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Occlusal harmony in complete denture is necessary

if the dentures are to be comfortable, to function


efficiently, and to preserve the supporting
structures.

It is difficult to see occlusal discrepancies intra
orally with complete denture.

The resiliency of the supporting soft tissues and
displaceability of the tissues in varying degrees tend
to disguise premature occlusal contacts.

The tissues permit the dentures to shift; as a result,
after the first interceptive occlusal contact the
remaining teeth appear to make satisfactory
contacts.
The eye cannot be relied upon to observe
occlusal discrepancies, and the patient cannot be
depended upon to diagnosed occlusal faults.

It is the responsibility of the dentist to find and correct
these occlusal discrepancies and permit the patient
to depart free of occlusal disharmony.

Occlusal faults can be determined by obtaining
and interocclusal record from the patient and
remounting the dentures on an articulator.

These faults can be corrected by careful selective
grinding procedures.

Remounting of the dentures on the articulators and
selective sliding procedures should be carried out at
the time of placement of the dentures.

Selective grinding / Occlusal Reshaping
is defined as the,

intentional alteration of the occlusal
surfaces of the teeth to change their
form.


GPT-8
Teeth are altered by selective grinding
to make simultaneous cusp tip to cusp
tip contact on both sides of the arch
when the jaws are in left or a right lateral
position, balanced occlusion in a static
eccentric position exists.
When the mandible is in a straight
protruded relation with the maxilla and
the posterior teeth are altered to
make cusp contacts at the same time
to anterior teeth make incisal edges
contact , balanced occlusion protrusion
exists.
as small as 15 micron

Problems
caused

Compression of
articular disc

Occlusion is defined as any (static) contact
between the incising or masticating surfaces of
upper & lower teeth
Supported by roots that are anchored
to the bone

Moves independently in their socket

Malocclusion may remain uneventful for
years

Occlusal forces affect only concerned
teeth

Non vertical forces tolerated better

Mastication usually done in the second
molar region

Bilateral balance is not found

Proprioceptive mechanism enables the
patient to avoid prematurities and gives
better control

Supported by denture base placed
on slippery mucosa

Moves as a unit on their base

Malocclusion evokes immediate
instability & pain
Forces acting affect the whole base

Non vertical forces not tolerated

The second premolar area is
preferred for mastication

Bilateral balance is necessary for
denture stability
Poor feed-back mechanism, so
neuromuscular control is
compromised


Natural occlusion Artificial occlusion
Concepts of occlusion

1.Balanced occlusion

2.Monoplane/non-balanced occlusion

3.Lingualised occlusion
Defined as bilateral simultaneous, anterior and
posterior occlusal contact of teeth in centric and eccentric
positions.

SIGNIFICANCE

Swallowing
Stability
Maintains integrity of foundation tissues
Minimal stresses on TMJ
I ncreased efficiency

Hanaus quint

Condylar guidance
I ncisal guidance
Plane of occlusion
Compensating curve
Cuspal inclination
SELECTIVE GRINDING:


Modification of occlusal & incisal surfaces of
teeth at selected areas to correct occlusal
errors & gain a balanced occlusion.

Artificial teeth move about to a minor degree during
festooning and while the wax denture base is being
converted in to resin.

This tooth movement is due primarily to dimensional
changes in the wax denture base,in the investing
materials ,and in the resin denture base during curing.

Occlusal discrepancies caused by these
dimensional changes ordinarily are removed before
the dentures are polished.

Occlusal harmony in complete denture is necessary
so that the denture will be:
1- comfortable and functions efficiently.
2- preserve the supporting structures
1) Inaccurate maxillo-mandibular relation record by
the dentist.
2) Errors in the transfer of maxillo-mandibular relation.
3) ill-fitting record bases.
4) Incorrect arrangement of the posterior teeth.
5) Failure to close the flask completely during
processing.
6) Warpage of the dentures by over-heating them
during polishing.
7) Changes in the denture base material (dimensional
changes of the acrylic dough).


Schuyler, Friedrich and Vaeghan in 1935
observed the disturbances in occlusal
relationship and opening of the bite of full
dentures made of acrylic resin, even when the
flask was completely closed during processing.
Osborne and Taylor in 1941 have noted the
disturbance and attributed it to over packing
and the accompanying displacement of teeth
in the mold.

It was felt, however, that these changes
were caused in part by the volumetric
change of acrylic resin during polymerization.
Extra oral corrections

Recognizing pre mature contact
(Dark ring with a light centre)


Grind until multiple, uniform
distributed & even contacts.
Intra oral corrections

Using articulating papers.


