Setting Posterior Teeth

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Setting Posterior Teeth

• Set for Function

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Philosophies of Denture Occlusion

• Many philosophies of arranging denture occlusion
• No definitive scientific studies prove one
  occlusal scheme clearly superior

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Rationale for Dalhousie Approach

• Principals to choose an occlusal scheme
• Based on clinical experience
• Dalhousie two occlusal schemes
• Lingualized Occlusion
• Monoplane Occlusion

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Occlusal SchemesAttempts to Stabilize Dentures

• Lingualized Occlusion Contacts on centered on
  mandibular ridge minimizes movement
• Monoplane Occlusion Lack of cusps minimizes
  lateral forces on denture

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Lingualized Occlusion

• Centric contacts are maxillary lingual cusp to
  central fossa / marginal ridge

Based on the UCLA/IVOCLAR/ACP Series
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Lingualized Occlusion

• Anatomic teeth used in maxilla
• Better esthetics than Monoplane
• Shallow cusped mandibular teeth
• Forces centered over mandibular ridge

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Lingualized Occlusion

• No overbite
• May or may not have balancing contacts in
  excursions
• Anterior teeth - must make at least grazing
  contacts in excursions

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Lingualized Occlusion

• Maxillary anatomic (33)
• Mandibular Teeth
• Steep Condylar Guidance
• Shallow cusped (Anatoline)
• Shallow Condylar Guidance
• Non-anatomic (Portrait 0)

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Denture Occlusion Options
Semi-anatomic
Non-anatomic (balancing ramp)
Lingualized (lingual contact)
Non-anatomic
Anatomic
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Occlusal plane

• Set mandibular premolars 1st molar
• Level with occl plane
• Centered over ridge

Line indicating the crest of the ridge
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Balanced Lingualized Occlusion

• Maxillary anatomic opposing Mandibular shallow
  cusp

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• If using a lingualized posterior tooth form
  (Dentsply Anatoline)
• little or no Curve of Wilson
• lingual and buccal cusps of level with
  plane of occlusion

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15 degrees
Second molar elevated by 15 from the occlusal
plane
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Posterior teeth have 1mm space between the
buccal cusps
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Lingual cusps contact with the central fossae of
the opposing mandibular teeth
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• Maxillary lingual cusps firmly contact the
  central fossae of the mandibular teeth

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Centric Position
Verify centric No buccal cusp contacts
Centric Lateral excursions
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Working Excursions

• Verify excursive contacts
• Anterior teeth are in contact during lateral
  excursions

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Balancing Excursions
Note the balancing contacts
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Effect of Mandible Moving Downward During
Excursions
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Maintaining Balancing Contacts

• Change occlusal plane angle
• Increase compensating curves
• Increase cusp angles

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Achieving Balance

• Condylar angulation
• Recorded with protrusive record
• Cusp angle
• Selected by dentist

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Achieving Balance

• Occlusal Plane
• Determined by dentist with wax rims
• Curve of Spee Curve of Wilson
• Controlled by inclination of teeth

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Checking for Balance

• Feels Smooooooth in excursions
• - Fingers on Maxillary Canines
• - On Articulator

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Assessing Balance

• Jumps or bumps are due to cusp tips moving over
  other cusp tips, inclines, marginal ridges

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Occlusal RefinementOcclusal Adjustment,
Selective Grinding

• Set teeth as close to
• Maximum intercuspation
• Balance
• All setups will need some adjustment

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IIF Rule

• IIF you have contacts on the Inner Inclines of
  Functional cusps they are balancing contacts

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Rules for Balancing Contacts

• Balancing contacts should be lines, not points
• Balancing contacts should never be heavier than
  working contacts

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Find the Balancing Contact
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Find the Balancing Contact
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What type of Contact?
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What type of Contact?
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What type of Contacts?
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What type of Contact?
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Assess Contacts

• Centric Stops
• Excursions

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Non-Balanced Lingualized Occlusion

• Maxillary anatomic opposing mandibular
  non-anatomic

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Mortar pestle occlusion without maxillary
buccal cusp contact
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Lack of mandibular cusp angles and no attempt to
balance the occlusion
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• No compensating curves
• No overbite

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No overbite
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More for Class II patients

• Magnitude of Overjet

Class I
Class II
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• Magnitude of Horizontal Overlap

Class III
Class III patients Little or no overjet
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• Setting the posterior teeth
• Teeth should end prior to the ascending ramus

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• Mandibular teeth set to a flat plane and on the
  plane of occlusion

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• Maxillary lingual cusps should contact the
  central groove of the opposing teeth

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• The horizontal overlap should be ideal and
  should be sufficient to prevent biting of the
  cheek and corner of the mouth

Horizontal overlap
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• All maxillary teeth, with the exception of the
  lateral incisors and cuspids, should be on the
  plane of occlusion

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• Reestablish centric contacts as necessary

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Balancing Ramp If bilateral balance is desired a
balancing ramp can be generated
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Bilateral balance with Balancing Ramps
Working
Balancing

• In lateral excursions, at least three points of
  contact (both balancing ramps and anterior
  incisor contacts)

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Monoplane Occlusion
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Monoplane 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

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Monoplane Occlusion

• Eliminate cusps
• lateral forces reduced
• improves stability
• Simplifies tooth arrangement

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Monoplane Occlusion

• No overbite (would cause tilting)
• Overjet of 2 mm is used to create an illusion of
  overbite

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Monoplane Occlusion

• Excursions - may or may not contact on balancing
  sides
• Depends on condylar inclination and other aspects
  of the tooth arrangement

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Monoplane Occlusion

• Anterior teeth make contact in excursions
• Modifications have been proposed to minimize the
  tilting potential
• Balancing ramps
• Compensating curves

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Monoplane Occlusionwithout condylar influence
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Monoplane Occlusion
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Monoplane Occlusion

• 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

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Monoplane Occlusion

• Disadvantages
• Poorer appearance
• Can be unstable if condylar guidance is steep
  (posterior teeth separate, leaving only the
  anteriors in contact)

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Monoplane Occlusion

• Clinical remount on an articulator
• Practice doing a clinical remount

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Adjusting Monoplane Occlusion

• Main adjustment is flat
• If heavy prematurity near fossa, slightly shallow
  fossa