The International Journal of Periodontics & Restorative Dentistry

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The International Journal of Periodontics & Restorative Dentistry
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Checking the Occlusal Relationships of

Complete Dentures via a Remount
Procedure
Tomislav Badel, DMD, PhD* The establishment and examination of

Josip Pandurić, DMD, PhD** the occlusal relationships of denture
Sonja Kraljević, DMD, PhD*** teeth are integral to the clinical and lab-
Niks̆a Dulc̆ić, DMD, MSD**** oratory procedures of complete den-
ture fabrication. The occlusal contacts
of teeth in occlusion rims will change
after polymerization of acrylic resin
bases and following wearing in the
Correct occlusal relationships are part of the successful prosthetic treatment of
mouth.1
edentulous patients. Occlusal checking should be performed via a remount proce-
The relationships between artificial
dure because denture base materials and fabrication procedures cannot provide
teeth on complete dentures consid-
dimensionally accurate complete dentures. Occlusal errors caused by the adjust-
ment of denture bases to the denture foundation after a certain period of wearing
erably affects the uniform loading of
can also be corrected by means of remounting. The following remount procedures denture foundations and their stability
for complete dentures are described: fabrication of transfer casts, transfer of a during denture wearing. When den-
maxillary denture with a facebow, centric relation record, and mounting of dentures are first given to patients, clini-
tures with transfer casts in an articulator with a dental stone. Deflective occlusal cians often resort to a direct determi-
contacts of denture teeth in centric occlusion can be eliminated by selective nation of occlusion and grinding of
grinding and by tooth-guided excursive movements. In complete denture treat- denture teeth in the mouth. Direct
ment, priority is given to anterior/canine-guided occlusion. (Int J Periodontics grinding of occlusion is a difficult and
Restorative Dent 2007;27:181–192.) imprecise method of correcting
occlusal contacts. The seating of the
denture bases on the mucosa of den-
*Teaching and Research Assistant, Department of Prosthodontics, School of Dental
Medicine, University of Zagreb, Croatia. ture foundations is insufficiently secure
**Professor, Department of Prosthodontics, School of Dental Medicine, University of and not easily observed. Also, patients
Zagreb, Croatia. may have difficulties in performing
***Associate Professor, Department of Prosthodontics, School of Dental Medicine,
University of Zagreb, Croatia.
excursive occlusal contacts.
****Research Assistant, Department of Prosthodontics, School of Dental Medicine, A remount procedure is carried
University of Zagreb, Croatia. out for the purpose of establishing cor-
rect occlusal contacts of denture teeth;
Correspondence to: Dr Tomislav Badel, Department of Prosthodontics, School of Dental
Medicine, University of Zagreb, Gundulićeva 5, HR-10000 Zagreb, Croatia; this is done by placing the definitive
fax: +385-1-48-02-159; e-mail: tomislav.badel@sfzg.hr. dentures back on an articulator.
Volume 27, Number 2, 2007
182
Remounting is necessary for several Subsequent patient care com- on the stability of denture bases, mas-
reasons: prises control of patient comfort, con- ticatory efficiency, and the transfer of
trol of occlusal relationships, and timely masticatory forces to the supporting
• Acrylic resin is the basic constituent replacement with new dentures. areas. Specific tooth contacts during
material of complete dentures, and Occlusion of complete dentures is an mandibular movements or articula-
during its polymerization for the important factor in correct distribution tion are described as occlusal con-
definitive denture base it is liable to of masticatory loading on the denture cepts. The previously mentioned
dimensional changes. Regardless foundation, stability of the denture occlusal concepts are related to the
of the method of investing the bases, and, to a certain extent, patient arrangement of denture teeth as a
acrylic resin into the flask and the satisfaction.9 prosthetic factor of complete denture
type of polymerization used, the The purpose of this article is to wearing. The most commonly applied
process results in contraction, which present a remount procedure and a occlusal concepts for edentulous
causes a certain displacement of method of occlusal correction for com- patients are (1) balanced occlusion,
denture teeth and a change in the plete dentures. A remount procedure (2) lingualized occlusion, and (3)
occlusal contacts, which can affect is performed by means of transfer monoplane occlusion.11,12
the relationship between the func- casts. The first remounting is per- The concept of bilaterally bal-
tional margin of the denture and formed before the dentures are given anced occlusion is a completely
the denture foundation.2–4 to the patient, and the second and balanced occlusion, which was devel-
• Dimensional changes caused by third remountings are done after the oped for the purpose of stabilization of
water absorption from the oral envi- dentures have been worn for a period complete dentures and established by
ronment into the acrylic resin base of time. The first procedure corrects Gysi, who improved scientific knowl-
will occur beginning on the first day occlusal errors caused by imperfect edge about occlusion. Tooth contacts
of denture wearing. Expansion occurs laboratory fabrication, and the second occur on all surfaces, simultaneously,
in all three dimensions, and vertical procedure corrects dimensional and in all directions and mandibular
displacement of single teeth in vitro changes of the acrylic resin caused by movements. During functional move-
is established later. The method of water absorption from saliva. With the ments, teeth are supported on the lat-
polymerization used and the thick- third remounting, harmony of the den- erotrusive and mediotrusive side.
ness of the denture base have impor- ture teeth is achieved by the adjust- During laterotrusive movement, all
tant effects on the dimensional ment of denture bases on the denture teeth are in contact on the working
