Journal Club Presentation

Lingualized Occlusion For

Removable Prosthodontics

Becker CM, Swoope CC, Guckes AD

J Prosthet Dent 1977;38:601-8

Presented by:
Dr. Mujtaba
Ashraf
Dr. Mujtaba 7/19/17 1
MDS II
 Introduction

Dr. Mujtaba 7/19/17 2

 The literature is filled with discussions of the
various types of occlusal forms and posterior tooth
arrangements.
The search for the ideal denture occlusion has
been going on for almost two centuries in an effort
to find the tooth form which provides maximum
denture stability and masticatory efficiency
without compromising the health of the underlying
bone.

Dr. Mujtaba 7/19/17 3

 Prof. Alfred Gysi was first to design
and patent Cross-Bite Posterior
Teeth in 1927 . Each maxillary
tooth featured a single, linear cusp
that fit into shallow mandibular
depression. So the Concept of
lingualized occlusion was
introduced by A. Gysi in 1927.

Maxillary posterior teeth featured single,

linear cusps that fit into shallow mandibular
depressions.
Dr. Mujtaba 7/19/17 4
Today, the available occlusal forms can be
classified into three major groups :

anatomic- 30 degree cusps,

semianatomic- 20 degree cusps,

nonanatomic or cuspless- 0 degree cusps

Dr. Mujtaba 7/19/17 5

 Advantages of various cusp forms suggested in the literature

Cusp Form Advantages

Penetrates food more easily
Resists the rotation of denture bases through
Anatomic cusp interdigitation
occlusion Provides better esthetics
Acts as a guide for proper jaw closure
Does not lock the mandible in one position
Permits the use of less time consuming
techniques
Minimizes horizontal stress because of the
Non-anatomic absence of inclined planes
occlusion Adapts easily to Classes II and III jaw relations
More easily adjusted after changes in vertical
and horizontal relations
Easier to arrange in crossbite
Dr. Mujtaba 7/19/17 6
 Disadvantages of various cusp forms suggested in the literature

Cusp Form Disadvantages

More occlusal disharmony during settling and

difficult to correct by adjustment
Anatomic Precise jaw closure and base stability required for
occlusion interdigitation
Increased horizontal forces
Difficult to adapt to abnormal jaw relationships
Poor esthetics
Non-anatomic Decreased masticatory efficiency
occlusion More difficult to obtain balanced occlusion
Psychological

Dr. Mujtaba 7/19/17 7

LlNGUALlZED OCCLUSION

Dr. Mujtaba 7/19/17 8

 Lingualized occlusion is an attempt to maintain the
esthetic and food-penetration advantages of the
anatomic form while maintaining the mechanical
freedom of the non-anatomic form.

The lingualized concept utilizes anatomic teeth for the

maxillary denture and modified non-anatomic or
semi-anatomic teeth for the mandibular denture

Lingualized occlusion should not be confused with

placement of the mandibular teeth lingual to the ridge
crest, as suggested by several authors.
Dr. Mujtaba 7/19/17 9
 Lingualized Occlusion has been defined as a form
of denture occlusion that articulates the maxillary
lingual cusps with the mandibular occlusal surfaces
in centric, working, and nonworking mandibular
positions. GPT-9

Dr. Mujtaba 7/19/17 10

 EVOLUTION
Gysi was first to report the biomechanical advantages of
lingualized tooth forms (1927).

The basic concepts of lingualized occlusion were first

suggested by Payne (1941).

Pound discussed a similar occlusal concept and used the term

lingualized occlusion (1973).

Ortman, Murrell, Becker, and Kelly provided additional

support for this occlusal concept (1977).
Dr. Mujtaba 7/19/17 11

Parr GR, Loft GH. The occlusal spectrum and complete dentures. Compend Contin Educ Dent 1982; 3:241-50
Parr GR, Ivanhoe JR. Lingualized occlusion:an occlusion for all reasons. Dent Clin North Am 1996;40:103-12
 Gysi designed and patented
Cross-Bite Posterior Teeth in
1927.

Each maxillary tooth featured a

single, linear cusp that fit into a
shallow mandibular depression.

