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Setting Posterior Teeth

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Title: Setting Posterior Teeth


1
Setting Posterior Teeth
  • Set for Function

2
Philosophies of Denture Occlusion
  • Many philosophies of arranging denture occlusion
  • No definitive scientific studies prove one
    occlusal scheme clearly superior

3
Rationale for Dalhousie Approach
  • Principals to choose an occlusal scheme
  • Based on clinical experience
  • Dalhousie two occlusal schemes
  • Lingualized Occlusion
  • Monoplane Occlusion

4
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

5
Lingualized Occlusion
  • Centric contacts are maxillary lingual cusp to
    central fossa / marginal ridge

Based on the UCLA/IVOCLAR/ACP Series
6
Lingualized Occlusion
  • Anatomic teeth used in maxilla
  • Better esthetics than Monoplane
  • Shallow cusped mandibular teeth
  • Forces centered over mandibular ridge

7
Lingualized Occlusion
  • No overbite
  • May or may not have balancing contacts in
    excursions
  • Anterior teeth - must make at least grazing
    contacts in excursions

8
Lingualized Occlusion
  • Maxillary anatomic (33)
  • Mandibular Teeth
  • Steep Condylar Guidance
  • Shallow cusped (Anatoline)
  • Shallow Condylar Guidance
  • Non-anatomic (Portrait 0)

9
Denture Occlusion Options
Semi-anatomic
Non-anatomic (balancing ramp)
Lingualized (lingual contact)
Non-anatomic
Anatomic
10
Occlusal plane
  • Set mandibular premolars 1st molar
  • Level with occl plane
  • Centered over ridge

Line indicating the crest of the ridge
11
Balanced Lingualized Occlusion
  • Maxillary anatomic opposing Mandibular shallow
    cusp

12
  • 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

13
15 degrees
Second molar elevated by 15 from the occlusal
plane
14
Posterior teeth have 1mm space between the
buccal cusps
15
Lingual cusps contact with the central fossae of
the opposing mandibular teeth
16
  • Maxillary lingual cusps firmly contact the
    central fossae of the mandibular teeth

17
Centric Position
Verify centric No buccal cusp contacts
Centric Lateral excursions
18
Working Excursions
  • Verify excursive contacts
  • Anterior teeth are in contact during lateral
    excursions

19
Balancing Excursions
Note the balancing contacts
20
Effect of Mandible Moving Downward During
Excursions
21
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22
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23
Maintaining Balancing Contacts
  • Change occlusal plane angle
  • Increase compensating curves
  • Increase cusp angles

24
Achieving Balance
  • Condylar angulation
  • Recorded with protrusive record
  • Cusp angle
  • Selected by dentist

25
Achieving Balance
  • Occlusal Plane
  • Determined by dentist with wax rims
  • Curve of Spee Curve of Wilson
  • Controlled by inclination of teeth

26
Checking for Balance
  • Feels Smooooooth in excursions
  • - Fingers on Maxillary Canines
  • - On Articulator

27
Assessing Balance
  • Jumps or bumps are due to cusp tips moving over
    other cusp tips, inclines, marginal ridges

28
Occlusal RefinementOcclusal Adjustment,
Selective Grinding
  • Set teeth as close to
  • Maximum intercuspation
  • Balance
  • All setups will need some adjustment

29
IIF Rule
  • IIF you have contacts on the Inner Inclines of
    Functional cusps they are balancing contacts

30
Rules for Balancing Contacts
  • Balancing contacts should be lines, not points
  • Balancing contacts should never be heavier than
    working contacts

31
Find the Balancing Contact
32
Find the Balancing Contact
33
What type of Contact?
34
What type of Contact?
35
What type of Contacts?
36
What type of Contact?
37
Assess Contacts
  • Centric Stops
  • Excursions

38
Non-Balanced Lingualized Occlusion
  • Maxillary anatomic opposing mandibular
    non-anatomic

39
Mortar pestle occlusion without maxillary
buccal cusp contact
40
Lack of mandibular cusp angles and no attempt to
balance the occlusion
41
  • No compensating curves
  • No overbite

42
No overbite
43
More for Class II patients
  • Magnitude of Overjet

Class I
Class II
44
  • Magnitude of Horizontal Overlap

Class III
Class III patients Little or no overjet
45
  • Setting the posterior teeth
  • Teeth should end prior to the ascending ramus

46
  • Mandibular teeth set to a flat plane and on the
    plane of occlusion

47
  • Maxillary lingual cusps should contact the
    central groove of the opposing teeth

48
  • The horizontal overlap should be ideal and
    should be sufficient to prevent biting of the
    cheek and corner of the mouth

Horizontal overlap
49
  • All maxillary teeth, with the exception of the
    lateral incisors and cuspids, should be on the
    plane of occlusion

50
  • Reestablish centric contacts as necessary

51
Balancing Ramp If bilateral balance is desired a
balancing ramp can be generated
52
Bilateral balance with Balancing Ramps
Working
Balancing
  • In lateral excursions, at least three points of
    contact (both balancing ramps and anterior
    incisor contacts)

53
Monoplane Occlusion
54
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

55
Monoplane Occlusion
  • Eliminate cusps
  • lateral forces reduced
  • improves stability
  • Simplifies tooth arrangement

56
Monoplane Occlusion
  • No overbite (would cause tilting)
  • Overjet of 2 mm is used to create an illusion of
    overbite

57
Monoplane Occlusion
  • Excursions - may or may not contact on balancing
    sides
  • Depends on condylar inclination and other aspects
    of the tooth arrangement

58
Monoplane Occlusion
  • Anterior teeth make contact in excursions
  • Modifications have been proposed to minimize the
    tilting potential
  • Balancing ramps
  • Compensating curves

59
Monoplane Occlusionwithout condylar influence
60
Monoplane Occlusion
61
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62
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

63
Monoplane Occlusion
  • Disadvantages
  • Poorer appearance
  • Can be unstable if condylar guidance is steep
    (posterior teeth separate, leaving only the
    anteriors in contact)

64
Monoplane Occlusion
  • Clinical remount on an articulator
  • Practice doing a clinical remount

65
Adjusting Monoplane Occlusion
  • Main adjustment is flat
  • If heavy prematurity near fossa, slightly shallow
    fossa
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