Determination of the occlusal plane

using a custom-made occlusal plane

analyzer: A clinical report
Sumit V. Bedia, BDS,a Shankar P. Dange, MDS,b and Arun N.
Khalikar, MDSc
Government Dental College and Hospital, Aurangabad,
Maharashtra, India
In fixed prosthodontic procedures, when it has been determined that restoration of all or most of the posterior teeth
is necessary, the use of the Broderick occlusal plane analyzer provides an easy and practical method to determine an
occlusal plane that will fulfill esthetic and functional occlusion requirements. However, several manufacturers of semiadjustable articulators offer no such occlusal plane analyzers for use with these instruments. This article demonstrates
the use of a custom-made Broderick occlusal plane analyzer with a semiadjustable articulator to determine the correct
curve of Spee for the occlusal plane. (J Prosthet Dent 2007;98:348-352)
Usually, the term, plane, is related
to a flat surface. However, this is not
the case with the occlusal plane. Instead of a flat surface, the plane of
occlusion represents the average curvature of the occlusal surface. The
position of the anterior teeth is determined by esthetics, the demand for
anterior guidance, and phonetic considerations. Posterior teeth positions
are defined by 2 curves, an anteroposterior curve, referred to as the curve
of Spee, and the mediolateral curve,
referred to as the curve of Wilson.1,2
Based on anthropological observations in 1919, Monson proposed that
the anteroposterior curve forms part
of a 3-dimensional sphere, the center of rotation of which is located in
the region of the glabella.3 The radius
of this curve is reported to be an estimated 4 inches (10.4 cm), as proposed by Monson. The 3 most com-

monly used methods for establishing

an acceptable plane of occlusion
are direct analysis on natural teeth
through selective grinding, indirect
analysis of facebow-mounted casts
with properly set condylar paths, and
indirect analysis using the PankeyMann-Schuyler (PMS) method with
the Broderick occlusal plane analyzer
(BOPA).1 When it has been determined that restoration of all or most
of the posterior teeth is necessary, the
PMS technique using BOPA provides
a simple and practical method to assist in determining the preliminary
occlusal plane on diagnostic casts.
It assists in locating the cusp tips of
the posterior teeth. In addition, it can
demonstrate how much tooth reduction or porcelain addition is needed
to idealize the occlusal plane.
The use of Monsons theory is only
a starting point for the analysis. Pa-

tients may have mandibular anterior

teeth that are not positioned ideally.
With some experience and training,
dentists can use the BOPA as an integral part of their practice. The BOPA
has now been adapted to only a few
articulator systems, such as the Denar
Anamark Fossae (Teledyne Waterpik,
Ft Collins, Colo) and all models of
Hanau articulators (Teledyne Waterpik).4,5 For those manufacturers of
semiadjustable articulators who do
not offer such occlusal plane analyzers for use with their instruments, a
custom made clear acrylic resin BOPA
may be fabricated. This clinical report
describes the effective application of
a custom-made BOPA in conjunction with a semiadjustable articulator
without the need for any alteration to
the upper member of the articulator.

Awarded Best Scientific Paper Presentation prize at the 8th National Convention of Prosthodontic Postgraduate Students of the
Indian Prosthodontic Society, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Government of Pondicherry Institution,
Pondicherry, India, June 2006.
Awarded Best Scientific Paper Presentation prize at the 34th Indian Prosthodontic Society Conference, Kanniyakumari, India,
November 2006.
Postgraduate student, Department of Prosthodontics.
Professor and Head, Department of Prosthodontics.
c
Associate Professor, Department of Prosthodontics.
a

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November 2007
CLINICAL REPORT
A 55-year-old man was referred to
the Department of Prosthodontics,
Goverment Dental College and Hospital, Aurangabad, Maharashtra, India,
with a chief complaint of the inability
to masticate food efficiently on the
right side for the past 4 to 5 months.
On clinical examination, long-span
fixed partial dentures were present between the maxillary right first premolar to the maxillary right second molar and between the mandibular right
first premolar to the mandibular right
third molar (Fig. 1). The fixed partial
dentures had marginal discrepancies
and were fabricated with flat occlusal
surfaces at a reduced occlusal vertical
dimension. The occlusal plane on the
right side was at a lower level compared to the left side. The fixed partial
dentures were removed, and irreversible hydrocolloid (Neocolloid; Zhermack, Badia Polesine, Italy) impressions of maxillary and mandibular
teeth were made and poured in type
III stone (Kalstone; Kalabhai Karson
Pvt Ltd, Mumbai, India). Diagnostic
casts were mounted on a semiadjustable articulator (Model 8800; Whip
Mix Corp, Louisville, Ky) (Fig. 2). Visual examination confirmed a marked
discrepancy in the level of the occlusal
plane on the left side. The mandibular left first and second molars were
extruded, resulting in inadequate occluso-gingival space for the pontics
which would replace the maxillary left
first and second molar. On the right
side, all posterior teeth were previously prepared and did not provide
information regarding the level of the
original occlusal plane.
The use of a Broderick flag was
indicated to assess, and, if necessary,
redesign, the level and orientation of
the occlusal plane. Since no such flag
was supplied by the manufacturer,
a custom-made flag was fabricated
using a 2-mm-thick clear acrylic resin sheet (Gujrat State Fertilizer Co,
Ahmedabad, Gujrat, India) (4 inch
x 4 inch), which fit into a slot of the
same dimensions in a clear acrylic

