17

Oclusal relationships for removable partial

dentures
Desirable Occlusal Contact Relationships for
Remov_ble P_l'ti_l Dentul'e_
Methods fof Estahlishing Occlusal
Relatiomhips
MateriaJs for Artifici_l Postel'iol' eeth

he fourth phas_! in th" tr"atm"nt of patient_

#ith removable partial dl'nt$Jfl'_ i_
the establ$sl'lment of a functional and harmonious
occlusion% Occlusal harmon& bet#een a partial
dl't'tu$'$' (l%t'd thl' rl'maining natural teeth is a ma)or
factor in the preservation of the health of their
surrounding structures%
*n the treatment of patients #ith complete dentures+
the inclination of the cond&le path is the onl& factor
not #ithin the control of the dentist All other fadors
ma& be altered to obtain occlusal balance and harmon&
in eccentric podtion_ to conform #ith a particular
concept Md philosoph& of occlusion%
,alanced occlusion is desirable #ith complete
dentures because unbalanced occlusal stresses ma&
cauoc lll%otabilit& of the dcnturco and tr_um_ to
th" %(upporting %(tr$%%$dur"-% h"-" otreooeo C((ln
re((lch '! point th!+t C!'$%%$_e_ movement of the
denture bases% *n partial dentures+ ho#
'-ee Chapter .+ under discussion on the si/ phases of
partial denture service%
Establishing Ja# Relatiom
fol' _ M_ndihulal' Removable Partial
Denture Oppo_ing
a Ma/illar& Complete Denture
-elf0Assessment Aids
ever+ because of the attachment of the partial denture to
the abutment teeth+ occlusal stresses can be transmitted
directl& to the abutment teeth and other supporting
i(itructures+ rei(iulting in sustained stresses that ma& be
more damaging than those transient stresses found in
complete dentures% failure to provide and maintain
ade1uate ocdu(2ion on the partial denture is primaril& a
result of 3$4 lac5 of support for the denture base+ 3.4 the
fallac& of establishing occlusion to *t single static )a#
relation record+ and 364 an unacceptable occ$usal p$ane%
*n "7tablishins occlusion on a partial d"nture the
influence of the remaining natural teeth b
usuall& -8Ch that the occlusal forms of the teeth on the
partial denture must bc made to conform to an
(9tlre(9td& e22tabli22hed ocelll22al pattern his pattern
ma& n:'$ve heen :'$ltered b& occlusal ad)ustment or
restoration2 ho#ever+ the pattern present at the time the
partial denture is made dictates the occlusion on the
partial denture% he onl& e/ceptions are those in #hich
an opposing complete denture can be made to
355
6;<
McCrac5en's removable partial prosthodontics
function harmoniousl& #ith the partial denture or in
#hich onl& anterior teeth remain in both archeg and the
incigal relatiOnghip can be made so that tooth contacts
do not disturb denture stabilit& or retention% *n these
situations )a# relation record(; and the arrangement of
the teeth ma& proceed in the same manner as #ith
complete dentures+ and the same general principles
appl&%
=ith all other t&pes of partial dentures the remaining
teeth dictate the occlusion% he dentist should strive for
planned contacts in centric occ$u$'iion and no
interference(; in lateral e/cur
sions% S6mIJ claim that a ftmcti6nal YIJlati6mhip 6f the
partial denture to the natural dentition may be adjusted
satisfactorily in the mouth. *t is doubtful that thb can be
done ade1uatel&%
he establishment of a satisfactor& occlusion for the
partial denture patient should include the follo#ing( 3$4 +
$$$ anal&sis of the e/i(;ting occlu(;ion2 3.4 the
correction of e/i(;ting occlusal disharmon&2 364 the
recording of centric relation or +m ad)usted centric
occlusion2 3>4 the recording of eccentric )a# relations or
fundional eccentric occlusion2 and 3;4 the correction of
occlusal discrepancies created b& the fit of the
frame#or5 and in processing the denture%
DE-*RA,?E OCC?8-A? CO@AC
RE?A*O@-A*P- BOR REMOCA,?E PAR*A?
DE@8RE-
he follo#ing occlusal arrangements are recommended
to develop a harmoniou(; occ$uM* relationship of
partial dentures and to enhance stabilit& of the partial
dentures(
$% -imultaneous bilateral contacts of oppos
ing posterior teeth must occur in centric occlusion%
. Occlusion for tooth0supported partial denture(; ma&
be arranged $'iimilar to the occlu% sion seen in a
harmonious natural dentition% -tabilit& of thc partial
dentures is ensured b& direct retainers at both ends of
the denture bfi-e 3Big% $D0$4%
6% ,alanced occlusion in eccentric positions should be
formulated #hen the partial denture is oppE;ed b& a
ma/illar& complete denture 3Big% $D0.4% hi(; i(;
accompli(;hed primaril& to promote the stabilit& of
the
complete denture% Ao#ever+ simultanl'ous contactt'i in a
protrut'iive relationt'ihip do not receive priorit& over
appearance+ phonetics+ andFor a favorable occlusal
plane%
>% =or5ing side contacts should be obtained
for tb(G mandibular distal e/tension denture
A H
Big% $D0$ Opposing partiall& edentulous arches having prospective abutments bounding all
edentulous spaces% A+ ?inear #or5ing contacts ma& be developed if group function does not ta5e
molars out of contact in #or5ing position% ,+ Posterior balancing and protrusive contacts #ould not
add to stabilit& of either restoration and should be avoided%
Chapter
$D
3Big% $D064% hese contacts should occur
simultaneousl& #ith #or5ing side contacts of the
natural teeth to distribute the stress over the greatest
possible area% Masticator& function of the denture is
improved b& such an arrangement%
;% -imultaneous #or5ing and balancing contacts should
be formulated for the ma/illar& bilateral distal
e/tension partial denture #henever possible 3Big% $D0
>4% -uch an ar_angement #ill compemmte in part for
the unfavorable po3Iition th:(( ma/illar& artificial
teeth must occup& in I+"btion to th" r"sidu(ll ridge+
#hich is usuall& lateral to the crest of the ridge%
Ao#ever+ this desirable relationship must often De
compromised #hen the patient's *$nterior teeth hl$ve
em e/ce;slvel& steep vertical overlap #ith little or
A
c
Occlusal relationships for removable partial dentures
6;D
no horiJontal overlap% Even in this situation+ #or5ing
side contacts can be obtained #ithout resorting to
e/cessivel& steep cuspal inclinations
<% Onl& #or5ing contacts need to be formulated for either
the ma/illar& or mandibular unilateral distal e/tension
partial denture 3Big% $D0;4% ,alancing side contacts
#ould not enlll$nce the stl$bilit& of the denture
because it is entirel& tooth supported b& the frame#or5
on the balancing side%
D% *n th" Class *C r"mov(lbh_ p(lrti(ll denture
configuration% contact of opposing anterior teeth in the
planned intercuspal position is desirable to prevent a
continuous eruption of the opposing natural incisors
3Big% $D0<4+ unless the& are other#ise prevented from
e/trusion by means of a lingual plate+ au/il
,
D
Big% $D0. A+ Class * partiall& edentulous arch opposed b& edentulous ma/illar& arch% -tabilit& of
ma/illar& complete denture can be promoted b& developing balanced occlusion% ,+ ?inear #or5ing
contacts% C+ ,alancing contacts are arranged+ thus minimiJing tipping stresses to complete denture%
D+ Protrusive contact of posterior teeth #ill better distribute forces to entire basal seat of complete