changes of acrylic resin dentures.4–6 foundation. side, and on the nonworking side, at
• The mucosa of the denture foun- least one pair of antagonist teeth is in
dation, on which the denture base contact.13 The concept of reduced
still must find its position, reacts to Occlusal concepts for occlusion according to Gerber is char-
denture wearing. Prosthetic factors complete dentures acterized by bilateral balance within
that influence the wearing of com- certain areas of movement; by means
plete dentures are the arrangement There are three different occlusal con- of the occlusal surface pattern, occlusal
of denture teeth and occlusal rela- cepts for the natural dentition: bilat- contacts are shifted toward the middle
tionships. Changes in occlusal con- erally balanced occlusion, unilaterally of the residual ridge or orally, in the
tacts may affect patient comfort and balanced occlusion, and canine/ante- sense of lingualized occlusion.14
can initiate pathologic changes on rior guided occlusion.10 With com- The lingualized occlusion creates
the denture foundation. The posi- plete dentures, the occlusion must reduced contacts on the palatal cusps
tion of denture bases on the den- satisfy the patient’s needs for com- in the fissures of mandibular teeth.
ture foundation changes during the fort, function, and esthetics.1 Tooth Therefore, the buccal cusps are out of
entire denture-wearing period.7,8 contacts have an important influence contact, and during masticatory func-
183
tion the pressure is transferred lingually premolars and molars in maximal inter- the mouth is protected, and the sec-
to the foundation of the mandibular cuspal position, while the intercanine ond molars are omitted to permit bet-
complete denture. Pound described area is held outside contacts. During ter stabilization of the dentures. This
this concept as unilateral balanced laterotrusive movement, antagonist concept is recommended in the fabri-
occlusion, whereby during unilateral tooth contacts are present only on cation of complete dentures according
movement, the sliding movement has canines, whereas every other tooth to Gutowski,25 in the modified method
no support with the sliding movement contact, including the nonworking according to Lauritzen,18 and accord-
on the balancing side (opposite to the side, is considered as an interference. ing to the Innsbruck concept of fabri-
working side). During protrusive move- This concept has shown practical value cation of complete dentures.26
ment, balance is achieved by means of in the initial treatment of temporo-
contact between the anterior teeth mandibular disorders by means of a
and the rearmost molars. This kind of stabilization splint. The activity of the Remount procedure
occlusal relationship provided better jaw-closing muscles is reduced, which
stability for complete dentures during then reduces eccentric clasping of Problems with the occlusal relation-
mastication.15 teeth and strain in the temporo- ships of teeth on complete dentures
Monoplane occlusion includes mandibular joint.21 are caused by various factors. These
occlusal contacts of the maxillary and Nowadays this occlusal concept include unstable trial bases for the
mandibular teeth in maximum inter- for complete dentures is described by interarch relationship record, incorrect
cuspation, disclusion of posterior the predominant performance of use of a facebow, transfer of casts on
teeth as a result of their arrangement movements on canines or sequential an articulator, inaccurately established
in a single plane, and contacts of ante- performance on premolars (elements vertical and horizontal dimensions,
rior teeth during mandibular move- of anterior guidance are twice as long irregular arrangement of posterior
ments. The concept of the arrange- on anterior teeth in relation to poste- teeth, excessive use of pressure during
ment of posterior teeth without cusps rior teeth), and therefore this concept pressing of the acrylic resin into the
was modified later. This concept is is called anterior-posterior sequence of flask, inadequately closed flask during
also called nonbalanced occlusion guidance elements or sequential guid- polymerization, and overheating of the
because occlusal balance is not ance with the prevalence of anterior finished dentures during final polish-
achieved with it.11,16,17 teeth/canines.22–24 According to the ing. All these factors result from errors
According to Stallard, bilateral basic principle, the guidance surface on the part of the clinician or the tech-
occlusion is inadequate for both nat- on a canine is steeper compared with nician in the course of fabrication of
ural teeth and complete denture that on distal teeth, and therefore their complete dentures.1
teeth.17 Therefore the most recent con- disclusion is achieved. Anterior teeth Remounting begins with attach-
cept for the arrangement of denture are arranged without occlusal contacts. ing the maxillary complete denture to
teeth in complete dentures is ante- Posterior teeth are arranged so that the transfer tray with a bite registration
rior/canine guidance, introduced by their occlusal surfaces in the medial material (Fig 1). The transfer in relation
Schwab and Stuart and later modified plane show an anteroposterior curve to the cranial referential plane (axis
by Gausch and Gutowski.18 (the curve of Spee). The arrangement orbital plane) is performed with an
Stuart and Stallard introduced the and mutual contacts of posterior teeth anatomic facebow, which gives satis-
principle of anterior/canine guidance show characteristics of lingualized factory accuracy and is practical to use.
into clinical practice, along with occlusion, which enables better trans- The facebow is then placed on an artic-
D’Amico later; this became the main fer of masticatory pressure onto the ulator (Fig 2). Rather than split dental
characteristic of the gnathologic edentulous alveolar ridge and better stone casts, it is better to use a control
school.19,20 Canine-guided (protected) stabilization of mandibular and maxil- system with a magnet (eg, the SAM
occlusion implies uniform contacts of lary complete dentures. The floor of Axiosplit system for the SAM 3 articu-
184
Fig 1 (left) Preparation for transfer of com-