These teeth were reasonably

esthetic, easy to arrange, and
encouraged vertical force
transmission via their mortar-
and-pestle anatomy.

Gysis Cross-bite Posterior Teeth

Dr. Mujtaba 7/19/17 12

Gysi A. Special teeth for cross-bite cases.Dent Digest 1927;33:167-71

 By 1935, Dr. FA French had patented
his Modified Posterior Teeth.

The maxillary teeth featured shallow

fossae, while the mandibular teeth
displayed narrow, planar occlusal
surfaces.

Dr. Frenchs Modified Posterior Teeth

Dr. Mujtaba 7/19/17 13

French FA. The problem of building satisfactory dentures. J Prosthet Dent 1954;4:769-81
 PAYNES CONCEPT

This changed in 1941, when

Dr. SH Payne introduced a
more cogent form of
lingualized occlusion.

According to Payne article,

a mortar-and-pestle
arrangement was created via
judicious recontouring of
30-degree teeth.

Dr. Mujtaba 7/19/17 14

Payne SH. A posterior set-up to meet individual requirements. Dent Digest 1941;47:20-2
 The maxillary lingual
cusps maintained
contact with the
mandibular teeth in
eccentric movements.

In contrast, the
maxillary buccal cusps
did no contact to the
opposing teeth during
mandibular movements.

Dr. Mujtaba 7/19/17 15

Payne SH. A posterior set-up to meet individual requirements. Dent Digest1941;47:20-2

 POUNDS CONCEPT

Pound also championed

lingualized occlusion in his
articles and presentations.

Pound used maxillary teeth having

cusp angles greater than 30
degrees in conjunction with
mandibular teeth having cusp
angles of 20 degrees or less.

He carefully reshaped mandibular

fossae to produce cross-arch
balance.
Dr. Mujtaba 7/19/17 16

Pound E. Utilizing speech to simplify a personalize denture service. J Prosthet Den1970;24:586-600

 Pound ensured that maxillary
buccal cusps did not contact
mandibular teeth during
eccentric mandibular
movements.

He accomplished this by
reducing the facial surfaces of
the mandibular posterior teeth
rather than elevating the buccal
cusps of the maxillary teeth.

Though the method for eliminating maxillary buccal contact was

dissimilar, the mechanical results were nearly identical to those described
by Payne.
Dr. Mujtaba 7/19/17 17
 OBJECTIVE
In a lingualized occlusion scheme, the objective is the
elimination of buccal cusp contacts in order to
alleviate lateral stresses or lateral dislodging forces.

Dr. Mujtaba 7/19/17 18

 The lingual cusps of the upper posteriors make contact in
centric relation in the central fossae of the lower
posteriors.

Dr. Mujtaba 7/19/17 19

The buccal cusps are out of
contact; however the lingual cusps
are in contact in centric, working
and balancing movements.
For this reason, all the stresses
created during working and Working Side
balancing motions are of a
downward nature, thus creating
stability.

Dr. Mujtaba 7/19/17 20

Balancing Side
 INDICATIONS FOR LINGUALIZED
OCCLUSION
Lingualized occlusion can be used in most denture
combinations.
It is particularly helpful when the patient places high
priority on esthetics but non-anatomic occlusal
scheme is indicated because oral conditions such as
severe alveolar resorption, a Class II jaw relationship,
or displaceable supporting tissue.
If the non anatomic occlusal scheme is used, esthetics
in the premolar region are compromised. With
Lingualized occlusion, the esthetic result is greatly
improved while still maintaining the advantages of a
non-anatomic system.
Dr. Mujtaba 7/19/17 21
 A monoplane occlusal scheme limits esthetic results in the
premolar region.
Dr. Mujtaba 7/19/17 22
 A lingualized occlusion provides improved esthetics in
the premolar region.
Dr. Mujtaba 7/19/17 23
 Lingualized occlusion also can be used
effectively when a complete denture opposes a
removable partial denture.

Patients having parafunctional habits, so that

reduced amount of horizontal forces are
transmitted to supporting tissues.