denture in contrast to contacts onl& b& opposing anterior teeth%
c
, A
D
Big% $D06 A+ ,ilateral distal e/tension mandibular arch opposed b& natural dentition *n ffi"/illar&
ouch% MatJter catJttJ have been oriented in articulator in centric relation% ,+ Acr&lic resin
r"cord bag"g aAach"d to fram"#or5 ar" ug"d to g8Pport artificial teeth that have been
arr2mg!'cG
il' G'('a_iG'('ttG'(' il'terctt-pation% C+ =or5ing contacts ha#' bl'l'F' developed after articulator #as
programmed #ith eccentric records% E+ Aalanclng contacts are purposefull& avOlded because the&
#ould not enhance stabilit& of restoration% Protrusive balance is also avoided in order to achi"v" ,m
acc"pbbl" apP"arance+ phoneticg+ and a favorable occGngal plan!+
A ,
Big% $D0> Casts of opposing Class * partiall& edentulous arches correctl& oriented on programmed
articulator% A+ Resultant restoration has linear #or5ing side contacts of opposing posterior teeth
occurring simultaneousl& #ith contact of opposing canines on #or5ing side% ,+ ,alancing contact
should be arranged to minimiJe tipping of ma/illar& removable partial denture and to broadl&
distribute forces accruing to its supporting structures 3abutments and residual ridges4%
Chapter $D Occlusal relationships for removable partial dentures
6;K
A
,
Bib' $D0; A, Class *** 3s5eletal classification4 mandibular arch opposed b& natural dentition% R
Artificial teeth #ere arranged for ma/imum intercuspation in centric occlusion #ith linear #or5ing
contact_% C, ro_tnior protruEJive and balancins contacts have been avoided because _uch
arranL+ement #ould not enhance stabilit& of thc unilateral restoration%
A
,
Big% $D0< Class *C ma/illar& arch opposed b& mandibular dentulous arch% A+ Contact of
prostheticall& supplied teeth and opposing mandibular teeth has been developed in the planned
intercuspal position to prevent continued eruption of mandibular teeth% ,+ Contact of anterior teeth in
eccentric positions is avoided to eliminate unfavorable forces to ma/illar& anterior residual ridge%
6<E
McCrac5en's removable partial prosthodontics
Big% $D0D Posterior teeth should not be arranged distal to
up#ard incline of residual ridge% @ote that this
beginning incline has been mar5ed on land area of cast
as reference point%
iar& bar+ or b& splinting% Contact of the opposing
anterior teeth in eccentric positions can be developed
to enhance !incisive function but should be arranged
to permit balanced occlusion without excursive
interferences.
H% ,alanced contact of opposing posterior teeth in a
straightfor#ard protrusive relationship and functional
e/cursive positions is desirable onl& #hen an
opposing complete denture or bilateral distal
e/tension ma/illar& partial denture is placed 3see
Bigs% $D0. and $D0>4%
K% Artificial posterior teeth should not be arranged
farther distall& than the beginning of a sharp up#ard
incline of the mandibular residual ridge or over the
retromolar pad 3Big% $D0D4% o do so #ould have the
effect of shunting the denture anteriorl&%
A harmonious relationship of opposing oc
clusal and incisal surfaces alone is not ade1uate to
ensure stabilit& of distal e/tension removable partial
dentures% *n addition+ the relationship of the teeth to the
residual ridges must be considered% Bilateral eccentric
contact of the mandibular distal extension partial denture
need not be formulated to stabilize the denture. he buccal
cusps+ ho#ever+ must be favorabl& placed to direct
stress to#ard the buccal shelf+ #hich is the primar&
support area in the mandibular arch% *n such positions
the denture is not sub)ected to
e/cessive tilting forces 3Big% $D0H4% On the other hand+ the
artificial teeth of the bilateral, distal extension, maxillary partial
denture often must be placed laterally to the crest of the
residual ridge 3Big% $D0K4% -uch an unfavorable position
can cause tipping of the denture+ #hich is restrained onl&
b& direct retainer action on the balancing side% o
enhance the stabilit& of the denture+ it seems logical to
provide simultaneous #or5ing and balancing contacts in
these situations if possible%
METHODS FOR ESTA!"SH"#$
O%%!&SA! RE!AT"O#SH"'S
Bive methods of establishing interocclusal relations for
removable partial dentures #ill be briefl& described%
,efore describing an& of these+ it is necessar& that the use
of a face0bo# mounting of the ma/illar& cast and the
pertinent factors in partial denture occlusion be consid0
ered% he techni1ue for appl&ing the face0bo# has been
described briefl& in Chapter $.%
Although a hinge a/is mounting ma& be desirable for
complete oral rehabilitation procedures+ an& of the
common t&pes of face0bo# #ill facilitate mounting of the
ma/illar& cast in relation to the cond&lar a/is of the
articulating instrument #ith reasonable accurac& and are
acceptable for a removable partial denture% As suggested
in Chapter $.+ it is still better that the plane of occlusion
be related to the a/isorbital plane% ,ecause the dominant
factor in partial denture occlusion is the remaining natural
teeth and their proprioceptive influence on occlusion+ a
comparable radius at the oriented plane of occlusion on
an acceptable instrument #ill allo# reasonabl& valid
mandibular
movements to be reproduced% -uch instruments
are the Hanau models 3$H60. and 96-H2-0), the Dentatus
model ARA+ the =hip0Mi/ ..EE+ and similar
instruments%
Articulators can simulate but not duplicate )a#
movement% A realiJation of the limitations of a specific
instrument and a 5no#ledge of the procedures that can
overcome these limitations are necessar& if an ade1uate
occlusion is to be created%
he recording of occlusal relationships for the
partiall& edentulous arch ma& var& from the
Chapter
$D
A
c
Occlusal relationships for removable partial dentures
6<$
,
Big% $D0H A+ Artificial po_terior teeth are _elected that are
nano#er buccolinguall& than natural teeth the& are to replace%
8sing (smaller teeth i(s thought to decrea(se occlu(sal load
applied to residual ridges% ( -tabilit& of restoration is enhanced
b& positioning buccal cusps of posterior teeth to direct stress
to#ard the buccal shelf% @ote that this landmar5 has been
mar5ed on the land area of cast posterior to retromolar pad
(arrow). C Posterior teeth have been arranged and occlu(sal
(surface(s have been ad)u(sted for harmonious occlusion%
Bi_% $D0K *t is often necessar& to arran_e posterior teeth for
ma/illar& distal e/tension removable restoration lateral to crests
of residual ridges to accommodate positions of posterior teeth in
opposing arch% his position is unfavorable2 ho#ever+ stabilit&
can be improved b& arranging simultaneous #or5ing and
balancing contacts in occlusal scheme%
McCrac5en's removable partial prosthodontics
simple apposition of opposing casts b& occluding
sufficient remaining natural teeth to the recording of )a#
relations in the same manner as for a completel&
edentulous patient% As long as there are natural teeth that
remain in contact+ ho#ever+ the cuspal influence that
those teeth #ill have on functional )a# movements
dictates the placement of the artificial teeth and the
occlusal scheme%
he hori?Ontdl )d= reldtion 3planned intercuspal