plete dentures in an articulator with a face-
bow begins with attaching the maxillary
complete denture to the transfer tray with a
bite registration material (Dimension Bite,
ESPE).
Fig 2 (right) Transfer of the occlusal sur-

face in relation to the axis orbital plane is
achieved by placement of a facebow (SAM,
Präzisionstechnik) in the transverse horizon-
tal plane of the mandible and a point on the
inferior border of the right and left bony
orbit (orbitale) and on the maxillary com-
plete denture attached with screws, which is
placed on the edentulous jaw. The patient
assists in the procedure so that he or she
holds the anterior part of the facebow with
the hands and fixes the denture on the den-
ture foundation by biting into cotton pellets.
Fig 3 (left) The maxillary denture is

removed from the mouth together with the
facebow and is mounted on the upper por-
tion of the articulator (SAM 3). The under-
cuts of the denture base are filled with firm
silicone (Optosil P Plus, Heraeus Kulzer).
Fig 4 (right) Mounting of the maxillary

complete denture in the SAM 3 articulator
with a hard stone (Vel-Mix Stone, Kerr)
accomplishes simultaneous fabrication of a
transfer cast for remounting.
lator, Präzisionstechnik). The denture is the maxilla when the properly aligned of the centric relation record. Centric
dried, and the undercuts of the den- condyle/disc assemblies are in the most relation of the mandible is recorded
ture base are filled with firm silicone superior positions against the eminence bimanually with a thermoplastic com-
(Fig 3). The transfer casts are made of irrespective of tooth position or vertical pound, which is placed on the dried
hard stone and are mounted on the dimension.” Centric relation is the opti- mandibular complete denture over the
upper stand of the articulator (Fig 4). As mal arrangement of joint, disc, and external and internal surfaces of the
soon as the stone is hardened, the sil- masticatory muscles. The mandibular posterior teeth. The making of a record
icone is removed from the dentures, position in which the condyles are in is enabled by finger rests for the oper-
and the adherence of the denture to centric relation and denture teeth are in ator, made of a thermoplastic com-
the cast is checked. maximal intercuspal position is usually pound, which are placed in the area of
The next step is creating a hori- called centric occlusion.28 the buccal flange of the denture. In
zontal maxillomandibular relationship Centric relation is determined this way, a steady seating of the
record with the mandible in centric rela- once again by a remount procedure, mandibular denture on the denture
tion. Dawson27 defined centric relation and the mandibular complete denture foundation is achieved. The mandibu-
as “the relationship of the mandible to is mounted in the articulator by means lar denture, with a wax layer, is
185
Fig 5 (left) The centric record of the hori-

