlusion. Journal of Prosthetic Dentistry. 1985 Mar 1;53(3):431-3.