Professional Documents
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Introduction
The study from Suguru Kimoto et
al.4 showed greater satisfaction of
the patient wearing dentures with a
lingualised occlusion concept.
The article The effect of occlusal
contact localisation on the stress
distribution in complete maxillary
denture5 describes the connections
which contribute to broken
dentures. According to this study, it
is the form of occlusion and the
positioning of the teeth in relation
to the alveolar ridge which leads to
an unstable load and to broken
dentures.
Complete Denture
Stability During
Chewing
Max Bosshart
To obtain unilateral chewing stability: forget about balanced occlusion, it
doesnt work, but: Perfect equilibrated occlusion is essential during
parafunctional mandibular movements to prevent unbalanced loads on the
supporting alveolar ridges.
1. Food is almost always chewed on one side only (Hiltebrandt, 1933/35)1.
2. During mastication the teeth of the denture wearer only finally come into
con-tact when the food load has become softened (A. Gerber, 1946)2, 3.
3. Therefore the bi-lateral equilibrium is ineffective for chewing stability.
4. For the unilateral chewing stability of dentures, immobility is the key.
5. Parafunctional contacts are occurring both day and night. In order to
distribute these forces evenly, correct centric and equilibrating contacts are
necessary.
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Conventional Set-up
Fig. 1: The ideal point of pressure on the tooth is the area shown with a
green arrow. The chewing force is directed to the middle of the alveolar
ridge. Forces directed in a more buccal direction, as the red arrows show,
progressively increase the deformation of the denture. The denture is no
longer well fitting (blue area) and in time, could initiate a crack zone in
the palatal part of the denture.
Fig. 2: The lower teeth exert pressure on the upper teeth in a buccal
direction (red arrow). This multiple cyclic reaction can lead to a crack in
the denture and a gap developing between the denture and the torus
palatinus.
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Fig. 4 : With the reduction of the buccal cusps (minimum 2mm) we have
the mastication force in the lingual/palatal area, which is orientated
almost vertically. Sagittal Stability
Model Analysis
Anyone building a house knows that he has to analyse the
ground it will be supported on. When setting up a denture
we need to do the same, we call it model-analysis.
We draw on the side of the model the different zones,
positive, neutral and negative/unstable areas. We use
different colours to get a quick analysis of the situation
(Fig. 7).
Balanced Occlusion
The arrangement of the teeth is still recognised as being a
balanced occlusion and the molar teeth are important in
parafunctional jaw movement. (Figs. 10a and 10b). Apart
from unilateral chewing stability as described above,
continuous posterior contacts are important during nonfunctional tooth contacts. The even distribution of the
forces over the complete upper and lower alveolar ridges
will protect the natural tissues from overload or at least
diminish the forces to a minimum. During all functional
and parafunctional movements, the elimination of all
prematurities is indispensable.
Fig. 6: This image shows in which direction the mastication force on the
upper jaw is directed. As a consequence of the poor position of the teeth,
according to the Spee curve, the force is in a disadvantageous angle to
the ridge and the pressure pushes the upper denture forward
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Fig. 8a
Fig. 7:
Fig. 8b
Figs. 8a and 8b: In this set-up the second upper molar is 3mm out of
contact. Therefore it is not possible to chew with it. Also we can observe
the large gap between upper and lower buccal cusps on the first molar.
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Final Remarks
In order not to detract from the principles of the Gerber
System we have, on purpose, not gone into too many
details. It is important to understand the forces during
mastication and the way they interact. (Who knows why,
knows how!). Of course many other factors are to be
observed, from medical history to the very important
aesthetics, impression taking and many more.
The method developed by Professor Gerber15 guarantees
success when all the relevant aspects are respected. Those
aspects contain all steps of a treatment, beginning with
the first appointment, continuing with the preprosthetic
treatment, first and second impressions, centric
registration, set-up of the teeth poviding aesthetic and
static/dynamic requirements, trying-in, properly executed
Retrusive Movement
A simple test shows, if a retrusive movement exists. With
the head in an upright position and by keeping the teeth
slightly closed, incline the head backwards, a slight sliding
of the lower teeth can be observed.
With the condyle centred in its physiologic place (due
to the form of the glenoid fossa) the retrusive movement is
also oriented downwards. There is no other way for the
condyle than down because of the posterior wall (Fig. 14).
Denture occlusion must be balanced; the correct
simulation allowing the physiologic mandibular
movements is of major importance.
Fig. 9a
Fig. 9b
Figs. 9a and 9b: If sufficient space is lacking, we recommended not to
place any upper molar at all.
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Fig. 10
Fig. 11
Figs. 10 and 11: Beside the static orientation of the posterior teeth,
balanced occlusion is an absolute must to protect the soft and hard
natural tissues from local overload, occurring specially during
parafunctional jaw movements.
Fig. 14: Sagittal view of a TMJ. By the form of the posterior wall
it is obvious that the retrusive movement must also be directed
downward.
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