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-This is prosthodontics lecture five, its a continuation of lecture four. - According to the doctor,The references for studying this lecture are the slides , the additional notes given by the him which are important to understand . -during this lecture the doctor clarified some terms in general, and the record provided ended before the doctor started talking about articulators. SO articulators are included and this script is not enough to study the lecture, it only contains information not written in the slides.

Occlusal schemes for CD

***In dentate patients, these types of occlusion occur: *Canine guidance occlusion: Teeth are anchored in bone, when the mandible slides over to the right or to the left, the only teeth contacting will be the canines . *Group function: if there are other teeth in contact in addition to the canines, like molars or premolars. *Anterior Guidance (AG): when the mandible goes forward, upper and lower anterior teeth will be sliding over each other separating the posterior teeth.

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*In natural teeth, contact is only on one side( THE FUNCTIONAL SIDE) and other teeth are out of contact. This means that there is pressure on canines, but canines are naturally firm and can withstand this pressure. And if the occlusion was a group function then its even better. *when you make any restoration , crown or bridge for a dentate patient , you should follow the canine guidance occlusion and anterior guidance occlusion . this crown or restoration should be out of occlusion and shouldnt touch other teeth because this will be an interference. So, when the patient moves his mandible , the crown or restoration should be touching only in the ICP. ***In Complete denture patients , we are making the occlusion because they dont have teeth. We cant make it a canine guidance or AG occlusion , because dentures are only sitting on the mucosa, and teeth are not anchored to bone. If an edentulous patient is wearing a denture fabricated on the canine guidance occlusion, when he moves his mandible to the right contacts between teeth will cause deflection to the complete denture and dislodgement on the other side. So in CD the opposite is done, when the mandible moves ,there should be contact on the working and non working sides, because when theres contact on both sides we achieve

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balanced occlusion , and the denture doesnt dislodge on movement . For example when the patient bites on the right side , the upper left side of the denture will not fall down because it contacts the lower left side of the denture. In CD fabrication we make simultaneous contact between teeth all the way round when the mandible moves to the left, right, forward or backward to stabilize the denture. Occlusal schemes for CD *Posterior teeth cuspal inclination* Teeth used in complete denture are classified into three types, according to the angle of the cusps: 1-Anatomic teeth ( used in the clinic) -30,33 ( more common), 45 degrees -Advantages: they are esthetically pleasing to the patient. -Disadvantages: * relation registration should be accurate because these teeth have fossae and cusps, so the mandible will lock in one place which is the CR ( cusp to fossa) . any deviation from the tooth CR ( centric relation) will cause cusp to cusp contact of teeth.
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*because they have cusps , more load is transferred to the underlying ridges , so they are not the best choice in patients with resorbed ridges. 2-Semi anatomic teeth -20 degrees. - Less prominent cusps. 3-Flat or monoplane teeth -0 degrees, you flat the cusps using the bur to remove them. -Advantages: even if relation registration was not accurate , it wont matter because its a flat occlusion and teeth will touch anywhere and will not lock. -Disadvantages: non esthetic Teeth Materials: 1) Acrylic resin: Adv. they are easily bonded to the acrylic base because they are both of the same material so its a chemical reaction. Dis. Poor resistance to wear. 2) Porcelain : Adv. Esthetic, resistance to wear Dis. Should be attached to the base using mechanics because they are of different materials, noise while eating.

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3) Composite: used in dentures opposing natural dentition. 4) Metal onlays: Acrylic+ Metal alloys on the occlusal surface to maintain occlusion and resist tooth wear.

Occlusal Schemes: Bilateral balanced occlusion (BO) : it is achieved by adjusting four factors of the Hanaus Quint which are the incisal guidance, compensation curve, cuspal inclination, and occlusal plane. And the condylar inclination which cant be adjusted or changed . these adjustment are: Ant. Teeth are set edge to edge , so lower teeth dont slide over upper teeth and they are at the same level. Pos. curvature goes upward Mediolaterally. Buccal cusps made higher than lingual , so whatever motion the patient does they will be in simultaneous contact. ** Christensens phenomena: in dentate patients when the mandible goes forward, the condyles will slide over the fossa. Thats why it will drop down and go forward. This drop will create a space between upper and lower teeth.

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In CD, this phenomena doesnt exist , because when you adjust the four factors of Hanaus Quint , you tilt the teeth upward to cover this problem and adjust the space. *Balanced occlusion could be achieved using anatomical and non anatomical teeth. Anatomic teeth. Non Anatomic teeth: another advantage not mentioned in the slide is that it doesnt transfer load to underlying ridges. And another disadvantage is that they are not esthetic, and dont penetrate food like anatomic teeth.

Monoplane articulation (MPA): ( non anatomical teeth) -Everything is set at zero degree on the articulator. -Non anatomic teeth are really manufactured for Monoplane articulation. - Upper Non anatomic teeth are set to a flat surface and you try to maximize contact between upper and lower teeth. -the difference between BO and MPA using non anatomic teeth , is that in BO theres contact between teeth all over the way round, while in MPA there is no balance there. -Advantages of MPA are the disadvantages of BO and vice versa.
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Additional Advantages : 1- Freedom of closure. This is really important when it is difficult to obtain the CR , for example in parkinsons disease you cant guide the mandible to CR. So the patient is free to close anywhere. 2- It decreases the load on ridges , which are resorbed and flat, and we are already struggling in the secondary impression. The ridges are flat , you dont want to provide your occlusion with a defective contact to deflect the denture , you want a flat stable occlusion. Lingualized Occlusion -It is the same as BO, but only the palatal cusps are touching. -Prominent palatal cusps with short facial cusps. So the only teeth contacting are palatal cusps of posterior teeth during all movements. These upper teeth are occluding against flat lower teeth . By this we get the best of two occlusions, the BO and MPA.

Good luck Nagham Rabi

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