zontal interarch relationship is performed by
bimanual stabilization of the mandibular
complete denture and unforced mandibular
guidance into centric relation. The patient
bites gently with the complete dentures
into an impression compound (Impression
Compound, Kerr).
Fig 6 (right) The mandibular complete

denture with finger rests and a record of the
occlusal surfaces of posterior teeth made of
a thermoplastic compound. Impressions in
the record are chilled in water and reduced
with a scalpel. The procedure of making a
centric record is repeated.
Fig 7 (left) Dentures attached to the cen-

tric record are carefully removed from the
patient’s mouth.
Fig 8 (right) The maxillary denture is

mounted on the upper transfer cast in the
articulator. The mandibular denture is
attached to the maxillary denture by means
of the centric record. After the undercuts of
the denture base are filled with firm sili-
cone, the transfer cast is fabricated, and the
mandibular denture is mounted on the
lower part of the articulator.
immersed in a water bath at 52°C for the operator’s assistance. The dentures The mandibular denture base and
20 seconds and placed on the denture are removed from the mouth, and the the floor of the mouth are filled with
foundation in the patient’s mouth. The impressions are chilled in water and firm silicone for fabrication of transfer
patient is instructed to guide the their depth and uniformity checked. casts. The dentures are mounted in
mandible into centric relation until con- Only the canines and the cusps of pos- the articulator by means of the record
tact is reached (Figs 5 and 6). The terior teeth are allowed to make (Fig 8). The dentures are fixed on the
mandibular denture is then removed impressions. The procedure is casts using an applicator for thermo-
from the mouth and chilled in water. repeated if uneven pressure causes plastic gluing (ie, Pattex, Henkel). The
The impressions in wax are removed impressions of different depth. The centric record control is repeated by
with a scalpel, and the procedure is maxillary denture teeth must fit per- removal of the impressions, and the
repeated in the mouth by guidance fectly into the respective impressions control in the articulator is performed
into centric relation. The patient, in the on the mandibular denture. The den- by means of a system of split casts.
upright position, touches the mandibu- tures, attached to the final centric
lar denture gently and simultaneously record, are carefully removed from the
to the maxillary dental arch without patient’s mouth (Fig 7).
186
Occlusal errors maxillary palatal cusp is narrowed

by widening the central fossa, and
The final correction of possible occlusal the mandibular buccal cusp is
disharmony on dentures is carried out ground on the buccal side by
with the procedure of selective grind- widening the central fossa. The
ing. Each occlusal error is corrected palatal cusp is ground on the palatal
by grinding of specific tooth surfaces, side and the mandibular buccal
which preserves the desired tooth form cusp is ground buccally so that the
and type of occlusion.1 teeth telescope into each other. The
On denture teeth, occlusal errors cusps are not reduced (Fig 10c).
can include errors in centric occlusion,
errors during protrusive movements, On the working side, occlusal
and errors on the working and non- errors can be in the frontal and sagit-
working (balancing) side. tal plane (Figs 11 and 12). By selective
In centric occlusion, A and/or C grinding of specific cusp inclines, the
and B contacts should be established correct contacts are achieved accord-
on posterior denture teeth in the ing to the chosen occlusal concept.
frontal plane for each pair of antago- According to the concept of bilaterally
nist teeth (Fig 9).29 There are three balanced and lingualized occlusion,
types of occlusal errors1: uniform contacts are established on
all posterior teeth, whereas the canine
• Any pair of antagonist teeth can be guidance concept requires contacts
too long and thus keep other teeth only on the canines or the first premo-
out of contact. To correct this error, lars of the working side.
the fossae are deepened by grind- Errors in the frontal plane can
ing so that teeth can telescope into include:
each other. The cusps are not
reduced (Fig 10a). • The maxillary buccal cusp and the
• Mandibular and maxillary teeth may mandibular lingual cusp are too
be placed almost edge to edge. To long. To correct this error, the
correct this error, the cusp inclines length of the cusps is reduced by
are ground. The buccal inclines of grinding to change the incline
the maxillary teeth and the lingual extending from the central fossa to
inclines of the mandibular teeth are the cusp tip. The central fossa is
ground. The central fossae are not deepened, but the maxillary
widened. The maxillary palatal cusp buccal cusps and the mandibular
is narrowed by grinding on the lingual cusps are reduced (Fig 11a).
palatal side, and the mandibular • The buccal cusps are in contact,
buccal cusp is narrowed by grinding but the lingual ones are not. The
on the buccal side. The cusps are maxillary buccal cusps should be
not reduced (Fig 10b). ground from the central fossa to
• Maxillary teeth can be placed too the cusp tip to reduce the cusp
far buccally in relation to mandibu- and change the lingual cusp incline
lar teeth. To correct this error, the to become less steep (Fig 11b).
187
Fig 9 (left) Fingers demonstrate the A, B,