position or centric relation4 in #hich the restoration is to
be fabricated should have been determined during
diagnosis and treatment planning Mouth preparations
also should have been accomplished based on this
determination+ including occlusal ad)ustment of the
natural dentition+ if i'J8ch #e# indicated% herefore one
of the follo#ing conditions should e/bt( 3$4 centric
relation and planned inter_1J.'i.'rQJ> _i%ti"%_
_"%i%#:)+d1 '@im G'_ 1vid1#2+1
of occ$#i$*$ patholog&+ therefore the decision should be
to fabricate the restoration in centric
relation2 3.4 centric relation0 and the planned intercuspal
position do not coincide but the planned intercuG'2pal
poG'2ition iG'2 clearl& defined and the dechsion has been
made to fabricate the restoration in the planned
intercuspal position2 364 centric relation and the planned
interc8,pal position do nut cuindde dnd the inter?8spdl
position is not clearl& defined+ therefore the decision
should be made to fabricate the r_Htoration in c%2mtric
r_lahoni and 3>4 poHterior teeth are not present in one or
both arches and the denture #ill be fabricated in centric
relaMn%
Occlu,tl* relationships ma& be established b& use of
the most appropriate of the follo#ing methods to fit a
particular partiall& edentulous situation%
Direct appositiOn of casts
he firt metho! is used #hen there are sufficient
opposing teeth that remain in contact to ma5e thc
c/(i,tin$4 ja"W rclation,hip obvio8, or !=hcn onl&
a fo# tooth aro to bo roplacod% on short denture bases
and there is no evidence of occlusal patholog&% *n this
method+ opposing casts ma& be occluded b& hand% he
occluded casts should be held in apposition #ith rigid
supports attached #ith stic5& #a/ to the bases
of the casts until the& are securel& mounted on the
articulator%
At best+ this method can onl& perpetuate the e/isting
occlusal vertical dimension and an& e/isting occlusal
disharmon& present bet#een the natural dentition%
Occlusal anal&sis and the correction of an& e/isting
occlusal disharmon& should precede the accepting of
such a )a# relation record% he limitations of such a
method should be obvious% Met+ such a )a# relation
record is better than an inaccurate interocclusal record
bet#een the remaining natural teeth 8nless a record is
made that does not influence the closing path of the
mandible because of its bul5 andG or the consistenc& of
the recording medium+ direct apposition of opposing
ca,h+ at GeMt eliminate, the po,,ibilit& of the patient's
giving a fault& )a# relationship%
Iuteracclusal records witlt posterior
teeth remainin"
A secon! metho!, #hich is a modification of the first is
used #hen sufficient teeth remain to support the partial
denture 3Nenned& Class *** or C*aG'2G'2 C4+ but the
relation of oppoG+2lng teeth does not permit the ocduding
of casts b& hand% *n such situations+ )a# relations must be
established Cl, for fi/ed re,torations that 8,e !ome t&
pe uf interu??luM* fe?8fd%
Tht lm_t urxurutt of tht_t mdhod_ i_ tht intaocclusal wax
recor!. he successful recording of centric relation #ith
an interocclusal #a/ record #ill be influenced b& the
bul5 and the consistenc& of the #a/ and the accurac& of
the #a/ after chilling% E/cess #a/ that contacts muco,d*
surfaces ma& distort soft tissues+ thereb& preventing
accurate seating of the #a/ record onto the stone casts%
Distortion of #a/ during or after removal from the
mouth ma& also interfere #ith accurate seating%
herefore a definite procedure for ma5ing interocc$usal
#a/ records is given as follo#s(
A uniforml& ,oAcncd+ metal0reinforced #$afer of
baseplate or sot0up #a/ is placod% bet#een the teeth+
and the patient is guided to close in centric relation
3Big% $D0$E4% Correct closure should have been
rehearsed before placement of the #a/ so that the
patient #ill not hesitate or deviate in closing% he #a/
is then
6<.
Chapter
$D
Big%$D0$E Alu#a/ #afer shap%ed to )ust clear lingual
surfaces of teeth in lo#er arch% =ater bath is used to
uniforml& soften Alu#a/% =a/ record is corrected
#ith impression paste or bite registration paste%
removed and immediatel& chilled thoroughl& in
room0temperature #ater% *t should be replaced a
second time to correct the distortion that results from
chilling and then again chilled after removal%
All e/cess #a/ should no# be removed #ith a sharp
5nife% *t is most important at this time that all #a/
that contacts mucosal surfaces be trimmed free of
contact% he chilled #a/ record again should be
replaced to ma5e sure that no contact #ith soft tissue
e/ists%
wax record should be further corrected with a bite
registration paste, which is used as the final recording
me!ium. *n ma5ing such a corrected #a/ record+ the
opposing teeth 3and also the patient's lips and the
dentist's gloves4 should first be lightl& coated #ith
petroleum )ell& or a silicone preparation% he bite
registration paste is then mi/ed and applied to both
sides of the metal reinforced #a/ record% *t is
1uic5l& placed+ and the patient is assisted #ith
closing in the rehearsed path+ #hich #ill this time be
guided b& the previous #a/
Occlusal relationships for removable partial dentures
6<6
record% After the paste has set+ the corrected #a/
record is removed and inspected for accurac&% An&
e/cess pro)ecting be&ond the #a/ matri/ should be
removed #ith a sharp 5nife until onl& the registration
of the cusp tips remains%
-uch a record should seat on accurate casts #ithout
discrepanc& or interference and #ill provide an accurate
interocclusal record% =hen an intact opposing arch is
present+ use of an opposing cast ma& not be necessar&%
*nstead+ a hard stone ma& be poured directl& into the
impression paste record to serve as an opposing cast%
Ao#ever+ although this ma& be an acceptable procedure in
the fabrication of a unilateral fi/ed partial denture+ the
advantages of having casts properl& oriented on a suitable
articulator contraindicates the practice% he onl& e/ception
to this is if the ma/illar& cast on #hich the partial denture
is to be fabricated has been mounted previousl& #ith the
aid of a face0bo#%
*n such an instance an intact lo#er arch ma& be
reproduced in stone b& pouring a cast directl& into the
interocclusal record%
An interocclusal record also ma& be made #ith an
ad)ustable frame% Reference to this method #as made in
Chapter $. 3see Big% $.0$;4% he ad)ustable frame #as
devised for use #ith materials that offer no resistance to
closure+ such as Jinc o/ide and eugenol impression pastes%
-ome of the advantages of using a metallic o/ide paste
over #a/ as a recording medium for occlusal records
follo#( 3$4 uniformit& of consistenc&2 3.4 ease of
displacement on closure2 364 accurac& of occlusal surface
reproduction2
3>4 dimensional stabilit&2 3;4 the possibilit& of some
modification in occlusal relationship after closure+ if it is
made before the material sets2 and 3<4 less li5elihood of
distortion during mounting procedures%
hree important details to be observed #hen one uses
such a material are as follo#s(
$% Ma5e sure that the occlusion is satisfactor&
before ma5ing the interocclusal record%
.% ,e sure that the casts are accurate reproduc
tions of the teeth being recorded%
