Philosophies of occlusion for implants
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Philosophies of Occlusion for Implants. Implant Occlusion. Single Crown Fixed Partial Dentures Full arch prostheses (screw retained) Overdentures. M any Philosophies of Occlusion. No definitive scientific studies to prove: one type of tooth form one type of occlusal scheme

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Implant occlusion l.jpg
Implant Occlusion

  • Single Crown

  • Fixed Partial Dentures

  • Full arch prostheses (screw retained)

  • Overdentures


M any philosophies of occlusion l.jpg
ManyPhilosophies of Occlusion

Nodefinitivescientificstudies to prove:

  • one type of tooth form

  • one type of occlusal scheme

  • to be clearly preferred by patients

  • to be more efficient than another


Tooth forms occlusal schemes l.jpg

Anatomic

Non Anatomic

Canine Guidance (Mutually Protected)

Group Function

Lingualized (Balanced)

Monoplane

Tooth Forms Occlusal Schemes



Occlusion implants l.jpg
Occlusion & Implants

  • Evidence Based Review

    Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

  • No Preferred occlusal scheme

  • Clinicians advocate axial loading of implants,

    but no evidence, at present,

    demonstrating benefits


Occlusion implants7 l.jpg
Occlusion & Implants

  • Evidence Based Review

    Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560

  • No evidence at present that

    • progressive occlusal loading of implant is beneficial

    • occlusal overload is detrimental to implants


Absence of scientific evidence l.jpg

Absence of Scientific Evidence

Not proof against!

Follow best available clinical principles

Do not build in heavy non-axial loading or overloading


Clinical principles for occlusion l.jpg

Clinical Principles for Occlusion

Based on Clinical Experience

Not Scientific Evidence


General principles l.jpg
General Principles

Improve denture stability or axial loading of single teeth

  • Centric contacts on flat surfaces, not inclines


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General Principles

Posterior Overjet to Avoid Cheek Biting


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General Principles

Improve denture stability or single tooth loading

  • Center occlusal contacts over ridge

  • Simultaneous posterior contacts in centric


General occlusal principles l.jpg
General Occlusal Principles

For overdentures or full arch prostheses opposing a CD:

  • No anterior contacts in centric

    • Minimizes anterior resorption

  • Grazing anterior contacts in excursions

    • Incising


Occlusal schemes l.jpg
Occlusal Schemes

  • Canine Guidance

  • Group Function

  • Lingualized

  • Monoplane

Single Teeth

FPD’s

Dentures


Crowns or fpd s l.jpg
Crowns or FPD’s

  • Either canine guidance or group function works - no preference

  • Use what the patient has

  • Use what would be easiest


Overdentures or full arch prostheses l.jpg

Overdentures or Full Arch Prostheses

ALL Occlusal Schemes Devised to Maximize Denture Stability


Lingualized occlusion l.jpg
Lingualized Occlusion

  • Maxillary cusped tooth

  • Mandibular cuspless or shallow cusped tooth

  • Maxillary lingual cusp balanceslike a mortar in a pestle


Lingualized occlusion18 l.jpg
Lingualized Occlusion

  • Lingual cusp contacts opposing central fossae

  • Mandibular cuspal inclines are shallow (0°, 10°)

  • Less lateral displacement


Lingualized occlusion how stability is improved l.jpg
Lingualized OcclusionHow Stability is Improved

  • Simultaneous bilateral anterior and posterior in all excursions

  • Tilting forces theoretically neutralized


Enter bolus exit balance l.jpg
Enter Bolus Exit Balance?

  • Many patients chew bilaterally

  • Biting forces maximum close to intercuspation (where balance most effective)

  • Non-functional aspects (swallow)


Point of loading affects stability l.jpg

L

M

D

B

C

Point of Loading Affects Stability

  • Browning, 1986

    • Loaded centrally, M, D, L,B

    • B caused unseating

    • Central loading better than distal loading


Lingualized contacts l.jpg
Lingualized Contacts

  • Only buccal cusp contact is inner incline of mandibular teeth (balancing)

Working Side

Balancing Side


Iif rule l.jpg
‘IIF’ Rule

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



Rules for balancing contacts l.jpg
Rules for Balancing Contacts

  • Balancing contacts should be lines, not points

  • Balancing contacts should never be heavier than working contacts


Balanced occlusion lingualized l.jpg
Balanced Occlusion (Lingualized)

  • Indirect evidence that balanced occlusion may:

    • reduce ridge resorption (Maeda & Wood, 1989)

    • allow for increased functional forces in excursions (Miralles et al, 1989)


Lingualized cusp angles l.jpg
Lingualized Cusp Angles

  • Always use steep cusped maxillary tooth (33°)

  • When condylar guidance is steeper use more cusp angle in mandible (10°)


Lingualized occlusion28 l.jpg
Lingualized Occlusion

  • Balance cannot be set without an articulator

  • Clinical remount on an articulator - fewer adjustments


Condylar inclination l.jpg
Condylar Inclination

  • Posterior teeth separate as working condyle moves forward (and downward)

  • Anterior teeth contact

  • Closer to condyle, more separation

  • More anterior separation of Premolars if steep anterior guidance



Maintaining balancing contacts l.jpg
Maintaining Balancing Contacts

  • Change occlusal plane angle

  • Increase compensating curves

  • Increase cusp angles or effective cusp angles


Checking for balance l.jpg
Checking for Balance

Feels Smoooooothin excursions

  • - Fingers on max. canines

  • - Check on articulator


Assess contacts l.jpg
Assess Contacts:

  • Centric Stops

  • Excursions


Improving denture occlusion l.jpg
Improving Denture Occlusion

  • Most important cusp - maxillary lingual

  • Mandibular buccal cusps more lateral - more tipping


When not to balance l.jpg
When Not to Balance

  • Difficulty in obtaining repeatable centric record

    • incoordination,

    • muscle splinting

  • Dramatic malocclusions

  • Severe ridge resorption

    • lateral forces displace the denture

    • Implants tend to negate this factor


Monoplane occlusion l.jpg
Monoplane Occlusion

  • Cuspless teeth set on a flat plane with 1.5- 2 mm overjet

  • No cusp to fossa relationship

  • No anterior contacts present in centric position

  • No overbite


Monoplane occlusion how stability is improved l.jpg
Monoplane OcclusionHow Stability is Improved

  • Elimination of cusps

    • Lateral forces reduced, improving stability

    • Simplifies denture tooth arrangement


Monoplane occlusion with condylar inclination l.jpg
Monoplane OcclusionWith Condylar Inclination


Monoplane occlusion with condylar inclination39 l.jpg
Monoplane OcclusionWith Condylar Inclination


Ensure teeth set over ridge l.jpg
Ensure Teeth Set Over Ridge

  • Minimize tilting/tipping

  • Maximize stability

  • Minimize contacts on buccal of flat cusps


Monoplane occlusion41 l.jpg
Monoplane Occlusion

  • Functional, but unesthetic

  • Not balanced - flat

  • Zero degree teeth can be balanced if condylar inclinations are shallow


Monoplane occlussion when l.jpg
Monoplane Occlussion - When?

  • Jaw size discrepancies, malocclusions

    • cross-bite, Cl II, III

  • Minimal ridge

    • reduces horizontal forces

    • implants help

  • Uncoordinated jaw movements


Summary l.jpg

Summary

No definitive studies to show one type of occlusion is best

Follow established clinical principles

Assess each case - adapt to clinical situation

Continue to read the literature


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