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Philosophies of Occlusion for Implants

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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  1. Philosophies of Occlusion for Implants

  2. Implant Occlusion • Single Crown • Fixed Partial Dentures • Full arch prostheses (screw retained) • Overdentures

  3. 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

  4. Anatomic Non Anatomic Canine Guidance (Mutually Protected) Group Function Lingualized (Balanced) Monoplane Tooth Forms Occlusal Schemes

  5. Denture Tooth Forms and Occlusal Forms

  6. Occlusal Scheme & Axial Loading Evidence Based Reviews • Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560 • Carlsson. Odontology 2009; 97:8-17 • No Preferred occlusal scheme • Clinicians advocate axial loading of implants, but no evidence, at present, demonstrating benefits

  7. Loading and Overloading • Evidence Based Review Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560 • No evidenceat present that • progressive occlusal loading of implant is beneficial • occlusal overload is detrimental to implants* * At least one case study now - unstable prosthesis, bone loss reversed Int J Oral Maxillofac Impl 2008;23:153-157.

  8. Occlusal Table & C/R Ratios • Evidence Based Review Carlsson 2008 • No evidence of risk at present from: • Increased Crown/Root Ratio • Increased occlusal table • Porcelain vs. Acrylic

  9. Absence of Scientific Evidence Not proof against! Follow best available clinical principles Do not build in heavy non-axial loading or overloading

  10. Clinical Principles for Occlusion Based on Clinical Experience Not Scientific Evidence

  11. General Principles Improve denture stability or axial loading of single teeth • Centric contacts on flat surfaces, not inclines

  12. General Principles Posterior Overjet to Avoid Cheek Biting

  13. General Principles Improve denture stability or single tooth loading • Center occlusal contacts over ridge • Simultaneous posterior contacts in centric

  14. 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

  15. Occlusal Schemes • Canine Guidance • Group Function • Lingualized • Monoplane Single Teeth FPD’s Dentures

  16. Crowns or FPD’s • Either canine guidance or group function works - no preference • Use what the patient has • Use what would be easiest

  17. Overdentures or Full Arch Prostheses ALL Occlusal Schemes Devised to Maximize Denture Stability

  18. Lingualized Occlusion • Maxillary cusped tooth • Mandibular cuspless or shallow cusped tooth • Maxillary lingual cusp balanceslike a mortar in a pestle

  19. Lingualized Occlusion • Lingual cusp contacts opposing central fossae • Mandibular cuspal inclines are shallow (0°, 10°) • Less lateral displacement

  20. Lingualized OcclusionHow Stability is Improved • Simultaneous bilateral anterior and posterior in all excursions • Tilting forces theoretically neutralized

  21. Enter Bolus Exit Balance? • Many patients chew bilaterally • Biting forces maximum close to intercuspation (where balance most effective) • Non-functional aspects (swallow)

  22. 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

  23. Lingualized Contacts • Only buccal cusp contact is inner incline of mandibular teeth (balancing) Working Side Balancing Side

  24. ‘IIF’ Rule • IIF you have contacts on the Inner Inclines of Functional cusps they are balancing contacts

  25. Test!

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

  27. 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)

  28. Lingualized Cusp Angles • Always use steep cusped maxillary tooth (33°) • When condylar guidance is steeper use more cusp angle in mandible (10°)

  29. Lingualized Occlusion • Balance cannot be set without an articulator • Clinical remount on an articulator - fewer adjustments

  30. 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

  31. Effect of Mandible Moving Downward During Excursions

  32. Maintaining Balancing Contacts • Change occlusal plane angle • Increase compensating curves • Increase cusp angles or effective cusp angles

  33. Checking for Balance Feels Smoooooothin excursions • - Fingers on max. canines • - Check on articulator

  34. Assess Contacts: • Centric Stops • Excursions

  35. Improving Denture Occlusion • Most important cusp - maxillary lingual • Mandibular buccal cusps more lateral - more tipping

  36. 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

  37. 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

  38. Monoplane OcclusionHow Stability is Improved • Elimination of cusps • Lateral forces reduced, improving stability • Simplifies denture tooth arrangement

  39. Monoplane OcclusionWith Condylar Inclination

  40. Monoplane OcclusionWith Condylar Inclination

  41. Ensure Teeth Set Over Ridge • Minimize tilting/tipping • Maximize stability • Minimize contacts on buccal of flat cusps

  42. Monoplane Occlusion • Functional, but unesthetic • Not balanced - flat • Zero degree teeth can be balanced if condylar inclinations are shallow

  43. Monoplane Occlussion - When? • Jaw size discrepancies, malocclusions • cross-bite, Cl II, III • Minimal ridge • reduces horizontal forces • implants help • Uncoordinated jaw movements

  44. 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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