6% rim the record #ith a sharp 5nife #herever
it engages undercuts+ soft tissues+ or deep
grooves%
6<<
McCrac5en's removable partial prosthodontics
%sta&lishin" occlusion &y the recor!in" of occlusal
pathways
The fifth method of establishing occlusion on the
partial denture is the registration of occlusal
pathways and the use of an occluding template
rather than a cast of the opposing arch. When a
static jaw relation record is used, with or without
eccentric articulatory movements, the prosthetically
supplied teeth are arranged to o_d"de a__ording to
a specific concept of ocdusion. n !he o!her hand,
when a functional occlusal record is used+ the teeth are
ft\l'Idifi_d tl'l accl(Opt *(OCl(Or& rl(Ocordl(Od
*(Occl(Ontric )a='
movement%
hese movcmcnts arc madc more complicated b& the
influence of the rema*ning natural teeth% Occlu(Jal
harmon& on complete dentures and in comple# mouth
rehabilitation ma& be obtaini('d b& thi(' =(i(' of si('vi('ral
d$fferent instruments and% techni1ues% -chu&ler has
emphasiJed the importance of establishing first the
anterior tooth relation and incisal guidance before pro0
ceedin6 #ith an& complete 0oral rehabilitation+ Others
have sho#n the advantages of establi,hing canine
guidance fi, a 5e& to functional occlu(2ion before
proceeding #ith an& functional regi(2tration again(2t an
oppo((2ing pro((2theticall& re(2tored arch% hb i(2 done on
the theor& that the canine teeth serve to guide the
mandible during %%cc%%ntric mo#Gm"nh2 #h"n th"
opposing t""th CO*D" into functional contact+ *t a5a
has b""n puinted uut that the canine teeth transmit peri0
odontal proprioc"ptor impulses to the muscles of
mastication and thus have an influence on mandibular
movement even #ithout actual contact guidance%
Ao#ever+ a''( long a''( the occluM* surfaces of
lmrestorer4 n2(Jt$$r2(JI teeth rem2(Jin in conflict+ d, in
mdn& d pdrtidll& dentulou$; mouth+ these teeth #ill
al#a&s be the primar& influence on mandibular
movement% he degree of occlusal harmon& that can be
obtained on a fi/ed or removable restoration #ill depend
on the occlusal harmon& that e/ists bet#een these tggth
Regarding occlusion+ hompson has #ritten(
!Observing the occlusion #ith the teeth in static relations
and then moving the mandible into various eccentric
positions is not sufficient% A d&namic concept is
necessar& in order to produce an occlusion that is in
functional
harmon& #ith the facial s5eleton+ the musculature+ and
the temporomandibular )oints%!P ,& adding !and #ith
the remaining natural teeth+! the re1uirements for partial
denture occlusion #ill be more completel& defined+
-ome of the methods described previousl& ma& be
applied to the construction of partial dentures in both
arches simultaneousl&+ #hereas the registration of
occlusal path#a&s re1uires that an opposing arch be
intact or restored to the e/tent of planned treatment% A
diagnosGic #a/up of both ma/illar& and mandibular
arches #ill
facilitate visualiJation of the proposed mouth+ preparation
and restorative procedures re1uired' to accommodate the
planned occlusal scheme+
corred orientation of the occlusal plane+ correct
arch form+ and complete tooth modification(s to
accommodati(' thi(' partial denture design+ all at th"
d"sired vertical dimension of occlusion% *f partial
dentures are planned for both archc,+ a decision is
necessar& as to #hich denture is to be made first and
#hich is to bear a functional occlusal relation to the
opposing arch% 7enerall& the mandibular arch is restored
first and the ma/illar& partial denture occluded to that
re((2tored arch% *f the ma/illar& arch i(; to be re(;tored
#ith a complete denture or a fi/ed pall*al denture or
cro=$$(;+ a full dlagno(;$$c #a/0up must be done
before establishing the occlusion on the opposing partial
denture% *f opposing fi/ed partial dentures or opposing
occluding cro#ns are to be fabricated+ it ma& be
advantageous to develop the occlusion and fabricate
them simultaneousl& to ensure optimal positioning+
cuspal relationship% and functional integrit&
Regardle(;(; of the method u(;ed for recording )2(J#
rel2(Jtions+ #hen one arch is completel& re$;tored
Qi$'$;t+ tl0mt dl'ch i(2 treated a(2 an intact arch even
though it is #holl& or partiall& restored b& prosthetic
means% he dentist must consider at the time of
treatment planning the possible advantages of
establishing the final occlusion to an intact arch%
PBrom hompson JR( emporomandibular disorders(
diagnosis and dental treatment in the temporomandibular
)oint% *n -arnat ,+ ed( )he temporoman!i&ular *oint, ed+
.+ -pringfield+ ***+ $K<>+ ,ernard 7% -arnat and Charles
C homas+ pp $><0$H>%
_tep'b&'step procedure for re)isterin) occlu_al
path#a&G(0 After the frame_or5 haG( been ad)usted to fit
the mouth+ the techni1ue for the regiF'tration of occlusal
path#a&s is a; follo#s(
$% -upport the #a/ occlusion rim b& a denture
base having the same degree of accurac& and
_hbilit& M th_ fini_h_d d_ntul'_ bag_0 *dMll&+ this
#ould be the final denture base+ #hich is one of the
advantages of ma5ing the denture #ith a metal
base% Other#ise+ ma5e a temporar& base of C?C
resin or sprin5led autopol&meriJing acr&lic resin+
either of #hich is essentiall& identical to the final
acr&lic resin
A
,
Bi_% $D0$6 A+ After correctlon of edentulous area to
functional form+ frame#or5 io rcocatcd accuratcl& on
_orrcctcd master cast+ an& undercuts are bloc5ed out
#ith #a/+ and thin coating of model releaG(e agent is
!pplicd to surface of cast% A+ @c# base is made #ith
v*r _rr&lir rp_in to form rpcorrl h2I_p th2It i_ a_ nearl&
a_ pO__ibllG idlGntii'M to form of finishl'd dl'ntul'l'
bas*'
Alter curing+ frame#or5 i_ lifted ((*fld ((*flM th_h or
e/cess is trimmed a#a&% ills base is then used to
est_blish occll$s:*I rehtion_ b& #h2Itpvpr mpthocl 2_
uluiutl'((u+ ucpt(nuin$; on oppmin$J dentition and
dentiot' E pr"f"r"nc"%
Chapter $D Occlusal relationships for removable partial dentures
6<D
Fi)* $D0$> E/ample of completed occlusal registration in
hard inla& #a/ supported b& accurate record bases% @ote
that #idth of each cusp in all e/tremes of mandibular
movement iF' recorded a; continuou; glE;;M ;urface%
Met+ anatom& of each oppo(Oing tooth i(2 #ell defined%
Completed regi;tra?ion mu(Ot be plac32Gd bac5 onto
magtl'Gr cagt #ithout intl'GrCiming debri(O or
di(Ocrepanc& and ,ecurcd thcrc #ith otic5& #a/ (OE that
accurac& of occlu;Cll regiotration #ill be maint:lined
&a+e. *n an& distal e/tension partial denture+ ma5e
thi; ba(;e on a Ci'l(;t that ha(; been corrected to the
functional or supporting form of the edentulous ridge
3Big% $D0$64% Plac_ a film of hard gtic5& =aR on th_
bag_ before the #a/ occlusion rim is secured to *t%
he wa, used for the occlusion rim should be
hard enough to support biting stress and should be
tOugh enough to resist fracture% Pec5's purple hard
inla& 0#a/ has proved to be suitable for the ma)orit&
of patients% Ao#ever+ _omp individll:Gl_ #ith #e:G5
mll_culature or hmder mouths ma& have difficult& in
reducing thi; $a-. *n such situiltion; use a slightl&
less hard #a/% Ma5e the occlusion rim #ide enough
to record all e/tremes of mandibular movement.
