Balanced occlusion

Department of Removable Prosthodontics

nd
2 year

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DIFFERNCES BETWEEN NATURAL AND ARTIFICIAL OCCLUSION:
To understand the complete denture balanced occlusion one must know the differences
between complete denture occlusion and natural occlusion.

Artificial occlusion Natural occlusion

1. Supported by a denture base placed on Supported by roots which are firmly anchored to
slippery mucosa the bone

2. Moves as a unit on their base Moves independently in their socket

3. Malocclusion evokes immediate Malocclusion may remain uneventful for years

instability and pain

4. Forces acting on complete denture Occlusal forces affect only the concerned teeth
affect the whole base

5. Non-vertical forces are usually not well Non-vertical forces are tolerated much better
tolerated

6. The second premplar area is preferred Mastication is usually done in the second molar
for mastication.( it is the anteroposterior region
center of the occlusal table); mastication
in the second molar region can cause
shifting of the bases

7. Bilateral balance is usually considered Bilateral balance is not naturally found and is
necessary for denture stability considered detrimental

FUNCTIONS OF COMPLETE DENTURE OCCLUSION:

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A complete denture occlusion should:

Improve masticatory function

Minimize harmful non vertical or lateral forces
Contribute to the stability of the denture bases
Contribute to the health and preservation of the alveolar bone and soft tissues
Maintainance of the comfort and well-being of the patient

IDEAL REQUIREMENTS OF THE COMPLETE DENTURE OCCLUSION:

Stability of the denture and its occlusion when the mandible is in both centric and
eccentric relations
Balanced occlusal contacts(tripod contact) during all eccentric movements
Unlocking (removing interferences) the cusps mesiodistally so that the denture
can settle when there is a ridge resorption.
The cuspal height should be reduced to control the horizontal forces.
Functional lever balance should be obtained by vertical tooth to ridge crest
relatioship. ( lever balance is a balance against leverage forces acting on the
denture. Presence of positive contact on the opposing side provides lever
balance.).
Cutting, penetrating and shearing efficiency of the occlusal surface equivalent to
that of natural dentition.
Incisal clearance during posterior functions like chewing.
Minimal area of contact to reduce pressure while crushing food
Sharp ridges, cusps and slice ways to increase masticatory effieciency.

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BALANCED OCCLUSION:

The balanced occlusal scheme has gained wide spread acceptance as the ideal occlusal
scheme for complete dentures. The term balanced articulation is also used.

Definition acc. To GPT-8: Is the bilateral, simulataneous, anterior and posterior occlusal
contact of teeth in centric and eccentric positions.

Or the simultaneous contacting of the maxillary and mandibular teeth on the right and
left and in the posterior and anterior occlusal areas in centric and eccentric positions,
developed to lessen or limit tipping or rotating of the denture bases in relation to the
supporting structures.

MECHANICS OF BALANCED OCCLUSION:

In natural teeth or in unbalanced occlusion, when the mandible is protruded so that the
incisal edges of the upper and lower teeth contact, there is a gap between the upper and
lower teeth in the posterior region ( also referred to as Christensens phenomenon ). Such
an occlusion in complete dentures could cause tipping or instability of the dentures in the
posterior section. Thus the stability of the denture can be improved if there are
simultaneous anterior and posterior contacts when the mandible is protruded (protrusive
balance).

In the same way, when the mandible is moved to one side (working side) with the teeth in
contact on that side, a space may be observed on the opposing side ( balancing side). This
again can lead to instability because of the uneven contacts. Giving simultaneous occlusal
contacts on both sides of the arch ( working and balancing sides ) would improve stability
of the denture. This is known as lever balance.

Inferences: when the patient moves his lower denture from centric occlusion to eccentric
occlusion, the occlusal surfaces glide along each other. Any obstruction to this movement
is known as interference. Interference may be the result of an obstructing cusp or ridge.

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 OBJECTIVES OF THE BALANCED OCCLUSION:

1. Create simultaneous bilateral contacts from the centric to eccentric occlusal

positions thus reducing tipping forces.
2. when gliding from centric to eccentric positions these contacts should be free of
interferences.
3. these movements and contacts should be in harmony with the temporomandibular
joints and neuromuscular activity.

Advantages of balanced occlusion:

Some feel that balanced occlusion was not necessary or possible especially during
mastication with food in the mouth. Thus came the statement-Enter bolus, exit balance

However it was shown that teeth do not contact occasionally during mastication.
Teeth contact occurs through the day even when there is no food in the mouth.
Eccentric tooth contacts are increased in bruxism.
Thus it can be seen that balanced occlusion

1. improves the stability and retention of the denture bases

2. reduces soreness and resorption caused by the denture base movement
3. Dentures more comfortable to the patient.

