CD_files/Implant%20Occlusion.ppt
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Transcript of CD_files/Implant%20Occlusion.ppt
Philosophies of Occlusion for Implants
Implant Occlusion
Single CrownSingle Crown Fixed Partial DenturesFixed Partial Dentures Full arch prostheses (screw retained)Full arch prostheses (screw retained) OverdenturesOverdentures
Many Philosophies of Occlusion
NoNo definitivedefinitive scientificscientific studiesstudies to prove: to prove: one type of one type of tooth formtooth form one type of one type of occlusal schemeocclusal scheme to be clearly to be clearly preferredpreferred by patients by patients to be more to be more efficientefficient than another than another
Tooth Forms Occlusal Schemes
AnatomicAnatomic Non AnatomicNon Anatomic
Canine Guidance Canine Guidance (Mutually Protected)(Mutually Protected)
Group FunctionGroup Function Lingualized Lingualized
(Balanced)(Balanced) MonoplaneMonoplane
Denture Tooth Forms and Denture Tooth Forms and Occlusal FormsOcclusal Forms
QuickTimeª and aTIFF (LZW) decompressor
are needed to see this picture.
Occlusion & Implants
Evidence Based Review Evidence Based Review Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560
No Preferred occlusal schemeNo Preferred occlusal scheme Clinicians advocate axial loading of implants, Clinicians advocate axial loading of implants,
but no evidence, but no evidence, at present,at present,
demonstrating benefitsdemonstrating benefits
Occlusion & Implants
Evidence Based Review Evidence Based Review Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560Taylor, Wiens et al. J Prosthet Dent 2005;94:555-560
No evidence No evidence at presentat present that that progressive occlusal loading of implant progressive occlusal loading of implant
is beneficialis beneficial occlusal overload is detrimental to occlusal overload is detrimental to
implantsimplants
Absence of Scientific Evidence
Not proof against!Not proof against!
Follow best available clinical Follow best available clinical principlesprinciples
Do not build in heavy non-axial Do not build in heavy non-axial loading or overloadingloading or overloading
Clinical Principles for Occlusion
Based on Clinical ExperienceBased on Clinical Experience
Not Scientific EvidenceNot Scientific Evidence
General Principles
Improve denture stability or axial Improve denture stability or axial loading of single teethloading of single teeth
Centric contacts on flat surfaces, Centric contacts on flat surfaces, not inclinesnot inclines
General Principles
a
1-2 mmNonanatomicsetup1-2 mmAnatomic setupCenter overlower ridge
Posterior Posterior Overjet to Overjet to Avoid Cheek Avoid Cheek BitingBiting
General Principles
Improve denture Improve denture stability or single stability or single tooth loadingtooth loading
Center occlusal contacts Center occlusal contacts over ridgeover ridge
Simultaneous posterior Simultaneous posterior contacts in centriccontacts in centric
General Occlusal Principles
For overdentures or full arch For overdentures or full arch prostheses opposing a CD:prostheses opposing a CD:
No anterior contacts in centricNo anterior contacts in centric Minimizes anterior resorptionMinimizes anterior resorption
Grazing anterior contacts in Grazing anterior contacts in excursionsexcursions IncisingIncising
Occlusal Schemes
Canine GuidanceCanine Guidance Group FunctionGroup Function LingualizedLingualized MonoplaneMonoplane Dentures
Single Teeth
FPD’s
Crowns or FPD’s
Either canine guidance or group function Either canine guidance or group function works - no preferenceworks - no preference
Use what the patient has Use what the patient has Use what would be easiestUse what would be easiest
Overdentures or
Full Arch Prostheses
ALLALL Occlusal Schemes Devised to Occlusal Schemes Devised to Maximize Denture StabilityMaximize Denture Stability
Lingualized Occlusion
Maxillary cusped toothMaxillary cusped tooth Mandibular cuspless or shallow cusped Mandibular cuspless or shallow cusped
toothtooth Maxillary lingual cusp Maxillary lingual cusp balancesbalances
like a mortar in a pestle like a mortar in a pestle
Lingualized Occlusion
• Lingual cusp contacts Lingual cusp contacts opposing central fossaeopposing central fossae
• Mandibular cuspal inclines Mandibular cuspal inclines are shallow (0°, 10°)are shallow (0°, 10°)
• Less lateral displacementLess lateral displacement
Lingualized OcclusionHow Stability is Improved
Simultaneous bilateralSimultaneous bilateral anterior and posterior in anterior and posterior in all all excursionsexcursions
Tilting forces theoretically Tilting forces theoretically neutralizedneutralized
Enter Bolus Exit Balance?