.% *nform th" patient that the occhA%ion rim
must be #orn for .> hours or longer% *t should be
#orn constantl&+ including nighttime+ e/cept for
removal during meals% ,& #earing and biting into a
hard #a/ occlusion rim+ a record is made of all
e/tremes of )a# movement 3Big% $D0$>4% he #a/
occlusion
6<H
McCrac5en's removable partial prosthodontics
rim must maintain positive contact #ith the opposing
dentition in all e/cursions and must be left high
enough to ensure that a record of the functional path
of each cusp #ill be carved in #a/% his record should
include not onl& voluntar& e/cursive movements but
also involuntar& movementc2 and chang+ec2 in )a#
movement caused b& changes in posture% E/treme )a#
positions and habitual movements during sleep should
also be recorded%
he occlusal paths+ thus recorded+ #ill represent
e:Jch tooth in its three0dimensional aspect% Although
the cast poured against this #ill resemble the opposing
teeth+ it #ill be #ider theln the teeth that carved it
because it represents those teeth in all e/tremes of
movement% he recording of occlusal paths in this
manner eliminates entirel& the need to reproduce
mandibular movement on an instrument%
*nstruct the patient in the removal and placement
of the partial denture that supports the occlusion rim
0and e/plain that b& che#ing in all directions+ the #a/
#ill be carved b& the opposing teeth% he opposing
teeth must be cleaned occasionall& of accumulated
#a/ particle_% t i_ neces_ar! that the
patient comprehend #hat is to be accom
plished and understand that both voluntar& and
invOluntar& movements must be recordtOd%
,efore dismissing the patient+ add or remove #a/
#here indicated to provide continuouc2 contact
throughout the che#ing range% o accomplish this+
repeatedl& #arm th! !!a/ !!ith a hot spatula and have
the pat5llt d8$2t( and lhe# intu the #armed #a/ rim
#ith the opposing dentition+ each time adding to an&
areas that are deficient% An& a%rea left un((%uppu%rteu%
b& it$2 flu# under occlusal forces must be reinforced
#ith additional #a/% *t is important that the #a/ rim
be absolutel& dr& and free of saliva before additional
#a/ is applied% Each addition of #a/ must be made
homogeneous #ith the larger mass to avoid separation
or fracture of the occlusion rim during the time it is
being #orn% ?eave the #a/ occlusion rim from $ to 6
mm high+ depending on #hether vertical dimension is
to be increased%
6% After .> hours+ the occlusal surface of the #a/ rim
should sho# a continuous gloss+ #hich indicates
functional contact #ith the opposing teeth in all
e/tremes of movement 3see Big% $D0$>4% An& areas
deficient in contact should be added to at this time%
The reasons for maintaining positive occlusal contact
throug+hout the time the occlusion rim i(2 being #orn
are that 3a4 all opposing2 teeth ma& be placed in
function2 3b4 an opposing denture+ if present+ #ill
become full& (2eelted2 and 3c4 vertical dimension of
occlusion in the molar region #ill be increased+ thus
the head of the mandibular cond&le #ill be reposi0
tioned and temporomandibular tissues can return to a
normal relationship%
*f during this period the #a/ occlusion rim has not
been reduced to natural tooth contact+ #arm it b&
directing air from the air s&ringe through a flame onto
the surface of the #a/% ,& holding the #a/ rim #ith
the fingers #hile #arming it+ a gradual softening
process #ill result+ rather than a melting of the
surfaces alread& established% Repeatedl& #arm the
occlusion rim and replace it in the mouth until the
occlusal height has been reduced and lateral
e/cursions have been recorded% At this time+ use
additional #a& to support those areas left unsupported
b& the flo# of the #a/ to the buccal or lingual
surfaces% rim the areas obviousl& not in
volved+ thus narro#ing the occlusion rim
as much as possible% Remove those areas pro)ecting
above the occlu(;ill surface+ #hich b& their presence
might limit functional movement%
Aaving accomplished seating of the denture and
changes in mandibular position b& the previous period
of #ear+ it is possible to complete the occlusal
registration in an operator&% Ao#ever+ if all
inCOluntar& movements and those caused b& changes
in posture are to be recorded+ the patient should again
#ear the occlusion rim for a period of time%
>% After a second .>0 to >G20hour period of #ear+ the
registration should be complete and acceptable% he
remaining teeth that serve as vertical stops should be
in contact+ and the occlusion rim should sho# an
intact gloss&
Chapter "#
surface representing each cusp in all e/tremes of
movement%
@atural teeth formerl& in contact #ill not
necessaril& be in contact on completion of the occlusal
registration% hose teeth that have been depressed over
a period of &ears and those that have been moved to
accommodate overclosure or mandibular rotation ma&
not be in contact #hen mandibular e1uilibrium has
been reestablished% -uch teeth ma& possibl& return to
occlusal contact in the future or ma& ha# to be r_stor_d
to occlusal contact after initial placement of the
denture% ,ecause the mandibular position ma& have
been changed during the process of occlusal
registration+ the cuspal reIation of some of the natural
teeth ma& be different than before+ his fact must be
recogniJed in determining the correct restored vertical
dimemion of occlmion%
Occlusion thus established on the partial denture
#ill have more complete harmon& #ith th%% opposing
nMur($$ or artificial teeth than can be obtained b&
ad)ustments0in the mouth alone+ because occlusal
ad)ustment to accommodate voluntar& movement does
not necess2(Iril& prev%%nt occlusal disharmon& in all
postural pO-itions or during periods of stress%
Burthermore+ occlusal ad)ustment in the mouth #ithout
occlu_al anal&sis is limited b& the dentist's abilit& to
correctl& interpret oeehIs2(II mar5ings made in0
traorall&+ #hether b& articulating ribbon or b& other
means%
he registration of occlusal path#a&s has
additional advantages% *t ma5es obtaining )a#
relation(O po(O(Oible under actual #or5in$; con0
ditions+ #ith the denture fr2(Ime#or5 in its termindl
po<itionl the oppo<ing teeth in funct*On+ and an
OppO-ing denture+ if present+ full& seated% *n some
instances it also ma5es pos_ible the recover& of $E<t
vertical dimen<ion Of OCCl8-ion+ either unilaterall&
or bllaterall&+ #hen overclosure or mandibular rotation
has occurred%
he completed registration is no# read& for