and C contacts between the cusps and fos-
sae of the distal teeth in centric occlusion.
Fig 10 (right) Occlusal errors and their

correction in centric occlusion: (a) the teeth
are too long, (b) the teeth are almost edge
to edge, and (c) the horizontal overlap of
the teeth is too great.
A B C a b c
Buccal Lingual
Fig 11 (left) Occlusal errors and their cor-

rection in the frontal plane on the working
side: (a) the buccal cusp of one tooth and
the lingual cusp of its antagonist tooth are
M M
too long, (b) the buccal cusps are too long,
and (c) the lingual cusps are too long.
D D
Fig 12 (right) Occlusal errors and their
correction in the sagittal (mesiodistal) plane
on the working side: the position of the a b
a b c
cusps is (a) mesial or (b) distal to its maximal
intercuspal position. M = mesial; D = distal.
• The lingual cusps are in contact, of the maxillary buccal cusps are is excessive contact on the nonworking
but the buccal cusps are not. The ground distally as if they were nar- side.
mandibular lingual cusps are rowed, and the distal inclines of Occlusal errors on the nonworking
reduced by grinding their buccal the mandibular cusps are ground side can be so severe that the teeth on
inclines. The maxillary palatal cusp mesially. In this way, the same cus- the working side are held out of con-
is not reduced, and the central pal inclination is achieved (Fig 12a). tact. To correct this error, the paths are
fossa is not deepened (Fig 11c). • The maxillary buccal and lingual ground over the mandibular buccal
cusps are placed distally to their cusp to reduce the incline of the part
Errors in the sagittal plane can maximal intercuspal position. This of the cusp that is preventing tooth
include the following: error can also occur along with the contact on the working side. Each
buccolingual errors. To correct this, interfering cusp is preserved as much
• The maxillary buccal or lingual grinding is performed on the max- as possible. Grinding is not performed
cusps are placed mesially to their illary cusps distally and on the on the lingual cusps that can be
maximal intercuspal position. This mandibular cusps mesially (Fig 12b). included in this contact. According to
error can occur along with any of the lingualized and canine/anterior
the three errors already described. If there is no occlusal contact on guided occlusal concept, each bal-
To correct this, the mesial inclines the working side, the cause of this error ancing contact should be removed.
188
Fig 13 The intercuspal relationship Figs 14a and 14b Centric stops are achieved by selective grinding on the mandibular
between the fossae and the cusps of the complete denture (a, left) and (b, right) the maxillary complete denture.
complete denture teeth is indicated with a
permanent marker.
Correction of occlusal (Figs 14a and 14b). It is important that Correction of right and left tooth-
contacts in the articulator the incisal pin contacts the incisal table guided lateral movement can start if
simultaneously with tooth contacts. the articulator is programmed (with the
Correction of occlusal relationships The next step is the elimination of SAM articulator by setting of Bennett
begins with placement of the dentures deflective occlusal contacts during angle with the red SAM extension at 10
on the casts in the articulator. The rela- straight protrusive movement. The degrees on both sides). The process
tionship between the fossae and cusps edge occlusion of anterior teeth is starts with right lateral movement. The
on the buccal and oral surfaces of pos- transferred to the articulator by a pro- maxillary portion of the articulator is
terior teeth from the cusp tip to the trusive interocclusal record, and this moved toward the left, whereby the
largest circumference of the tooth position is maintained by means of a condylar ball on the working side
is recorded with a permanent marker protrusive screw and contact between touches the rear wall of the housing. It
(Fig 13). the incisal pin and the anterior guid- is necessary to establish contacts on
Contacts in centric occlusion are ance holder. Only the incisors make canines by selective grinding.
marked with thin articulating paper. simultaneous and uniform contacts. Deflective contacts are eliminated by
Bilateral, simultaneous, and uniform The deflective contacts are ground grinding of excursive contacts (of the
contacts of all distal teeth—and of the with a bur on the palatal side of the bite part beside the cusp), and contacts
canines if desired—should be achieved edge for esthetic reasons (Figs 15 and nearer to the fossae are preserved,
by grinding. A and/or C and B contacts 16). Then the maxillary portion of the because this is the area of centric stops
are established for each tooth (see Fig articulator is moved gradually, 1 mm at (Fig 17). By arranging the denture teeth
9). A sufficient number of anteropos- a time, toward centric occlusion to according to anterior/ canine guidance,
terior and buccolingual stabilizing establish contacts on the canines, and each contact on the nonworking side
tooth contacts are needed. Every if contacts between incisors are not during laterotrusive movement is con-
deflective contact is trimmed with a possible, contacts should be estab- sidered an interference and should be
bur to preserve tooth morphology. lished on the first premolars as well eliminated. The same corrections are
Incisors must be kept out of occlusion (protrusive group contacts). carried out on the left side (Fig 18).
189
Fig 15 (left) Insufficient contacts on the