Bedia et al

resin base, attached to the upper

member of the articulator. A sheet
of blank paper was attached to both
sides of the flag to receive the markings. The maxillary cast was removed
from the articulator, and the flag was
attached on top of the upper member

of the articulator (Fig. 3). The anterior survey point (ASP) was chosen on
the midpoint of the disto-incisal edge
of the mandibular left canine from
which a long arc with a 4-inch radius
was drawn on the flag with a compass (Fig. 4, A). The posterior survey

1 Preexisting dentition.

2 Mounted diagnostic casts. Marked discrepancy was evident

in level of occlusal plane: mandibular left first and second molars
were extruded, resulting in inadequate occluso-gingival space.

3 Custom-made BOPA attached to semiadjustable articulator.

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Volume 98 Issue 5
point (PSP) was located on the distobuccal cusp of the mandibular left
second molar and a short arc was
drawn on the flag to intersect the long
arc at the center of the anteroposterior curve (Fig. 4, B).6 The point of the
compass was placed at the center of
anteroposterior curve on the flag, and
a 4-inch radius was drawn through
the buccal surfaces of the mandibular teeth (Fig. 5). The mandibular left
first and second molars were found to
be markedly extruded. Thorough evaluation of the occlusal plane revealed
that the left plane was approximately
1.5 mm higher than the right plane.
The solution was to lower the left
plane by approximately 1.5 mm, thus
creating a more pleasing appearance.
Another line, termed the preparation line, was scribed by opening
the compass by an amount equal to
the desired occlusal thickness of the
proposed restoration. A softened
modelling wax sheet (Modelling wax;
Deepti Dental Products of India Pvt
Ltd, Ratnagiri, Maharashtra, India)
was adapted to the buccal surfaces of
the mandibular cast. The wax was cut
carefully back to this line and trimmed
along the mucobuccal fold so that the
wax could be fitted accurately against
the teeth intraorally, and this was
termed the occlusal plane cutting
guide.
Trial preparations were performed
on articulated duplicate stone casts
using these markings as a guide, and
a diagnostic waxing was completed
with even occlusal contacts in maximum intercuspation and avoidance of
posterior interferences in protrusive
or lateral excursions. The decision was
made to restore the entire mandibular arch and maxillary arch with fixed
restorations, except for the maxillary
left posterior molars, for which a removable partial denture was planned.
The occlusal scheme was planned as
a group function occlusion. All prerestorative treatment was completed.
When preparing the mandibular
posterior teeth, the cutting guide was
placed snugly against the buccal surfaces of the dried teeth, and the entire

4 A, Anterior survey point (ASP) chosen as midpoint of disto-incisal edge of

mandibular left canine from which long arc of 4-inch radius is drawn on flag
with compass. B, Posterior survey point (PSP) located on disto-buccal cusp
of mandibular left second molar and short arc drawn on flag to intersect long
arc at center of anteroposterior curve.

5 Point of compass was placed at center of anteroposterior curve on flag

and 4-inch radius was drawn through buccal surfaces of mandibular teeth.
Mandibular left first and second molars were found to be markedly extruded.

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November 2007
occlusal surface of each tooth was reduced to the preparation line (Fig. 6).
Preparations were located sufficiently
more apically on the lingual surfaces
than on the buccal to accommodate
for the mediolateral curve. Following occlusal reduction, the teeth were
prepared according to the predetermined treatment plan.
Templates of the diagnostic waxing
were fabricated using vinyl polysiloxane putty (Flexitime, Easy Putty; Heraeus Kulzer, Hanau, Germany). These
templates were used to fabricate
provisional restorations in tooth-colored autopolymerizing resin (DPI-Self
Cure Tooth Moulding Powder; Dental
Products of India, Mumbai, India).
This allowed duplication of the occlusal anatomy from the waxing to the
provisional restorations. The polished
provisional restorations were then cemented intraorally with eugenol-free
provisional luting cement (Templute;
Prime Dental Products Pvt Ltd, Mumbai, India). Cementation was completed for the entire mandibular arch
first and then the maxillary arch. At
this time, most minor occlusal adjustments were performed to equilibrate
the occlusion. There was a significant
esthetic improvement in the preexisting occlusal plane. After a 4-week trial
period, the patient reported that the
provisional restorations were comfortable. No abnormal wear facets
were evident, occlusal contacts were
present in maximum intercuspation
(MI), no interferences in protrusive
and lateral excursions were detected,
and gingival health remained optimal.
The patient reported comfort and
satisfaction with masticatory performance and esthetics of the provisional restorations.
It was then decided to fabricate
the definitive restorations in porcelain
(Ceramco 3; Dentsply India Pvt Ltd,
Mumbai, India) and metal (MEAlloy;
Dentsply India Pvt Ltd). The same procedure that was used for determining
the occlusal plane was used effectively
to establish the correct occlusal plane
on the wax patterns. By using a special
wax cutting blade (Rotex, Mumbai,