Dr. Mujtaba 7/19/17 24

 Implant-supported overdentures to eliminate lateral
forces that can rock abutments loose over time.

Dr. Mujtaba 7/19/17 25

 PRINCIPLES

1. Anatomic posterior (30 or 33 degree) teeth are used for

the maxillary denture.
Tooth forms with prominent lingual cusps are helpful.

2. Non-anatomic or semi-anatomic teeth are used for the

mandibular denture.

Dr. Mujtaba 7/19/17 26

 Either a shallow or flat cusp form is used.
A narrow occlusal table is preferred when severe
resorption of the residual ridges has occurred.

3. Maxillary lingual cusps should contact mandibular

teeth in centric occlusion.

Dr. Mujtaba 7/19/17 27

 Modification of the mandibular posterior teeth is
accomplished by selective grinding which is
always necessary regardless of specific tooth or
material.

Selective grinding smooth the central fossae of

the mandibular teeth, lowers marginal ridges, and
forms slight buccal and lingual inclines

Dr. Mujtaba 7/19/17 28

 The mandibular buccal cusps
should not contact the upper
teeth in centric occlusion, as
is customary with usual
anatomic tooth placement.

It is helpful to slightly rotate

the maxillary posterior teeth
buccally to allow for slight
clearance of the buccal cusps
in the working position and
to reduce the need for
extensive grinding
Dr. Mujtaba 7/19/17 29
4. Balancing and working contacts should occur only on the
maxillary lingual cusps.

Dr. Mujtaba 7/19/17 30

Working Side Balancing Side

Dr. Mujtaba 7/19/17 31

 Reduction of antero-posterior interferences on the
mandibular teeth may be necessary in order to
provide a range of balanced occlusion in the
protrusive position.

Selective grinding for should be done

only on the mandibular teeth so that
lateral balancing contacts and the
vertical dimension of occlusion are
not changed.

Dr. Mujtaba 7/19/17 32

 A wide variety of cusped and non-cusped tooth
forms may be used to create arrangements that may
be considered to be lingualized occlusion.

Generally, maxillary teeth with cusp angles of 30

degrees are opposed by mandibular teeth displaying
cusp angles of 20 degrees.

Some of the most popular combinations include 30-

to 33-degree cusp designs for maxillary teeth and 0-
degree cusp designs for mandibular teeth.

Dr. Mujtaba 7/19/17 33

Working Balancing
Advantages of Lingualized Occlusion

Most of the advantages attributed to both the anatomic

and non-anatomic forms are retained.
Cusp form is more natural in appearance compared to
non-anatomic tooth form.
Good penetration of the food bolus is possible.
Bilateral mechanical balanced occlusion is readily
obtained for a region around centric relation.
Vertical forces are centralized on the mandibular teeth.

Dr. Mujtaba 7/19/17 34

 Summary

Lingualized occlusion provides a useful combination

of several occlusal concepts.
Many advantages of anatomic and non-anatomic
occlusions are retained. Adjustment to compensate for
minor changes in vertical and centric relation is
readily accomplished.
Satisfactory occlusion is easily obtained, and balanced
occlusion can be accomplished.
The lingualized occlusal concept is not a panacea, and
all other procedures still must be carefully executed.
Dr. Mujtaba 7/19/17 35
References

1. Sears, V. H. : Chewing Members, J. PROSTHET. DENT. 1: 761-

763, 1951. (Historical reprint of an original paper presented in
1922.)
2. Hall, R. E.: The Inverted Cusp Tooth, J. Am. Dent. Assoc. 18:
2366-2368, 1931.
3. Hardy, I. R.: The Development in the Occlusal Patterns of
Artificial Teeth, J. PROSTHET. DENT. 1: 14-28, 1951.
4. Sears, V. H.: Thirty Years of Non Anatomic Teeth, J. PROSTHET.
DENT. 3: 596-617, 1953.
5. Rapp, R.: The Occlusion and Occlusal Patterns of Artificial
Posterior Teeth, J. PROSTHET. DENT. 4: 461-480, 1954.

Dr. Mujtaba 7/19/17 36

Dr. Mujtaba 7/19/17 37