conversion to an occluding template% his is usuall&
done b& bo/ing the occlusal registration #ith modeling
cla& after it has been reseated and secured onto the
master or processing cast 3Bigs% $D0$; through $D0$D4%
Onl& the #a/ registration and areas for vertical stops
are left
Occlusal relationships for removable partial dentures
6<K
e/posed% *t is then filled #ith a hard die stone to form an
occluding template "see Chapter $H4%
*t is necessar& that stone stops be used to maintain the
vertical relation rather than rel&ing on some ad)ustable
part of the articulating instrument+ #hich might be
changed accidentall& 3Big% $D0$H4% Also+ b& using stone
stops and b& mountins both the denture cast and the h((G
mplate before separating th_m+ a gimpl_ hinge instrument
ma& be used%
MAER*A?- BOR AR*B*C*A? PO-ER*OR
EEA
he improved acr&lic resin teeth are generall& preferred to
porcelain teeth because the& are more readil& modified
and thought to more nearl& resemble enamel in their
abrasion potential against opposing teeth% *mproved
acr&lic resin teeth #ith gold occlusal surfaces are
preferabl& used in opposition to natural teeth+ restored
#ith gold occlusal surfaces+ #hereas porcelain teeth are
generall& used in opposition to other porcelain teeth%
Acr&lic resin tooth surfaces+ ho#eve? ma& in time
become impregnated #ith abrasive parhdGOs+ thGOfGOb&
becoming an abrasivfO sl*hstancp themselves% his ma&
e/plain #h& acr&lic r_gin teeth are sometimes capable of
#earing opposing gold surfaces% An evAluAtion of ocdu_A
contact or lac5 of contact+ ho#ever+ should be
m"ticulousl& accomplish"d at "ach <0month recall
appointment regardless of the choice of mdterial for
po<terior tooth forma+
Although some controvers& ma& still e/ist in regard to
the usc of porcelain or acr&lic resin artifiCial teeth+ there
is broad agreement that narro# 3reduced ,0?4 occlusal
surfaces are dc<irable% Po<terior teeth that _ill satisf& this
re1uirement should be selected+ and the use of tooth forms
having e/cessive bl$ccolingual dimension should be
avoided%
Acr&lic resin teeth are easil& modified and readil&
lend themselves to construction of cast gold surfaces on
their occlusal portions% A simple procedure for fabricating
gold occlusal surfaces and attaching them to acr&lic resin
teeth is described in Chapter $H under posterior tooth
forms%
6DE McCrac5en's removable partial prosthodontics
A
c
,
D
Bir2% $D0$; Bour vic#S of occlusal r+2+gistrat)on for lo#er Class ** partial denture% AI Occlusal
regbtration in #a/ returned to mast+2+r cast @ote e/treme horiJontal movement recorded%
D% -amc mot bo/ed #ilh cla&+ *"aving multiple ol+'clmml surfaces e/po_ed i*(; vcrtical ,top-%
C+ *ifftd of occlusal iOtops+ "liminating an& possible changes in vertical dim_*l_il$n of occ$u,ion
on articulator% !" $roce__ed denture remounted for occlusal r_ad)u_tmellt% @ote modification in
occlu,a* anatom& of iOtoc5 artificial teeth and slight increase in height of occlusal plane% his is
in harmon& #ith natural tooth contact else#here in arch%
Arran"in" teeth to an occlu!in" template
he occlusal surface of the artificial teeth+
porcelain or resin% must be modified to occlude
=ith the template% *n thi2+ ll%l%cthod the& arc actuall& onl&
ra# materials from #hich an
occlusal surface is developed that is in harmon& #ith an
e/isting occlusal pattern% herefore the
?eeth must b_ occluded too high and then modified to
fit the template at the established vertical dimension of
occlusion%
eeth arranged to an occluding template ordinaril&
should be placed in the center of the functional range%
=henever possible+ the
teeth should be arnJ%nged buccolinHuall& in the center of
the template% =hen natural teeth
have registered the functional occlusion+ this
ma& bi2G considered the normal ph&siologic
pO-ition of the artificial dentition regardless of
its relation to the residual ridge On the other hand+ if
some artificial occlusion in the op
posing arch has been recorded+ such as that
of an opposing denture+ the teeth should be arranged in a
favorable relation to their foundation+ even if this means
arranging them
slightl& buccall& or linguall& from the center of
the template%
Chapter
$D
A
c
_
he teeth are usuall& arranged to intercu_pllte #ith
the opposing teeth in a normal cuspal relationship%
=henever possible+ the mesiobuccal cusp of the
ma/illar& first molar should be located in relation to
the buccal groove of the mandibular first molar and all
other teeth arranged accordingl&% =ith a functionall&
generated occlusion+ ho#ever+ it is not
Occlusal relationships for removable partial dentures
6D$
,
D
BiF2+ $D0$< Bive vie#C* of occluClal regiCltration for
ma/illar& Class ** partial denture% Anterior teeth must be
tried in mouth and positioned for esthetics before posterior
teeth are arranged% A+ Partial vie# of %&du'otll n((
3;btratiun returned to master cast% Again+ note e/treme
horiJontal movempnt rpcornpc* R+ -ame C:$_t bo/ed
#ith cla&+ leaving multiple occlusal surfaces e/posed as
vertiCal stops% C+ Occlusal Cie# ot occluding template D+
Processed denture remounted for occl#)al read)uotment%
$6+ OccluClal otopo in full contact after processing and
occlusal read)ustment follo#ing remounting%
absolutel& necessar& that a normal opposing tooth
relatiOn-hip- be reestablished 3Big% $D0$*J4% *n the first
place+ the opposing teeth in a dental arch that is not
contiguous ma& not be in normal alignment+ and
intercuspation ma& be difficult to accomplish% *n the
second place+ the occlusal surfaces #ill need to be
modified so that the& #ill function favorabl& regardless of
their anteroposterior position 3Bi-' $D0.E4% ,"0
cause cusps modified to fit an occlusal template #ill be in
harmon& #ith the opposing dentition+ it is not necessar&
that the teeth themselves be arranged to conform to the
usual concept of #hat constitutes a normal
anteroposterior relationship%
McCrac5en's removable partial prosthodontics
Big $D0$D Rather thai' 8-l' cla& to span the arch from
one side to anothe? same ma& be done #ith #a/ #ith
less time and material% =a/ should form an acute angle
#ith occ*uiJal #a/ regiiJtration and e/posed occlusal
surfaces%
$'$g% $D0$F- Mrofile vie# of occlusal template and one of
its vertical stops% Despite fact that this is a record of ull
())*+.tr()).,*-))'. or *nandibulal -l.ove-l.ent for thi!+
patient 2matom& of occluding teeth can easil& be
identified%
6D.