Bedia et al

India) in the compass, the overwaxed

patterns were cut back to the correct
height (Fig. 7). The angle of the blade
automatically produced an acceptable mediolateral curve, positioning
the lingual cusps more apically than

the buccal cusps. Thus, through use of

the custom-made BOPA and a semiadjustable articulator, it was possible
to create an esthetic and functionally
correct occlusal plane (Fig. 8).
The selection of a 4-inch radius

6 Wax occlusal plane cutting guide used to prepare teeth.

7 By using wax-cutting blade in compass, overwaxed patterns were cut back to correct height.

8 Definitive restorations.

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may seem arbitrary. Depending on
the skeletal and dental morphology of the individual, the radius may
vary slightly. A 3.75-inch radius may
be indicated for a class II skeletal relationship, while a 5-inch radius may
be indicated for a class III skeletal relationship.7 The center of the curve
may also be moved in an anterior or
posterior direction from the intersection of the arcs, but should always lie
along the arc drawn from the anterior
survey point. This alteration will not
affect the position of the anterior survey point, an important consideration
when the position of the mandibular
anterior teeth is esthetically and clinically suitable.

SUMMARY
The use of BOPA aids the clinician
in the development of an initial mandibular occlusal plane in diagnostic
casts, and later, as an integral part
of both the contours of the definitive
restorations as well as a guide for the
actual tooth preparations. This simple
custom-made occlusal plane analyzer
enables the clinician to use an occlusal plane analyzer with a widely used
semiadjustable articulator when no
such accessory is available.

REFERENCES
1. Dawson PE. Evaluation, diagnosis and
treatment of occlusal problems. 2nd ed. St
Louis: Elsevier; 1989. p. 85, 373-81.
2. The glossary of prosthodontic terms. 8th
ed. J Prosthet Dent 2005;94:10-92.

3. Monson GS. Occlusion as applied to

crown and bridgework. J Nat Dent Assoc
1920;7:399-413.
4. Toothaker RW, Graves AR. Custom adaptation of an occlusal plane analyzer to a
semi-adjustable articulator. J Prosthet Dent
1999;81:240-2.
5. Small BW. Occlusal plane analysis using the
Broadrick flag. Gen Dent 2005;53:250-2.
6. Bowley JF, Stockstill JW, Attanasio R. A preliminary diagnostic and treatment protocol.
Dent Clin North Am 1992;36:551-68.
7. Lynch CD, McConnell RJ. Prosthodontic
management of the curve of Spee: Use
of the Broadrick flag. J Prosthet Dent
2002;87:593-7.
Corresponding author:
Dr Sumit V. Bedia
C-6/05, Breezy Apartments
Jeevan Bima Nagar
Borivali (West)
Mumbai, Maharashtra
INDIA 400103
Fax: +91-22-28935157
E-mail: sumitbedia@yahoo.com
Copyright 2007 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Noteworthy Abstracts of the Current Literature

The effect of personality type on denture satisfaction
Ozdemir AK, Ozdemir HD, Polat NT, Turgut M, Sezer H.
Int J Prosthodont 2006;19:36470.
Purpose: The aim of this study was to determine the correlation between personality type and denture satisfaction of
totally and partially edentulous patients.
Materials and Methods: Two hundred thirty-nine patients (107 women and 132 men) aged 31 to 78 years (mean,
51.87) using removable dentures (165 maxillary and mandibular partial, 51 maxillary and mandibular complete, and
23 maxillary complete and mandibular partial) were asked to fill out a questionnaire on their satisfaction with their
dentures with regard to esthetics, speaking ability, and masticatory function. Personality types were evaluated using
both the responses to this questionnaire and the Type A Behavior Pattern Test. Chi-square test and logistic regression
analysis were used to compare the denture satisfaction scores of the groups (Type A, Type B, and Type AB). The level
of statistical significance was set at P=.05.
Results: Denture satisfaction of the patients with regard to esthetics, speaking ability, and masticatory function was
affected by personality type. Statistically significant differences were found between Type A and types B and AB, as
well as between types B and AB.
Conclusion: The personality type of the patients had an effect on their satisfaction with dentures. The lowest denture
satisfaction values were observed in the Type A patients.
Reprinted with permission of Quintessence Publishing.

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