maxillary anterior teeth during protrusive
movement.
Fig 16 (right) Uniform protrusive contacts

on the maxillary anterior teeth are achieved
by selective grinding.
Fig 17 (left) Deflective contact on the

right second premolar (green) during right
laterotrusive movement.
Fig 18 (right) Contact between the

canines is achieved during tooth-guided lat-
eral movement without contacts of denture
teeth on the balancing (nonworking) side.
Purpose of a remount According to Suzuki et al, 31 the increases the vertical relation by 5 to 10
procedure occlusal forces, area, and number and mm. The functional record raises the
position of occlusal contact points bite by about 0.5 mm, and it is the most
Physical, biologic, and prosthetic fac- were significantly larger in an adjusted common procedure. Aiming at unifor-
tors determine the functional quality of group than in a nonadjusted group of mity and simultaneity of the bite in the
complete dentures.7,8 The denture complete dentures. area of distal teeth, this procedure has
base, mucosa under the denture base, Remounting of complete dentures been proven clinically reliable.34,36
and saliva enable retention by adhe- on preliminary casts should be The most often applied occlusal
sion, cohesion, and atmospheric pres- avoided. Preliminary casts are inade- concept is balanced occlusion.11,14 In
sure. Biologic factors are dependent quate because they are usually dam- the occlusal treatment of edentulous
on neuromuscular balance and the aged, and the insertion of complete patients, preference is more often
content and amount of saliva. The dentures is difficult because of dimen- given to the lingualized occlusal con-
residual ridge can, to a certain extent, sional changes. Alternatively, denture cept, which is achieved by a specific
mechanically hold the denture base bases can be attached to the articula- tooth form, and it is logical and less
on the denture foundation as well as tor with a putty material, although fab- complicated than balanced occlusion.
movable parts of the mucosa and mus- rication of stone transfer casts is a sim- It has been established that both bal-
cles that have a favorable effect on the ple and precise procedure.32–34 Check anced and lingualized occlusal
stabilization of complete dentures. record mounting blocks can be used schemes require less force to be
Prosthetic factors include the arrange- for faster mounting of dentures in the exerted during mastication, and
ment and occlusal contacts of denture articulator.35 therefore the denture-bearing tissues
teeth.7,30 Therefore the control and Determination of interarch rela- are subjected to lower forces than
correction of occlusal contacts during tionships is possible with the centric with the monoplane (nonbalanced)
denture fabrication, polymerization of relation record by means of a support- occlusion.11,17,37–41
the denture base, and subsequent ing pin, but this narrows the lingual Gausch22 was one of the first to
patient care are very important. area, prohibits muscle function, and report a positive experience in the
190
application of the canine/anterior bilization and destabilization forces, denture foundation. A remount pro-
guided occlusion on complete den- including freedom in centric occlusion, cedure, which can be repeated several
tures. Later, other authors reported centric relation, and the individual times, also helps. If the process of den-
successful performance with this pros- arrangement of denture teeth. ture base adjustment on the denture
thetic treatment.18,23–26 Although many factors influence foundation is not completed, a
According to Gutowski33 and patient satisfaction with complete den- remount procedure should be per-
Peroz et al,42 the advantage of canine/ tures—for example, denture quality, formed again after 2 to 6 weeks. It is
anterior guided occlusion is its sim- oral health, the patient-clinician rela- advisable to carry out a functional con-
plicity, because anteroposterior and tionship, the patient’s opinion about trol of dentures once a year. Recall is
bilaterally balanced occlusal schemes dentures, the patient’s personality, and necessary every 1 to 2 years of denture
are difficult to achieve. Esthetics and psychosocial factors—it has been wearing, together with remounting,
stability of complete dentures during reported that masticatory efficacy and relining of denture bases, and replace-
eccentric movements are better and satisfaction are more important than ment of the dentures with new ones
the occurrence of parafunctions is occlusion for patients with complete after 7 years of wearing.1,8,18,25,33
reduced. Less muscle activity is found dentures.9,45,46
in complete denture wearers with ante- Occlusion varies constantly
rior/canine guided occlusion than in depending on muscle tonus, remod- Conclusions
