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Complete Dentures > 3. Complete denture occlusion > Flashcards

3. Complete denture occlusion Flashcards

1
Q

Occlusion is

A

a dynamic concept describing
the integrated action of the components of
the masticatory system that control tooth
contact during function and dysfunction

The components of the masticatory system are:Teeth + periodontal ligament
TMJ + ligaments
Muscles of mastication

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2
Q

The components of the masticatory system are:

A

Teeth + periodontal ligament
TMJ + ligaments
Muscles of mastication

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3
Q

Parameters of jaw movement
(i.e. limit jaw movements)

A
  • Muscles of mastication
  • TMJ
  • Teeth

Total range of mandibular movement can be represented by an maximum envelope of movement which is limited
by border positions and described by Posselt (1952)
Described commonly by trace of lower mid-incisal point

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4
Q

saggital plane movements -

ICP –
RCP –
RAC –
O –
P –
FWS –
RP –

A

ICP – intercuspal position
RCP – retruded contact position
RAC – retruded arc of closure
O – maximum opening
P – maximum protrusion
FWS – freeway space / IOD / IOS
RP – rest position

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5
Q

Mastication

A

an intermittent rhythmic act in which the tongue, facial
and jaw muscles act in coordination to position the food between the teeth,
cut it and prepare it for swallowing

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6
Q

Parafunctional activities:

A

clenching / grinding / lip+
cheek biting / thumb sucking /nail or object biting

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7
Q

Jaw movements in general

A

▪Mandible suspended from skull by muscles, ligaments
(TMJ/sphenomandibular/stylomandibular), vessels,
nerves, soft tissue
▪Moves in 3-D space: limited by muscles, TMJ, teeth
▪Basic movements vertical plane: open, close
lateral plane: right-side, left-side
antero-posterior plane: protrusion,
retrusion
▪Functional movement almost always a combination of
translation and rotation but may be purely rotational

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8
Q

Jaw movement in general

A

▪Mastication - an intermittent rhythmic act in which the tongue, facial
and jaw muscles act in coordination to position the food between the teeth,
cut it and prepare it for swallowing
▪Speech
▪Swallowing
▪Respiration
▪Emotional expression
▪Parafunctional activities: clenching / grinding / lip+
cheek biting / thumb sucking /nail or object biting

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9
Q

Natural dentition
… movement and retained by…
Fine neuromuscular control by proprioception from …

A

Independent movement and retained by periodontal ligament
p.lig. + TMJ,
MoM, tongue

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10
Q

Anterior incising involves

A

separation of the posterior teeth

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11
Q

Lateral excursions produce

A

working side contacts on canines or
premolars (or both) with separation of teeth on the non-working side

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12
Q

Most so-called ‘malocclusions’ of natural teeth i.e. posterior contact
during incision or non-working side contact

A

are of no pathological
consequence – but may cause problems if you produce them
when placing fillings/crowns/bridges/partial dentures
Terms : canine guidance, group function, posterior and
anterior disclusion, non-working side interferences – refer

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13
Q

Complete dentures

A

Prosthetic ‘plates’ with teeth which are easily displaced
during function.
Teeth all linked together via denture base and move as
such
Dependent on a so-called ‘balanced
occlusion/articulation’ for stability during tooth contact

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14
Q

Functional differences between Natural Dentition (ND) and Artificial
Dentition (AD)

A
  • Stability: ND teeth are independent and
    firmly attached to bone
    AD united and rest on mucosa
  • Comfort: ND biting force greater (x5) than AD
    as pain threshold of mucosa easily
    exceeded
  • Chewing
    efficiency: ND > AD, x6 number of chewing strokes
    Real teeth don’t move, dentures do!
    Not very comfortable
    Not very efficient
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15
Q

Occlusion is based upon jaw relationships

A

The mandible has a three dimensional spatial
relationship with the maxilla and movement is
limited by – teeth, muscles and TMJ anatomy
* Any particular position has an antero-posterior
component, a vertical component, and a lateral
component

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16
Q

We need a start point to examine and assess and design occlusion for
any patient – dentate or edentate…? use what

A

If the intercuspal position (ICP), or centric occlusion, is deemed
acceptable we use that – the mandibular position that gives maximum
tooth contact
If ICP is deemed unacceptable or is non-existent we use the most
retruded position of the mandible (RCP)

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17
Q

Physiologic rest position or
Habitual position of mandible

A

The mandibular position assumed when the head is in
an upright unsupported position and the involved
muscles, esp. the elevator and depressor groups, are in
equilibrium in tonic contraction, and the condyles are
in a neutral, unstrained position.

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18
Q

Rest vertical dimension (or rest face height)

A

The vertical dimension of the lower face with the
mandible in the rest position.

19
Q

Occlusal vertical dimension
(or occlusal face height)

A

The vertical dimension of the lower face with the
teeth in centric occlusion.

20
Q

Interocclusal distance (Free Way Space / IOS)

A

(RVD – OVD) a range of 2-4mm at the incisors

21
Q

Retruded arc of closure

A

The arc described by any point on the mandible during a closing
movement made with the condyles in their most posterior
positions. In this position the mandible rotates about the hinge
axis – an arbitrary line passing through the heads of the condyles

22
Q

Retruded contact

A

The position of the mandible on the retruded arc of closure when
tooth (or rim) contact first occurs

23
Q

Retruded contact position / retruded jaw
relationship / centric jaw relationship

A

The relation of the mandible to the maxilla with
the mandible in its most retruded position at a
prescribed occlusal vertical dimension

24
Q

Occlusal scheme can affect:

A
  • retention
  • stability
  • masticatory function
  • occlusal force distribution
  • aesthetics
  • patient comfort
  • general patient satisfaction with dentures
25
Q

Occlusal scheme options

A

. Bilateral balanced articulation - the bilateral
simultaneous contact of teeth in RCP and during excursions
* Monoplane (non-anatomical) occlusion - ICP
and RCP correspond but no attempt to achieve contact in excursions
* Lingualised occlusion - where the maxillary palatal
(lingual) cusps articulate with the mandibular occlusal surfaces in RCP
and with the cuspal inclines in excursions (upper buccal cusps never
touch)

26
Q

Balanced
articulation

teeth angle
advantages
disadvantages
balanced contact and what contacts?