Central bearing devices.
correlator
coble device
Abrasive paste.
Extra-oral selective grinding is more preferable than
intra-oral selective grinding for the following reasons:

1) Presence of compressible tissue under the denture,
that may move with the denture especially in flabby
ridge and very resorbed ridges, while in extra-oral
selective grinding the dentures are on hard bases
(casts).

2) The bad psychological impact on the patient as
he will see his teeth ground in front of him in intra-
oral selective grinding.

3) Lateral excursion (right and left) and protrusive
movements are difficult.
Avoid grinding functional cusps. (BULL Rule)

Grind opposing fossae or marginal ridge.

Centric holding cusp reduced when it interferes with another centric holding
cusp

Can be reduced if it causes interferences in centric & eccentric position.

Elimination of protrusive interferences along a path of 3-5mm

Working side interferences are eliminated until canines meet edge to edge or
upto distance of 3-4mm.


The objectives as stated by Schuyler in 1935 are,

1)Maximum distribution of stress in centric maxillo-mandibular relation.

2)Retention of the maxillo-mandibular opening.

3)Harmony of guiding inclines, which distributes eccentric occlusal
stresses.

4) Reduction of the incline of guiding tooth surfaces, that occlusal
stresses may be more favorably applied to the supporting tissues.

5) Retention of sharpness of cutting cusps.

6) Increase in food exits.

7) Decrease in contact surfaces.
1. Laboratory remounting

2. Clinical remounting

3. Direct intraoral correction
Disadvantages
Cannot correct errors made while
recording jaw relations
Cannot correct errors made while
mounting the casts on the articulator
Does not compensate changes caused by
settling of the denture bases

Advantages
Correct errors made during recording of
jaw relations, or while mounting cast on
articulator
Less chair side time
Corrections away from the patients
view
No saliva which makes detection by
articulating paper difficult
No shifting of dentures or incorrect
closure by pt
The prematurities are ground until multiple,
uniformly distributed and even contacts are
obtained bilaterally
Clinical remounting is currently
the most commonly preferred
method of occlusal correction
Ask patient to bite
on cotton rolls for 10
min.
Guide mandible into
CR several times.
Bite registration
material is placed on
the post. teeth of the
mandibular denture

Guide mandible
into CR

Obtain
interocclusal
record of CR.
Mount upper
denture using
remounting jig

Mount lower
denture
OCCLUSAL INDICATORS
Qualitative Indicators
Articulating paper
Articulating silk
Articulating film
Metallic shim-stock film
High spot indicator
Occlusion sprays
Wax template
Quantitative indicators
T Scan occlusal
analysis system
It is a paper
impregnated with blue
dye

It is placed bilaterally
and teeth are tapped
together

High points will show a
dark staining or a dough
nut shape blue circles

High points are trimmed
with carborumdum
stone, till all contacts
show an equal
distribution of force.

Articulating paper
Micronised colour
pigments
Wax oil emulsion
Articulating Silk
8 microns thick
Universally
applicable
Articulating Film
Form a thin biocompatible film
To check the occlusion& approximal
contacts when checking the trial fit of
crowns.
Occlusion sprays
A softened wax is place between
both dentures, areas of heavy
contact will show thinning of wax or
even a hole.

Time
Magnitude
Distribution of
occlusal contacts
T Scan
Complete dentures
Fixed or removable
dentures
Complete arch
reconstruction
involving implants
Complete arch
reconstruction
involving FPD
Natural tooth
occlusal
equilibration
Disclusion time
reduction
Occlusal splints
Mandibular
repositioning
devices
T Scan
T Scan
T Scan
T Scan
left
right
1) Lock the articulator condyles to allow for hinge
movement only.

2) Use a blue articulating paper to mark teeth with high
contacts in centric relation.

3) Loosen the condyles allow for eccentric movemnts.

4) Use a red articulating paper to mark teeth with high
contacts at eccentric movements.

5) High points are evaluated and centric prematurities are
removed
t
.

A dark ring with a light
center usually denotes a
premature contact.

You should distinguish
between marks made
by normal occlusal
contacts and those of
premature contacts.

Articulating paper
should not be reused
many times and should
be changed often.

Make grinding until even
(same intensity), stable,
and multiple marks
spread over wide area in
both sides
OCCLUSAL ERRORS & THEIR SELECTIVE
GRINDING

a) A)Centric position errors:
1) Pair of opposing teeth hold other teeth out of contact:
- deepen the fossae corresponding to cusps till other teeth
came in contact.

