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Philosophies of Occlusion for Implants PowerPoint PPT Presentation


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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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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


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


Anatomic

Non Anatomic

Canine Guidance (Mutually Protected)

Group Function

Lingualized (Balanced)

Monoplane

Tooth Forms Occlusal Schemes


Denture Tooth Forms and Occlusal Forms


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 & 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

Not proof against!

Follow best available clinical principles

Do not build in heavy non-axial loading or overloading


Clinical Principles for Occlusion

Based on Clinical Experience

Not Scientific Evidence


General Principles

Improve denture stability or axial loading of single teeth

  • Centric contacts on flat surfaces, not inclines


General Principles

Posterior Overjet to Avoid Cheek Biting


General Principles

Improve denture stability or single tooth loading

  • Center occlusal contacts over ridge

  • Simultaneous posterior contacts in centric


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

  • Canine Guidance

  • Group Function

  • Lingualized

  • Monoplane

Single Teeth

FPD’s

Dentures


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

ALL Occlusal Schemes Devised to Maximize Denture Stability


Lingualized Occlusion

  • Maxillary cusped tooth

  • Mandibular cuspless or shallow cusped tooth

  • Maxillary lingual cusp balanceslike a mortar in a pestle


Lingualized Occlusion

  • Lingual cusp contacts opposing central fossae

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

  • Less lateral displacement


Lingualized OcclusionHow Stability is Improved

  • Simultaneous bilateral anterior and posterior in all excursions

  • Tilting forces theoretically neutralized


Enter Bolus Exit Balance?

  • Many patients chew bilaterally

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

  • Non-functional aspects (swallow)


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

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

Working Side

Balancing Side


‘IIF’ Rule

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


Test!


Rules for Balancing Contacts

  • Balancing contacts should be lines, not points

  • Balancing contacts should never be heavier than working contacts


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

  • Always use steep cusped maxillary tooth (33°)

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


Lingualized Occlusion

  • Balance cannot be set without an articulator

  • Clinical remount on an articulator - fewer adjustments


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


Effect of Mandible Moving Downward During Excursions


Maintaining Balancing Contacts

  • Change occlusal plane angle

  • Increase compensating curves

  • Increase cusp angles or effective cusp angles


Checking for Balance

Feels Smoooooothin excursions

  • - Fingers on max. canines

  • - Check on articulator


Assess Contacts:

  • Centric Stops

  • Excursions


Improving Denture Occlusion

  • Most important cusp - maxillary lingual

  • Mandibular buccal cusps more lateral - more tipping


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

  • 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 OcclusionHow Stability is Improved

  • Elimination of cusps

    • Lateral forces reduced, improving stability

    • Simplifies denture tooth arrangement


Monoplane OcclusionWith Condylar Inclination


Monoplane OcclusionWith Condylar Inclination


Ensure Teeth Set Over Ridge

  • Minimize tilting/tipping

  • Maximize stability

  • Minimize contacts on buccal of flat cusps


Monoplane Occlusion

  • Functional, but unesthetic

  • Not balanced - flat

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


Monoplane Occlussion - When?

  • Jaw size discrepancies, malocclusions

    • cross-bite, Cl II, III

  • Minimal ridge

    • reduces horizontal forces

    • implants help

  • Uncoordinated jaw movements


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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