those with balanced occlusion.43 eling of the supporting structures,
Remounting should definitely be tooth wear, and mental health.47 A fol- 1. Remounting of finished complete
performed after polymerization of den- low-up of patients with complete den- dentures is an integral part of
ture bases and before complete tures48 established that, in half of them, prosthetic treatment.
dentures are given to the patient.1 occlusion was not stable, and in some 2. The first remounting should be
However, the best timing of remount- of them, a new maximal intercuspal performed after polymerization of
ing after optimal incorporation of the occlusion was determined clinically. the denture bases, the second
denture into the patient’s mouth is The consequences of undesirable after 1 to 3 days, and the third
uncertain. According to Lauritzen,33 changes in occlusal relations include after 1 week of wearing.
this should be done after 8 to 10 days resorption of the edentulous jaw and 3. Occlusal errors can be corrected
of the patient wearing the complete abrasion of denture teeth. Remounting by selective grinding of denture
denture, and Dapprich and Oidtman18 can help reduce and prevent changes teeth. The anterior/canine guided
recommend it be performed after 2 in occlusion and improve denture com- occlusal concept is the preferred
weeks. Utz44 emphasized the different fort, as well as the efficacy of occlusal option for tooth arrangement. In
extent of occlusal changes in complete rehabilitation of edentulous patients.49 centric occlusion, only the poste-
dentures and recommended remount- Remounting of complete dentures rior teeth are in uniform and simul-
ing between the first and the third and control of occlusal contacts can taneous contact, whereas a slight
week of wearing. Gutowski25 recom- also be performed after denture relin- distance should be kept between
mended remounting after 1 to 3 days ing, although no considerable dimen- the anterior teeth. During lateral
of wearing and again after 1 week. sional changes in complete dentures movements, contacts on the bal-
The occlusal aspect of complete have been observed.50 ancing side are considered as
dentures plays a role in achieving uni- The success of prosthetic treat- occlusal interferences. The
form distribution of masticatory forces ment in edentulous patients is deter- arrangement of teeth in such
and improved retention and stabiliza- mined by acceptable function of com- occlusion is simpler, esthetics are
tion of denture bases.7 The occlusion plete dentures. Pressure points should better, and patients experience
of complete dentures should satisfy be eliminated in two or three visits, fewer parafunctional movements.
the dynamic interrelationships of sta- which can help heal any lesions on the
191
Acknowledgment 11. Lang BR. Occlusion for the edentulous 25. Gutowski A. Kompendium der Zahn-
patient. In: Zarb GA, Bolender CL, Carlsson heilkunde. Schwäbisch Gmünd: Eigen-
This article was made with the support of the GE (eds). Boucher’s Prosthodontic verlag, 1999.
Ministry of Science, Education and Sports of the Treatment for Edentulous Patients. St 26. Grunert I, Bösch H. Front-Eckzahngeführte
Republic of Croatia, project no. 0065010. Louis: Mosby, 1997:262–278. Totalprothesen—Ein praxisnahes Konzept.
12. Lang BR. Complete denture occlusion. Quintessenz Zahntech 2001;27:634–642.
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1994,71:150–153. Occlusion, vol 2. San Francisco: University complete dentures. J Prosthet Dent
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1987;58:689–693. chairside mounting procedure.
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consequent changes in vertical dimension. Wegemann U, Kurbel R. Reproduzierbar-
21. Ash MM, Schmidseder J. Schienen- keit der Handbissnahme bei Totalprothe-
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7. Palla S. Die Logistik des posterioren 1999:3–5. 1993;103:561–566.
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Hilfsmittel. In: Drücke W, Klemt B (eds). Pudwell ML, Taylor DT. A comparison of lin-
9. Palla S. Occlusal considerations in com- Schwerpunkte in der Totalprothetik. Berlin: gualized occlusion and monoplane occlu-
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and Practice of Occlusion. Chicago:
24. Kulmer S, Ruzicka B, Niederwanger A, 1983;50:176–179.
Quintessence, 1997:457–467.
Moschen I. Incline and length of guiding 39. Dubojska AM, White GE, Pasiek S. The
10. Türp J, Strub JR. Prosthetic rehabilitation elements in untreated naturally grown den- importance of occlusal balance in the con-
in patients with temporomandibular dis- tition. J Oral Rehabil 1999;26:650–660. trol of complete dentures. Quintessence
orders. J Prosthet Dent 1996;76:418–423.
Int 1998;29:389–394.
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40. Ohguri T, Kawano F, Ichikawa T,

