Denture Manual 52-81 (Anterior/Posterior Controlling Factors and occlusal setups)

Question 1

What is Thielman’s formula?

Which of these are the “posterior controlling factors” on denture occlusion? (3)

Answer 1

K (balance) = CG x IG / CH x CC x O

Cusp height
Compensating curve
Plane of occlusion

Question 2

Limitations and occlusal errors produced by the use of the Hanau articulator

Answer 2

1. Fixed intercondylar distance
2. Straight condylar path
3. No Fischer angle
4. No individual working condylar motion
5. Arbritary hinge axis location

Question 3

What phenomenon aids in compensation for limitations of the articulator?

Answer 3

REALEFF (resiliency and like effects)

Question 4

Four determinants of esthetics

Answer 4

Shade
Arrangement
Form
Phonetics

Question 5

Who in 1914 concluded that human teeth could be classified into three principal shapes? What are these shapes?

What did he advocate as the method to select the most pleasing appearance?

Answer 5

J Leon Williams

Rectangular, triangular, ovoid

Take the outline form of a patient’s face and flip it to find the shape that would harmonize their face

Question 6

Who in 1955 proposed the concept to “art, practice, and technique to achieve the esthetic goal in dentistry”, and what is that concept called?

Answer 6

Frush and Fisher

Dentogenic concept or dynesthetics

Question 7

Dynesthetics/dentogenic harmonizes what three attributes for tooth selection?

Answer 7

SPA

• Sex (male/female)
• Personality (vigorous, medium, delicate)
• Age (young, middle, elderly)

Question 8

Labial sounds - What are the sounds?

- What two errors in setup would lead to defective sounds?

Answer 8

P & B

1. Insufficient support of lips (thickness of denture flange)
2. Incorrect anterior posterior position of anterior teeth

Question 9

Labiodental sounds - What are the sounds?

• What happens if the incisors are too short?
• What happens if the incisors are too long?
• Who proposed using this method to set the central incisors?

Answer 9

F & V

• If too short - V sounds like F (Vivian sounds like Frank)
• If too tall - F sounds like V (Frank sounds like Vivian)
• Earl Pound

Question 10

Linguodental sound - Th

- What movement causes linguodental sounds?

Answer 10

1. Tongue extends between maxillary and mandibular anterior teeth
   - Setup of anteriors too anterior or too posterior

Question 11

Linguopalatal sounds - What are they?

- What movement creates them?

Answer 11

1. T & D

- Tip of tongue contacts anterior part of palate or lingual side of anterior teeth

Question 12

Sibilants

• What sounds?
• Who proposed using these sounds to help determine vertical dimension?

Answer 12

Ch, J, S

Earl Pound 1977

Question 13

A whistle sound can result from what two errors?

Answer 13

1. Too narrow of an arch

2. Opening two small

Question 14

What two things did Martone discover?

Hint: think of how he sets the initial “tone” for setting teeth

Answer 14

Maxillary incisors fall approximately 8 to 10 mm anterior of incisive papilla.

Also, a perpendicular line bisecting the incisal papilla should extend outward through the middle of the maxillary canines.

Question 15

Who determined that men display more mandibular anterior teeth than women?

Answer 15

Cade

Question 16

Who coined the phrase “speaking centric”, aka “closest speaking level”, aka “closest speaking space”?

Answer 16

Silverman 1950

Question 17

What three things are Pound known for?

Answer 17

1. Max anteriors - evaluating length and anteroposterior via F and V sounds
2. Let S Be Your Guide (1977) - Mandibular anterior arrangement
3. Originating the term “lingualized occlusion” (1970) based off the work of Payne 1941

Question 18

What are the five factors of occlusion?

Who developed this?

Answer 18

Condylar guidance
Incisal guidance
Compensating curve
Cusp height
Occlusal plane

Hanau (1926)

Fun fact: Hanau is an engineer from Capetown, South Africa. (Harry Page is also an engineer - mucostatic impressions)

Question 19

Advantages of anatomic teeth (pg 60)

Answer 19

1. Permits mechanically and physiologically balanced occlusion
2. Penetrates food more easily
3. Articulated in harmony with the TMJ and muscles of mastication
4. Resists rotation of denture bases through cusp interdigitation in laterotrusion
5. Offers better esthetics
6. Interdigitate
7. Cause “less” trauma to underlying structures

Question 20

Disadvantages of anatomic teeth (pg 61)

Answer 20

1. Little tolerate in their articulation and require exacting technique
2. Some claim that it produces lateral torque in eccentric movement, being more traumatic than noncusp teeth
3. Adjustment should be done on an articulator rather than intraorally
4. Relining and rebasing is more difficult

Question 21

Definition of semi-anatomic teeth (GPT pg 70)

• What do critics say is the disadvantage of semi-anatomic teeth?

Answer 21

Modified denture tooth occlusal forms with a 20 degree or less cuspal incline

All of the disadvantages of cusp teeth with none of the advantages of flat plane teeth

Question 22

Who advocated for semi-anatomic teeth (pg 61)

- He argued that by having less step cuspal inclines, you can have functional harmony with what anatomic structure?

Answer 22

Schuyler

Glenoid fossa

Question 23

What two things are Clyde Schuyler known for?