2) UPPER & LOWER TEETH ARE NEARLY END TO END:
- grind the inner inclines of upper buccal & lower lingual
cusps.
- grind lingual of upper lingual cusps.
- grind buccal of lower buccal cusps.

3) Upper teeth are far buccal to lower ones:
- grind the inner inclines of upper lingual cusps & lower
buccal cusps.


B) WORKING SIDE ERRORS:
1) Both upper buccal & lower lingual cusps are
long:
- grind the high cusp tips of non functional

2) Buccal cusps make contact but lingual dont:
- grind the buccal cusp tips & alter their inclines (in)non
functional cusps).

3) Lingual Cusps Make Contact But Buccal Dont:
- grind lingual cusps & alter their inclines (of non functional
cusp only).

4) Upper Buccal & / Or Lingual Cusps Are Mesial To
Intercuspation Position:
- reduce upper mesial inclines & lower distal inclines
5) UPPER BUCCAL & / OR LINGUAL CUSPS
ARE DISTAL TO INTERCUSPATION POSITION:
- reduce upper distal inclines & lower mesial
inclines

6) teeth on working side are out of
contact:
-selective grinding to balancing side

C) BALANCING SIDE ERRORS:
1) Balancing side show heavy contact,
and working side show no contact:
- grind the inner incline of lower buccal cusp.

2) No contact on balancing side:
- grind the buccal upper cusps on lower lingual
cusps of cusps on working side.


D) PROTRUSIVE POSITION ERRORS:

1) Anterior teeth show heavy contacts
with no posterior contact:
- reduce palatal surface of upper anteriors &
labial surface of lower anteriors.

2) Posteriors show heavy contact with no
anterior contact:
- grind distal inclines of upper cusps & mesial
inclines of lower cusps.

Note:
-You have to wipe markings every time to
ensure good localization of abnormal
contacts.

- after finishing selective grinding, teeth are
milled (polished) with pumice.


Disadvantages
Requires a lot of patient cooperation.
Patient should have good
neuromuscular control.
Saliva.
Inaccurate closure by patient.
Misleading due to resiliency of tissues
and shifting of denture bases.

Adjustment of occlusion can be done by-

Selective reshaping of ridges of cusps.
Changes can be made at angles of marginal ridge.
Reduction of cusp height can be done.
Reduction of sulcus by reducing angles of triangular and
oblique ridges.


While reduction do not create flat areas, always maintain
rounded contours polished surface of cusps and ridges.
All eccentric interferences should be removed first then
only centric relation interferences should be removed.
Occlusal contouring diamond instrument
#8833, maximum speed 120,000 R.P.M.
Football shaped diamond instrument 8868-
023, maximum speed 80,000 R.P.M.
Dura white stones, nmbers 1C2, 1C4, FL1,
KN3.
Enamel adjustment kit.
Selective grinding in complete denture
Prosthodontics is an important laboratory
procedure which is carried out by
remounting of the dentures after
processing is completed.

This remounting may either be laboratory
remount or patient remount.
In spite of carrying out each step in
denture construction very carefully, it is
seen that in the end when the dentures
are remounted there is an occlusal pre
maturities or interferences and selective
grinding may be needed.
1. Boucher's Prosthodontics Treatment for Edentulous Patients.
Twelfth Edition.Chapter 20.

2. Dalhousie continual education

3. Complete Denture Prosthodontics, 1
st
Edition, 2006 by John
Joy Manappallil, Chapter 19

4. Essentials of complete denture prosthodontics,2
nd
edition ,
Sheldon Winkler.

5. Textbook of complete dentures, Charles .M. Heartwell.

INDIAN DENTAL ACADEMY: SELECTIVE GRINDING IN COMPLETE
DENTURE , Aug 12,2013.

Acta Stomatol Croat, Vol. 35, br. 3, 2001.

Selective grinding in dental occllusion [Rev Belge Med Dent
(1984). 1990] - PubMed NCBI.

Dental equilibration by selective grinding [Av
Odontoestomatol. 1989] - PubMed NCBI.

CONCEPTS OF ARRANGEMENT OF ARTIFICAL TEETH, SELECTIVE
GRINDING AND BALANCED OCCLUSION IN COMPLETE
DENTURE PROSTHODONTICS, NUJHS Vol. 2, No.1, March 2012
ISSN 2249-7110 .

Occlusal adjustment by selective grinding and use of an
anterior De programmer,Tetsuo Saito* (Quintessence Int
1990;21:887-892.)