Matsumoto N. Influence of occlusal
scheme on the pressure distribution under
a complete denture. Int J Prosthodont
1999;12:353–358.
41. Massad JJ, Connelly ME. A simplified
approach to optimizing denture stability FACULTY POSITION AVAILABLE:
with lingualized occlusion. Compend PERIODONTIST
Contin Educ Dent 2000;21:555–569.
42. Peroz I, Leuenberg A, Haustein I, Lange K- The Faculty of Dentistry, Dalhousie University, Halifax, Nova Scotia, is
P. Comparison between balanced occlu-
seeking applications for a full-time, term appointment of two years possibly
leading to a tenure-track faculty position at the rank of Assistant, Associate or
sion and canine guidance in complete
Full Professor, in the Division of Periodontics in the Department of Dental
denture wearers—A clinical, randomized Clinical Sciences. Qualified candidates may be considered for a tenure-track
trial. Quintessence Int 2003;34:607-612. position.
43. Grubwieser G, Flatz A, Grunert I, Kofler
M, Ulmer H, Gausch K. Quantitative Responsibilities will include undergraduate teaching, collaborative research,
continuing education presentations and associated administrative duties.
analysis of masseter and temporalis
Depending on the successful applicant’s credentials (s)he may be invited to
EMGs: A comparison of anterior guided participate in planning a graduate program. The Division collaborates in
versus balanced occlusal concepts in research with other Divisions, Departments, Faculties, Universities, and the
patients wearing complete dentures. J School of Biomedical Engineering.
Oral Rehabil 1999;26:731–736.
Academic rank will be based on the successful candidate’s qualifications,
44. Utz K-H. Studies of changes in occlusion
experience, and achievements. It is expected that the successful applicant will
after the insertion of complete dentures.
have graduated from an accredited specialty program, or a non-accredited
Part I. J Oral Rehabil 1996;23:321–329. specialty program and hold a Ph.D. The successful applicant will also have
45. Van Waas MA. Determinants of dissatis- demonstrated experience in research, undergraduate and graduate teaching, and
faction with dentures: A multiple regression administration. Salary and rank will be commensurate with qualifications and
experience.
analysis. J Prosthet Dent 1990;64:569–572.
46. Berg E. Acceptance of full dentures. Int The successful applicant must be eligible for licensure in Nova Scotia. Private
Dent J 1993;43:299–306. practice privilege is integrated with the appointment.
47. Berry DC, Singh BP. Daily variations in All qualified candidates are encouraged to apply; however, Canadians and
occlusal contacts. J Prosthet Dent 1983;50: permanent residents will be given priority. Dalhousie University is an
386–391. Employment Equity/Affirmative Action employer. The University encourages
48. Utz K-H. Studies of change in occlusion applications from qualified Aboriginal people, persons with a disability,
racially visible persons, and women.
after the insertion of complete dentures.
Part II. J Oral Rehabil 1997;24:376–384.
Dalhousie University is one of Canada’s leading teaching and research
49. Firtell DN, Finzen FC, Holmes JB. The universities, with four professional Faculties, a Faculty of Graduate Studies and
effect of clinical remount procedures on a diverse complement of graduate programs. Collaborative and interactive
the comfort and success of complete den- research is encouraged, as is cooperation in teaching among the Faculties. We
inspire students, faculty, staff, and graduates to make significant contributions
tures. J Prosthet Dent 1987;57:53–57.
to our region, Canada, and the world. Dalhousie is located in Halifax, Nova
50. Pow EHN, Chow TW, Clark RKF. Linear Scotia; it is a vibrant capital city, and the business, academic, and medical
dimension change of heat-cured acrylic centre for Canada’s east coast.
resin complete dentures after reline and
rebase. J Prosthet Dent 1998;80:238–245. Review of applications will begin in February 2007. Applicants should submit
a letter of application with Curriculum Vitae, and up to three reprints of
research publications to the chair of the Search Committee listed below. Three
letters of reference are to be sent under separate cover.
Dr. Tom Boran

Search Committee
Faculty of Dentistry
Dalhousie University
Halifax, Nova Scotia
B3H 3J5

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