Answer 23

1. Semi-anatomic teeth

2. BULL rule - adjusting those cusps not in occlusal contact at MI/CO

Question 24

Define non anatomic teeth (pg 61)

Who first introduced them and who else has advocated for them? (GPT pg 61)

Answer 24

All teeth with occlusal forms that have no resemblance to anatomic teeth and offer occlusion without intercuspation

Hardy introduced in 1942

Sears, DeVan, Brudvick and Wormley

Fun fact: Neutrocentric not in GPT

Question 25

Advantages of non anatomic teeth (7)

Answer 25

1. Does not lock mandible in one position and permits use of simple, less time-consuming techniques and articulators 2. Minimize horizontal pressures due to absence of inclined planes 3. Permit closure in more than one position (CR becomes an area rather than a point) 4. Adapts easily to Class II and Class III jaw relations 5. Accommodate changes to vertical and horizontal relations 6. Make relining and rebasing simpler 7. Improve denture stability by permitting proper centralization of occlusal plane in relation to residual ridges

Question 26

Disadvantages of non anatomic teeth (6)

Answer 26

1. Less efficient for mastication because they do not penetrate food effectively 2. Inadequate food escape ways 3. Esthetically inferior to anatomic forms 4. Encourage a higher component of lateral or diagonal jaw movement during chewing and increase rather than decrease horizontal forces on denture bases 5. Nonanatomic forms may introduce a negative psychological influence in terms of food-penetrating ability 6. When set on a curved plane for balanced occlusion the inclined plane may cause skidding of the denture base

Question 27

Buccolingual placement of posterior teeth in mechanical positions (instead of anatomical) was advocated by who? (pg 63) - Advantages?

Answer 27

Sears (1948, 1957) and De Van (1956) | - Maximum stability, forces of mastication are at right angles to residual ridge

Question 28

Buccolingual placement of posterior teeth in mechanical positions (instead of anatomical) (pg 63) - Who was critical of mechanical positioning? - Disadvantages

Answer 28

Pound 1951 (and others) Argued that clinical residual ridge is often lingual to the bony ridge in mandibles with extreme alveolar ridge resorption

Question 29

Buccolingual placement of posterior teeth - anatomical positions (instead of mechanical) (pg 63) - Who advocated it? - Advantages and disadvantages

Answer 29

Pound, Roberts, Fish, Lamie, Neufield, Carlsson, Persson Disadvantage: Creates leverage leading to extensive denture movement (leading to resorption of the residual ridge)

Question 30

Superoinferior positioning of posterior teeth - Mechanical - Advantages - Disadvantages - Proponents

Answer 30

ADV: Keep occlusal plane closer to the denture base with less favourable ridge size and contour DADV: Increases leverage of the mandibular denture and exerts greater pressure on supporting tissues Proponents: Sears (1957) and Pleasure (1937)

Question 31

Superoinferior positioning of posterior teeth - Anatomic - Advantages - Proponents

Answer 31

ADV: Denture stability and masticatory function Proponents: Wright, Pound

Question 32

Payne advocated for what kind of tooth form for occlusal schemes?

Answer 32

Anatomic teeth (slightly more efficient) 1951-52 But many other studies say no evidence of superiority

Question 33

Define Christensen phenomenon

Answer 33

The space that occurs between posterior occlusal surfaces during mandibular protrusion Carl Christensen 1905 - Denmark dentist/professor

Question 34

Indications for non anatomic tooth forms Who advocated for non anatomic tooth forms

Answer 34

1. Class II or III malocclusion 2. Severe residual ridge resorption 3. Excessive inter arch distance 4. Poor neuromuscular skills 5. Poor patient adaptability 6. Reverse occlusal (Pleasure) curve in existing dentures

Question 35

Who first described lingualized occlusion? (pg 73) Four advantages?

Answer 35

Payne 1941 1. Better adapted to different types of ridges 2. Greater masticatory efficiency 3. Eliminates lateral interferences 4. Allows for settling without unbalancing articulation by cuspal inclination

Question 36

Three disadvantages of lingualized occlusion (pg 73)

Answer 36

1. Decreased masticatory efficiency 2. Does not resist rotation as well as cross-tooth cross-arch 3. May result in increased lateral forces

Question 37

Payne and Ortman; Becker - Indications for lingualized

Answer 37

Payne/Ortman - Use on virtually all cases, except flat ridges, cases with excessive interring distance Becker - Severe alveolar resorption, class II jaw relationship, displaceable supporting tissue

Question 38

Lingualized - contraindications (3)

Answer 38

1. Repeatable CR records not possible 2. 0-degree teeth set in monoplane are indicated (Parkinson, pathologic joint, some CII patients) 3. Flat ridges unable to resist lateral force

Question 39

Pound and Murrell recommend what degree teeth for lingualized? Are facebow and protrusive records essential? If not, what condylar inclination do you set your semi-adjustable articulator to?

Answer 39

33 degree maxillary versus 20 or 0 degree mandibular Not essential but advised. If not obtained, use 30-degree condylar inclination for Class I or III and 20 for Class II patients

Question 40

Payne and Ortman recommend what degree teeth for lingualized? (pg 76) Difference between Payne/Ortman and Pound/Murrell

Answer 40

33 degree versus 33 degree Identical to Pound/Murrell except: 1. They grind lingual cusp of mandibular posteriors and turn the tooth buccal lingually 2. Protrusive balance exists between maxillary second molar and mandibular second molar

Question 41

Which posterior teeth are not in contact for lingualized at laterotrusive and mediotrusive? How about which posteriors are in contact at protrusive?

Answer 41

1. First premolars not in contact at all excursives | 2. In protrusive, second molars in contact in protrusive (Payne/Ortman)

Question 42

Cross tooth cross arch aka Anatomic setup - Advantages (3) | - Disadvantages (3) (pg 78)

Answer 42

1. Esthetics 2. Better penetration of food, requiring less force and decreased vertical stresses on ridges 3. Anatomic occlusion arranged in harmony with muscles of mastication and TMJ during functional/non-functional movements DADV: 1. Precise technique required with exact JRR 2. Incline of cusps leads to greater lateral forces (considered more destructive to underlying ridges) 3. Requires more time and results not long-lasting (once slight ridge resorption occurs, adjustments needed)