A
,
Big% $D0$K A+ Cie# of interctlspation sometimes possible
#hen tl'l'th are arranged to occlusal template% his is
possible onl& #hen gross migration of opposing teeth
ha; not occurred% H( Cie# of modification to occlusal
surfaces necessar& #hen customar& intercuspation #ould
create ob)ectionable iJpace!% @ote that orisinal cusp0te0
cusp relation of artificial
teeth has been altered until marginal ridges have a?luall&
become C8iJPiJ% -uch occ*u,d* relationship is ontirel&
permissible and effective
ESTA!"SH"#$ +A, RE!AT"O#S -.OR A
MA#DT&T*AR REMO/A!E 'ART"A!
DE#T&RE O''OS"#$ A MA0"!!AR1
%OM'!ETE DE#T&RE
*t is common for a mandibular removable partial denture
to be made to occlude #ith an opposing ma/illar&
complete denture% he ma/illar& denture ma& alread& be
present or it ma& be made concurrentl& #ith the opposing
partial denture% *n an& event+ the establishment of )a#
relations
Chapter $D
A
a
Big%$D%.E A+ Occlusal surfaces after remounting and
final ucclu_al r_ad)u_tm_nt tv t_mplate% @ote func0
tlunal ucdu_al analom& re2mltint2% hiei iei entirel&
dAtiGriGnt ocdm+aI _urface from th6t #hich #m2
present on _toc5 artificial teeth aei manufactured% ,+
=hen dentist is arranging teeth to occluding template+
thin l*lur5in4() lupe 2(*hould be ueied in pTeiitionint2
and modif&ing ea:(h tooth to fit template% @ote that at
thi! earl& stage articulator ha(O been opened appro/i0
matel& E%; mm+ as evidenced b& slight space at vertical
slop%
in thig gitu(ltion m(lM hQ (lccomplid'l"d b& on" of
several methOds previOusl& outlined%
*f an e/isting ma/illar& complete denture is
gatighdor& (lnd the occlusal phne is ori"nted to an
acceptable anatomic+ functiona? and esthetic position
(which rarely occurs), then the complete denture need
not be replaced and the opposing arch is treated as an
intact arch as though natural teeth #ere present% A
face.&ow transfer is made of that arch+ and the cast is
mounted on the articulator% o accomplish this+ a face.
&ow
Occlusal relationships for removable partial dentures
6D6
record is made #ith the complete denture in place% After
the face0bo# apparatus is removed from the patient+ the
complete denture is removed from the pati"nt and an
irreversible h&drocolloid impression of the denture is
made% =hen the impre(2(2ion material hM (2et+ the denture
is r"moved+ cleaned+ and returned to the patient% A cast is
formed in the impression and then mounted on the
articulator #ith the face0bo# record% Ma/illomandibular
relations may be recorded on accurate record bases
attached to the mandibular partial denture frame#or5 b&
u(2e of a suitable recording medium% Centr*C relation is
recorded and transferred to the articulator% Eccentric
records can then be made to program the articulator%
*n rare instances+ #hen the mandibular partial denture
replaces all posterior teeth and the anterior teeth are
noninterfering+ a% central bearing point tracer ma& be
mounted in the palate of the ma/illar& denture and centric
relation recorded b& means of an intraoral (2t&lu(2 tracing
against a stable mandibular base% *f a st&lus )a# relation
recording method is used+ the st&lus must be carefull&
removed from the denture and attached to the same palatal
location of the stone cast that #as transferred to the
articulator via the face0bo# he mandibular cast can then
b" ori"nt"d b& #a& of the hori.ont(al p%# "lation
"cord and attachl9ld to the articulator%
=hen an e/i,ting complete denture is opposing the
arch on #h)ch a removable partial demure is fabricated+ a
cast of the complete denture ma& be #2ed during the
fabrication procedures Ao#ever+ #hen the occlusion is
correctt((u after proce(2(2ino' and the removable p(lrtial
d"ntur" is finaliJ"d during initial placement+ the
complete denture should be retrieved and mounted on the
articulator #ith a centric r"lation record at the desired
vertical dimension of occlusion% his #ill ensure a more
accurate
cuspal relationship and #ill avoid abrasion of the cusp
contacts that #ould occur b& using a stone cast of the
denture% his procedure is completed #hen the patient is
in the office so as not to deprive the patient of use of the
e/isting complete denture%
*f the relationship of the posterior teeth on the
ma/illar& denture to the mandibular ridge is favorable and
the complete denture is stable+
6D>
McCrac5en's removable partial prosthodontics
)a# relations ma& be established b& recording occlusal
path#a&s in the mandibular arch )ust as for an& opposing
intact arch% he success of this method depends on the
stabilit& of the denture bases+ the 1ualit& of tissue
support+ the relation of the opposing teeth to the
mandibular ridge+ and the interrelation of e/isting
artificial and natural teeth%
More often than not+ the e/isting ma/illar& complete
denture #ill not be dcceptdble to me bemuse of poor
tooth position% he denture #ill have been made to
occlude #ith malpoiJitioned mdndibuldr teeth+ #hich
have since been lost+ or the teeth #ill have been armnged
#ithout consideration for the future occlusal relation
#ith a mandibular partial denture% oo often one sees a
ma/illar& denture # ith po_teriur teeth arnll$ged close to
the residual ridge #ithout regard for interarch
relationship and #ith an occlusal plane that is too lo#%
8suall&+ ho#ever+ a ne# ma/illar& denture must be made
concurrentl& #ith the mandibular partial denture+ and )a#
relations ma& be established in one of t#o # dM$i%
*f the mandibular partial denture #ill be tooth
supported 3a Ncnned& Class *** arch accommodating a
bilateral reD2tovable prosthesis4+ the mandibular arch is
restored first% he same applies to a mandibular arch
being reiJtored #ith fi/ed partial dentures% *n either
situation the mandibular arch is completel& restored first+
and )a# relations are established as the& #ould &e to a
full complement of opposing teeth% hus the ma/illar&
com
plete denture is made to occlude #ith an intact arch%
On the other hand+ as is more often the situation+ the
mandibular partial denture ma& have one or more distal
e/tension bases% he iJituation then re1uires that the
occlusion be established on both dentures
simultaneousl&%
All mouth pr"parations and restorative procedures
re1uired to correctl& orient the occlusal plane+ correct the
arch form+ accommodate lhe de!+ired occlu(Oal (Ochl(lne+
and aC*%(8ll8llu:%lah(
the partial denture design must be accomplished on the
remaining natural teeth% *n addition+ all supporting
tissues must be in an acceptable state of health before
ma5ing the final impression% After ma5ing final
impressions+
#hich include the alter cast impression or the corrected
cast impression+ the ma/illar& occlusion rim is
contoured+ occlusal vertical relation #ith the remaining
lo#er teeth is established+ and a face0bo# transfer of the