Many patients chew bilaterallyMany patients chew bilaterally Biting forces maximum close to intercuspation Biting forces maximum close to intercuspation
(where balance most effective)(where balance most effective) Non-functional aspects (swallow)Non-functional aspects (swallow)
Point of Loading Affects Stability
Browning, 1986Browning, 1986
Loaded centrally, Loaded centrally, M, D, L,M, D, L, BB
BB caused unseating caused unseating
Central loading better than Central loading better than distal loadingdistal loading
MM
DD
LL
BBCC
Lingualized Contacts
Balancing SideBalancing Side
Working SideWorking Side
Only buccal cusp Only buccal cusp contact is inner contact is inner incline of incline of mandibular teeth mandibular teeth (balancing)(balancing)
‘IIF’ Rule
a
Inner Inclines (inside of cusp)Outer Inclines(outside of cusp)
B LBL
WorkingContacts IIFIIF you have contacts on the you have contacts on the IInner nner IInclines of nclines of FFunctional cusps unctional cusps
they are balancing contactsthey are balancing contacts
Test!
Rules for Balancing Contacts Balancing contacts should be lines, not Balancing contacts should be lines, not
pointspoints Balancing contacts should never be heavier Balancing contacts should never be heavier
than working contactsthan working contacts
Balanced Occlusion (Lingualized)
Indirect evidence that balanced occlusion may:Indirect evidence that balanced occlusion may: reduce ridge resorption reduce ridge resorption ((Maeda & WoodMaeda & Wood , 1989), 1989)
allow for increased functional forces in allow for increased functional forces in excursions excursions ((Miralles et al, 1989)Miralles et al, 1989)
Lingualized Cusp Angles
Always use steep cusped Always use steep cusped maxillary tooth (33°)maxillary tooth (33°)
When condylar guidance is When condylar guidance is steeper use more cusp angle steeper use more cusp angle in mandible (10°)in mandible (10°)
Lingualized Occlusion
Balance cannot be set without an articulatorBalance cannot be set without an articulator Clinical remount on an articulator - fewer Clinical remount on an articulator - fewer
adjustmentsadjustments
Condylar Inclination Posterior teeth separate as working Posterior teeth separate as working
condyle moves forward (and condyle moves forward (and downward)downward)
Anterior teeth contact Anterior teeth contact Closer to condyle, more separationCloser to condyle, more separation More anterior separation of More anterior separation of
Premolars if steep anterior guidancePremolars if steep anterior guidance
Effect of Mandible Moving Downward During Excursions
Maintaining Balancing Contacts
Change occlusal plane angleChange occlusal plane angle Increase compensating curvesIncrease compensating curves Increase cusp angles or effective cusp Increase cusp angles or effective cusp
anglesangles
Checking for Balance
Feels Feels SmSmoooooooooooothth in excursions in excursions
- Fingers on max. canines- Fingers on max. canines - Check on articulator- Check on articulator
Assess Contacts: Centric StopsCentric Stops ExcursionsExcursions
Improving Denture Occlusion
Most important cusp - maxillary lingual Most important cusp - maxillary lingual Mandibular buccal cusps more lateral - more Mandibular buccal cusps more lateral - more
tippingtipping
When Not to Balance
Difficulty in obtaining repeatable centric Difficulty in obtaining repeatable centric record record incoordination, incoordination, muscle splintingmuscle splinting
Dramatic malocclusionsDramatic malocclusions Severe ridge resorption Severe ridge resorption
lateral forces displace the denturelateral forces displace the denture Implants tend to negate this factorImplants tend to negate this factor
Monoplane Occlusion
Cuspless teeth set on a flat plane with 1.5- 2 Cuspless teeth set on a flat plane with 1.5- 2 mm overjetmm overjet
No cusp to fossa relationship No cusp to fossa relationship No anterior contacts present in centric No anterior contacts present in centric
positionposition No overbiteNo overbite
Monoplane OcclusionHow Stability is Improved
Elimination of cuspsElimination of cusps
Lateral forces reduced, improving stabilityLateral forces reduced, improving stability
Simplifies denture tooth arrangementSimplifies denture tooth arrangement
Monoplane Occlusion With Condylar Inclination
Monoplane OcclusionWith Condylar Inclination
Ensure Teeth Set Over Ridge
Minimize tilting/tippingMinimize tilting/tipping Maximize stabilityMaximize stability Minimize contacts on Minimize contacts on buccalbuccal of flat cusps of flat cusps
Monoplane Occlusion Functional, but unestheticFunctional, but unesthetic
Not balanced - flatNot balanced - flat Zero degree teeth can be Zero degree teeth can be
balanced if condylar balanced if condylar inclinations are shallowinclinations are shallow
Monoplane Occlussion - When? Jaw size discrepancies, malocclusions Jaw size discrepancies, malocclusions
cross-bite, Cl II, IIIcross-bite, Cl II, III Minimal ridgeMinimal ridge
reduces horizontal forcesreduces horizontal forces implants helpimplants help
Uncoordinated jaw movementsUncoordinated jaw movements
Summary
No definitive studies to show one type No definitive studies to show one type of occlusion is bestof occlusion is best
Follow established clinical principlesFollow established clinical principles Assess each case - adapt to clinical Assess each case - adapt to clinical
situationsituation Continue to read the literatureContinue to read the literature