Achieving balanced occlusion: by

Careful teeth arrangement in a programmed articulator ( semi adjustable or fully

adjustable ) in harmony with the factors affecting the balanced occlusion.
A programmed articulator is one in which the articulator movements are programmed
to stimulate the patients mandibular movements.
Initially the teeth are arranged tentatively.
Final balance is achieved by selective grinding of interferences.

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TYPES OF BALANCED OCCLUSION: Occlusal balance or balanced occlusion can be
classified as follows:

Unilateral balanced occlusion

Bilateral balanced occlusion
Protrusive balanced occlusion
Lateral balanced occlusion

Unilateral balanced occlusion:

This is a type of occlusion seen on occlusal surfaces of the teeth on one side when they
occlude simultaneously with a smooth, uninterrupted glide. This is not followed during
complete denture construction. It is more pertained to fixed partial dentures.

Bilateral balanced occlusion:

This is a type of occlusion that is seen when simultaneous contact occurs on both the
sides in centric and eccentric positions. Bilateral balanced occlusion helps to distribute
the load evenly across the arch and therefore helps to improve the stability of the denture
during centric, eccentric or parafunctional movements.

For minimal occlusal balance, there should be at least three points of contact on the
occlusal plane. More the no. of contacts, better the balance. Bilateral balanced
occlusion(B.O.) can be protrusive or lateral balance.

Protrusive balanced occlusion : This type of balanced occlusion is present when

mandible moves in a forward direction and the occlusal contacts are smooth and
simultaneous anteriorly and posteriorly. There should be at least three points of
contact in the occlusal plane. Two of these should be located posteriorly and one
should be located in the anterior region. This is absent in natural dentition.

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Posterior contact during protrusion to maintain balance.

Lateral balanced occlusion : In lateral balance, there will be a minimal simultaneous

three point contact (one anterior, two posterior) present using lateral movement of
the mandible.
Lateral balanced occlusion is absent in normal dentition. When a dentulous person
with canine guided occlusion moves his mandible to the right, there will be canine
guided disocclusion of all his teeth. That is, the canine will be the only tooth that
contacts the opposing tooth. Even the canine on the opposite side will not have
contact .
If this relationship is followed during teeth arrangement, then the denture will
loose stability due to lever action.
To prevent this the teeth should be arrange such that there is simultaneous tooth
contact in the balancing and working sides. (working side is the side to which the
mandible moves; here right. Balancing side is opposite to the working side; here
left).

Fig. a: Canine guided dis occlusion. This relationship is seen in natural dentition.

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Fig. b: Anterior and posterior tooth contact during-laterotrusion seen on the working
side.

(a).shallow cusp teeth allow the opposing members to slide through the
mastication. (b) teeth with higher cusp angle tend to lock the opposing teeth
during movement.(c.d.) dentures with steep incisal guidance tend to get displaced
during protrusion. (e.g) dentures with shallow incisal guidance produce lesser
interference during protrusion. However, the amount of anterior interference
depends on other factors like condylar guidance, etc,
An increase in any of the above factors will affect balanced occlusion leading to
compromised stability in the denture.
If the vertical overlap of the anterior teeth is increased for aesthetic and phonetic
reasons, then the horizontal overlap should be adjusted to reduce the incisal
guidance angle.
This adjustment provides space for free movement of the anterior teeth. Without
this adjustment, there will be increased anterior interference leading to initial
instability of the denture base during protrusion. In the long run, this may lead to
resorption of the residual alveolar ridge in the anterior region.

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FACTORS AFFECTING BALANCED OCCLUSION;

Condylar guidance
Incisal guidance
Plane of occlusion
Compensating curves
Cuspal inclination
Except for the condylar guidance, all factors can be altered by the dentist in the denture.
The condylar guidance is obtained from the patient.

What are the compensating curves?

The compensating curves are artificial curves introduced into the complete denture
occlusion in order to achieve a balanced occlusion. They are called compensating curves
because they compensate for the space (Christensens phenomenon ) formed between the
posterior portions of the upper and lower occlusal surfaces during eccentric movements
of the mandible.

It is determined by the inclination of the posterior teeth and their vertical relationship to
the occlusal plane so that the occlusal surface results in a curve that is in harmony with
the movement of the mandible as guided posteriorly by the condylar path.

The curvatures in the natural dentitions are:

Curve of Spee
Curve of Wilson
Pleasure curves