ma/illar& arch is made0 he ma/illomandibular relations
ma& be recorded b& an&one of the several methods
previousl& outlined+ and the articulator mounting
completed% Occlusion ma& be eiJtabliiJhed a for
complete denture;+ td5ing care to e;tablish a favorable
tooth0to0ridge relationiJhip in both archeiJ+ an optimum
occluiJal plane+ and cuspal harmon& bet#een all occlud0
ing teeth%
After tr&0in+ several methods ma& be used to
complete the restorationG'0 ,oth dentures ma& be
proce__ed concurrentl& and remounted for occlusal
correction+ ur the partial denture ma& be processed first+
and after it is completed and remounted+ the teeth+ still in
#a/ on the complete denture+ are ad)usted to an& discrep0
ancies occurring%
Correction of occlusal discrepancies created during
processing must be accomplished before the patient is
permitted to uae the denturc3a4% Methods b& #hich these
discrepancies ma& be corrected are discussed in Chapter
$H%
S%/0.AsS%SS1%2) AIDS
$% rue or false( Occlusal harmon& e/ists #hen the
masticating mechanism can carr& out its ph&siologic
functions #hile the factors of occlusion remain in a
health& state+ the factors of occlusion being the
temporomandibular )oinb+ the neuromuiJcular
mechanism+ and the teeth and their supporting
structures
.% Occlusal harmon& benveen a removable partial
denture and the remaining natural teeth is a ma)or
factor in preserving the health of the supporting
structures of the natural teeth% rue or falseL
6% he establishment of a satisfactor& occlusion fur a
partilll :%l_ntur_ pllti_nt _huuld include five
considerations or procedures b& the
dentist% ?ist the five musts%
>% Define centric relation in &our o#n #ords% ;% =hat is
ma/imum planned intercuspation
and ho# does it relate to centric occlusionL
Chapter
$D
<% =hat is meant b& eccentric occlusionL D%
Describe a balanced occlusion%
-% #o methods are commonl& used to de
velop an acceptable occlusion for a removable
partial denture patient% 7ive a brief description of
these t#o methods%
K% =hat records are necessar& to correctl& orient
casts to an arc on0t&pe articulator and to program
the articulatorL
$E% A harmonious relationship of opposing occl8G_++$
M$%d incigal gurfaceg+ in itgelf+ ig not ade1uate to
ensure stabilit& of distal e/tension removable
partial dentures% =hat other factor must be
recogniJed and dealt #ith to minimiJe un#anted
leveragesL
$$% hiGr_ ar_ differences among denti_t_ in
deMelopin_ contacts of opposing teeth in centric
and eccentric positions for partiall& edentulous
patients% Ans#er the follo#ing 1ueries correctl&
and tr& to rationaliJe the recommendations
contained in this te/t(
_% -imult!nM8g contactg of opposing po_te
nor teeth must occur iii the intercuspal position%
rue or fabeL
b% Ocdu,ion for tooth0,upported removable
partial dentures ma& be arranged to duplicate
the occlusion seen in a harmoniou, natural
dentition% rue or falseL
c% 8nder #hat circum(;tance, i(; a balanced
occlusion dcsimble for the partiall& edentulous
patientL
d% -hould #or5ing side contacts be devel
oped #hen a mandibular distal e/tension
denture is opposed b& natural teeth 3a_GO$Jming
all mandibular posterior teeth arc mi,,in*J4L
e% A patient #ith a Nenned& Class * ma/illar& arch
is being treated =!ith a removable partial
denture% *- it beneficial to develop balancing
and #or5ing contucbL R/plain =hat about
protrusive contactsL
f% Are balancing side contacts for a Nenned&
C*M2'2 ** ma/illar& arch desirableL =h& or #h&
notL
g% =hat are the desirable contact relationships of
artifical0natural teeth #hen one arch is a
Nenned& Class *C archL
h% =hat is the most distal e/tent that an artificial tooth
should be arranged in a Nenned& Class * or **
mandibular archL
Occlusal relationships for removable partial dentures
6D;
$.% A patient re1uires a tooth0supported mandibular
removable partial denture% he remaining teeth are
ma/imall& intercusping2 ho#ever+ this position does
not coincide #ith centric relation% here is no
temporomandibular )oint pathologic process+ no
neuromuscular disorder+ and no periodontal condition
aggravated b& occlusion% =ould one insist that the
patient be restored to have ma/imum intercuspation
coincide #ith centric relationL =h& or #h& notL
$6% 8nder #hat circumstances =!ould one develop an
occ$mion for a partiall& edentulous patient gO that
ma/imum intercuspation coincided #ith centric
relationL
$>% =hen must the dentist determine the horiJontal )a#
relation in #hich to develop the occlusion for the
partiall& edentulous patientL =h&L
$;% After the horiJontal rl'lationship of the )a#s to #hich
the occlusion #ill be developed has been determined+
occlusal relationships ma& be established b& five
methods% he choice of method #ill be determined b&
the e/isting partiall& edentulous situation of the
patient location of remaining teeth in each arch+ and
the prior correction of an& e/isting occlusal
discrepancies% )hese five method/ are 3a4 direct
opposition of casts+ 3b4 interocclusal records #ith
posterior te"th r"maining+ 3c4 occlusal relations
using occlusal rims+ 3d4 )a# relation records made
entirel& on occlusion rims+ and 3e4 recording
functionall& gen"rat"d paths% Justif& and briefl&
discuss the use of each of the five methods%
$<% =hat are the disadvantages of using onl&
=!a/ for ma5ing interocdllsal recordsL
$D% =hat are the disadvantages in developing
an occlu,ion to a stone template or stone
teeth on a castL
6D<
McCrac5en's removable partial prosthodontics
$H% Materials of #hich the occlusal surfaces of artificial
posterior teeth are made deserve serious
consideration b& the dentist%
hese considerations should be based on
minimiJing attrition of occlusal surfaces+
maintaining the established vertical dimension of
occlusion+ and maintaining positive planr#d contact
of posterior teeth% o best accomplish the preceding+
please give the material of choice for occlusal
surfaces that oppose 3a4 porcelain+ 3b4 enamel+ 3c4
restored natural teeth+ and 3d4 fi/ed partial denture
panties #ith gold occlusal surfaces%
$K% Acr&lic resin posterior teeth lend themselves to
easier modification than do porcelain teeth #hen the
interresidual ridge distance is small or #hen an
edentulous space to be restored #ith the denture is
grossl& restricted% Ao#ever+ acr&lic resin teeth have
one big dra#bac5 #hen occluded against an& other
occlusal surface+ including acr&lic resin% =hat is this
dra#bac5L
.E% he occlusal surfaces of acr&lic resin teeth attached
to a denture ma& be duplicated in gold and attached
to the same teeth% Describe this techni1ue%.$%
Occlusal discrepancies created during processing
procedures must be corrected before the patient is
given possession of the dentures% =hen should this
be accomplishedL Why is it necessary#