Bilaterally Balanced Occlusion
Introduction
I- Definition
II- Occlusal schemas in PAC
1- Bilaterally balanced occlusion
1-1-Bilaterally balanced meshed occlusion
1-1-1- generalized gear
1-1-1- non-generalized gear
1-1-1- Lingual impact gear
1-2-Bilaterally balanced non-interlocking occlusion
2- Bilaterally unbalanced occlusion
2-1- Monoplane occlusion
2-2- Occlusion in canine protection
CONCLUSION
BIBLIOGRAPHY
Bilaterally Balanced Occlusion
Introduction
Different occlusal concepts are now considered feasible on prosthetic restorations, each presenting advantages and disadvantages that the practitioner will have to take into account in order to guarantee the patient an aesthetically acceptable and neuro-muscularly integrated rehabilitation.
Occlusal schemes in PAC
I- Definition
An occlusal concept can be defined as: “the rules establishing the number and location of contacts for the meshing of teeth and sliding surfaces for the reference position and during excursion movements of the mandible.”
II- Occlusal schemas in PAC
In complete removable prosthesis, we can distinguish two main types of diagrams:
- Bilaterally balanced occlusion
- Unbalanced occlusion
Bilaterally Balanced Occlusion
II.1- Bilaterally balanced occlusion
* This is the occlusal scheme most often used in PAC.
– General principles
In statics:
– In centric relation: there must be stabilizing contacts between the posterior grinding surfaces, equal on each side, without contact of the anterior teeth.
In dynamics:
- In protrusion:
-A balanced protrusion articulation assumes a sliding of the centric relation at the incisal end-to-end without loss of contact of the antagonistic molars and premolars.
contacts during potrusion movement (10)
- In laterotrusion:
In diduction, balancing contacts are made between:
-the vestibular and lingual cusp tips on the working side
(contact of four cusps)
-the maxillary palatine and mandibular vestibular cusp tips on the balancing (non-working) side (10)
Bilaterally Balanced Occlusion
Cusp contacts during diduction (10)
II.1-1- Bilaterally balanced meshed occlusion
II.1.1.1- Generalized bilaterally balanced meshed occlusion
Two assemblies meet these criteria:
- Gysi’s montage.
- The Hanau assembly.
- Gysi’s montage:
– It requires the use of porcelain teeth with strong cusps at 33 degrees.
– In ORC, contacts are established according to cusp-embrasure relationships at the premolar level and cusp-fossae relationships at the molar level.
-It is indicated in patients whose closed chewing cycle allows precise inter-arch relationships to be established.
- The Hanau assembly:
- The occlusal relationships are identical to those of the Gysi assembly.
- On the other hand, balance results from the harmony which is established between the five components of the Quint of Hanau:
– The condylar slope.
– The cusp slope.
– The incisive slope.
– The occlusal plane.
– The compensation curve.
- This type of assembly is indicated in patients whose neuromuscular behavior, quality of support surfaces, and joint stability are inferior to those required for the Gysi assembly.
- The teeth used will be of the anatomical or semi-anatomical type.
- They will be made of porcelain or possibly improved resin, or composite.
The Hanau assembly (8)
II.1.1.2- Non-generalized bilaterally balanced meshed occlusion
Two types of assembly meet this designation:
- Ackermann’s montage.
- Strack’s montage.
- Ackermann’s montage:
This assembly has the following characteristics:
- In ORC the distribution of occlusal contacts is identical to that of the previous diagrams.
- During eccentric movements, bilaterally balanced occlusion is achieved only through anterior contact and contacts between the last molars, the intermediate teeth do not come into contact creating a gap in the articulation.
This type of assembly is particularly suitable when the anterior guide is marked.
Cusp relationship in ORC (8)
Bilaterally Balanced Occlusion
During a protrusion movement, the anterior and posterior teeth come into contact, but between these contacts a gap is established (8)
Strack’s assembly:
This assembly requires semi-anatomical, moderately cusped teeth, approximately 20 degrees.
In ORC and protrusion, the distribution and organization of occlusal contacts are comparable to those of a Hanau and GYSI assembly.
- In reduction:
- Working side vestibular contact only between PM and canine and absence of contact on the lingual side
- The molars are out of contact
- On the non-working side, all the upper palatal cusps are in contact with the lower vestibular cusps and their internal slope.
protrusive occlusal contacts according to Strack (8)
II.1.1.3- Bilaterally balanced occlusion with lingual impact
It is characterized in ORC by:
- Absence of contact between the anterior teeth.