A

Semi-anatomic
teeth (20-250 cusp
angle)

More efficient
chewing
Natural
appearance of
posteriors

Complex set up
Higher occlusal
forces generated
vertical and
lateral

Balanced contact
in RCP and
excursions

Buccal and lingual
cusps contact in
working side
excursions

27
Q

Monoplane

teeth angle
advantages
disadvantages
balanced contact and what contacts?

A

0-degree non-
anatomic cuspless
teeth

Less efficient
Poor appearance

Easy set up
Less force

Balanced contact in
RCP only

28
Q

Lingualised occlusion

A

Cusped uppers and
cuspless lower
posteriors
(specifically
manufactured for
purpose)

Some efficiency
Natural appearance
of uppers

Moderate set up
Less lateral force
? Good in resorbed
lowers

Balanced contact in
RCP and excursions
Maxillary palatal cusp only
contacts lower in
working side
excursions

29
Q

Our occlusal scheme of choice for complete dentures is
a …. occlusal set up

A

‘bilateral balanced articulation’

30
Q

In complete dentures …
For every other possible occlusal relationship there must be …

A

ICP must = RCP

bilateral or
anterior and posterior simultaneous contact

31
Q

Balanced occlusion

A

a static relationship
The simultaneous even occlusal contact between maxillary and mandibular
teeth bilaterally or anteriorly-posteriorly

32
Q

Balanced articulation

A

a dynamic relationship
The simultaneous bilateral, or anterior and posterior, occlusal contacts
between maxillary and mandibular teeth during the movement from one
balanced occlusion (i.e. during function) to another

33
Q

Why do we want balanced articulation?

A
  1. It increases the efficiency of the dentures by making them more stable and free from tipping on unbalanced contact (retention, stability, masticatory
    function, gen. satisfaction)
  2. It distributes the occlusal load over the whole denture bearing area and this reduces the risk of alveolar trauma and resorption (occ. force distribution,
    comfort)
  3. It increases the patient’s confidence by making sure that the dentures are re-seated evenly if they become dislodged (stability, comfort, gen. satisfaction)
  4. Uses posterior teeth with cuspal anatomy (masticatory function, aesthetics)
34
Q

How is balanced articulation achieved?

A
  1. Record the correct RCP relationship of the jaws and
    transfer this to an articulator capable of reproducing that patients mandibular movements i.e at registration stage
  2. By setting the teeth up in balanced articulation, using the factors governing balanced articulation, on the prescribed articulator (usually an average value articulator)
  3. Use and understand those factors (Hanau’s Quintet)
    influencing tooth position to achieve a set up in balanced articulation
35
Q

Contact during lateral movement

A

Working side, balancing side

36
Q

Contact on protrusion

A

At least three widely separated points of occlusion must exist

37
Q

Why record retruded contact position?

A

It is reproducible (because it is a border position)

  • Patients easily accommodate to it (via
    neuromuscular feedback from proprioceptors in TMJ,
    muscles of mastication, denture bearing mucosa)
  • In order to set up a balanced articulation occlusion we
    must record the most posterior position achievable as the average value articulator cannot reproduce ‘backwards’ movements
38
Q

How do we get a balanced
articulation set up for our patients?

A
  • Record RCP with registration rims
  • Prescription to technician – “please provide
    balanced articulation set up on an average
    value articulator for try in”
  • Technician completes trial set up
  • Clinician assesses trial set up on articulator
    and in the mouth
39
Q

Practical steps in obtaining a balanced articulation occlusal scheme

A
  1. Record blocks
  2. Average value articulator
  3. Factors of balanced articulation (Hanau’s Quintet)
40
Q
  1. Factors of balanced articulation (Hanau’s Quintet)
A
  • technician uses these to position teeth for occlusal set up to ensure balanced contacts
  1. Condylar guidance 300 / 350
  2. Incisal guidance 100 / 150
  3. Cuspal angles (height) 200 / 250: so-called semi-anatomic teeth
    (00 = flat cusp teeth, 300 / 350 = anatomic teeth)
  4. Plane of occlusion ala-tragal plane orientation +/-
  5. Compensating curves Spee / Wilson (change effective
    cusp height)
41
Q
  1. Average value articulator
A

Articulators are mechanical devices representing the temporo-mandibular joints, mandible and maxilla, to which such casts may be attached and observed in a
static and dynamic relationship. Their facility to duplicate mandibular positions and movements assists in diagnosis and treatments in the management of
patients.

42
Q

Compensating curves

A

Posterior plane surfaces separate on protrusion (Christensen’s Phenomenon)

Need to introduce a curve to the occlusal plane antero-
posteriorly (and laterally) to maintain cuspal contact
during excursions

43
Q

When the correct occlusal result
is achieved

A
  • We have given the patient the best chance
    for success (stable, comfortable and
    effective dentures) regarding occlusion
  • This does not guarantee overall patient
    satisfaction with dentures (success!)

Complete Dentures (8 decks)

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