- Occlusal contacts only between the palatal cusps of the posterior upper teeth and the antagonistic reception areas.
- Absence of contact between the mandibular vestibular cusps and the antagonistic receiving fossae. (8)
Bilaterally balanced occlusion with lingual impact (8)
Bilaterally Balanced Occlusion
Vestibular aspect of the Gerber montage highlighting the absence
of contacts between the mandibular vestibular cusps and the areas
of antagonistic reception.(8)
During eccentric movements:
By a harmonious sliding of the palatal cusp tips in the mandibular reception areas.
The Gerber assembly uses Condyloform® teeth, which are specially designed for this assembly.
This type of assembly is particularly indicated in patients with insufficient neuromuscular coordination, an unstable support surface, an open chewing cycle and in patients whose post-prosthetic control is difficult to ensure.
II.1.2- Bilaterally balanced non-interlocking occlusion
The principle:
Use of flat teeth without occlusal relief
Flat tooth without occlusal relief (10)
II.2- Unbalanced occlusion
II.2-1- Monoplane occlusion
This type of assembly created by De Van in 1954 under the name “neutral occlusion” or
“neutrocentric” requires flat teeth without any cusp relief.
This occlusal organization is characterized in RC by:
- A lack of contact between the anterior teeth.
- Contacts between the premolars and the antagonistic first molars, but the second molars are not in contact.
During eccentric movements :
– The posterior teeth are not necessarily in contact.
– During assembly no incisal overlap is established, however, in the antero-posterior direction the overjet depends on the type of skeletal relationships of the patient, and the tone of the lip.
Occlusal contacts during protrusion (8)
- At the posterior level, the two PMs and the first molar come into contact with the premolars and the antagonist molar.
- In contrast, the maxillary second molar is located approximately 0.5 mm above the occlusal plane.
II.2-2- Occlusion in canine protection
This occlusal organization is characterized in ORC by:
- Light contact between the anterior teeth.
- Contacts between posterior teeth involving all of the supporting cusps in a cusp-fossa relationship .
– During eccentric movements:
- Only the anterior teeth come into contact, eliminating any posterior contact.
- This occlusal scheme from the sealed prosthesis does not seem to be adapted to the complete prosthesis and no study has been able to demonstrate the superiority of canine protection over bilaterally balanced occlusion for the preservation of tissue integrity.
Occlusion in canine protection (8)
Conclusion :
Occlusion in PAC is a very important piece of data. Its correct determination and compliance with all the stated requirements remain the key to therapeutic success.
BIBLIOGRAPHY
1/ABJEAN J. Occlusion in clinical practice. Paris: Information Dentaire, 2002, -175p.
2/DuminilG.,Olivier.H, OrthliebJ/D.,Occlusion simply.2003
3/Bory.H., Gobert.B., Geometric and anatomical diagrams of the different mandibular movements – Dental Prosthesis No. 84 – October 1993
4/MK Le Roux, N. Graillon, JM Foletti, C. Chossegros. Physiology of the condylodiscal and masticatory muscular system. 2-008-B-10; 2020
5/J.-D. Orthlieb, L. Darmouni, A. Pedinielli, J. Jouvin Darmouni- Occlusal functions: physiological aspects of occlusion
human dental – 2013
6/ARCHIENC, LOUIS J, HELFER M, MAHIAT Y, MINETTE C, the complete removable prosthesis: a complex treatment 2006; 6: 12
7/Mariani. What occlusal concept for the totally edentulous. Chir Dent Fr. 1989; 477:53-59
8/Hüe O, Berteretche MV. Clinical Reality: Therapeutic Solution. Paris: Quintessence international; 2003.
9/Abduo J, occlusal schemes for complete denture: a systematic review. Int J prosthodont 2013, 1: 26-33
10/Schoendorff R, Orgiazzi G and Millet C, 1997 choice and assembly of teeth in complete prosthesis EMC Odontology [23-325-F-10]
Bilaterally Balanced Occlusion
Wisdom teeth can cause infections if not removed.
Dental crowns restore the function and appearance of damaged teeth.
Swollen gums are often a sign of periodontal disease.
Orthodontic treatments can be performed at any age.
Composite fillings are discreet and durable.
Composite fillings are discreet and durable.
Interdental brushes effectively clean tight spaces.
Visiting the dentist every six months prevents dental problems.