Oclusion en Dentadura Completa SUPER
Oclusion en Dentadura Completa SUPER
Oclusion en Dentadura Completa SUPER
0011-8532/04/$ - see front matter ! 2004 Elsevier Inc. All rights reserved.
doi:10.1016/j.cden.2004.03.006
642 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Fig. 1. The anatomic teeth are arranged in maximum intercuspation and according to
a balanced articulation concept (Pilkington-Turner vacuum fired 30 degree posteriors, Dentsply
International Inc., York, Pennsylvania). (Courtesy of Dr. Arthur Rahn, Medical College of
Georgia, School of Dentistry, Augusta, GA.)
B.R. Lang / Dent Clin N Am 48 (2004) 641–665 643
Fig. 2. The anatomic teeth are arranged with buccal cusp contacts during a protrusive
movement and according to a balanced articulation concept (Trubyte Pilkington-Turner"
vacuum fired 30 degree posteriors, Dentsply International Inc., York, Pennsylvania). (Courtesy
of Dr. Arthur Rahn, Medical College of Georgia, School of Dentistry, Augusta, GA.)
Fig. 3. The anatomic teeth are arranged to demonstrate a right working movement according
to a balanced articulation concept (Trubyte Pilkington-Turner" vacuum fired 30 degree
posteriors, Dentsply International Inc., York, Pennsylvania). (Courtesy of Dr. Arthur Rahn,
Medical College of Georgia, School of Dentistry, Augusta, GA.)
644 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Fig. 4. The anatomic teeth are arranged to demonstrate a left balancing movement according to
a balanced articulation concept (Trubyte Pilkington-Turner" vacuum fired 30 degree posteriors,
Dentsply International Inc., York, Pennsylvania). (Courtesy of Dr. Arthur Rahn, Medical
College of Georgia, School of Dentistry, Augusta, GA.)
position of the anterior teeth and was developed to preserve the phonetic
values of the patient in harmony with increased denture stability and
efficiency in the chewing cycle. In the tooth arrangement, a sharp upper
lingual cusp opposes a widened fossa in the lower teeth in maximum
intercuspation. The buccal cusps of the lower posterior teeth were reduced,
eliminating any deflective contacts during articulation. In effect, the occlusion
is lingualized by the elimination of contacts on the buccal cusps and by the
anteroposterior arrangements of the lower posterior teeth so that their lingual
surfaces are on or within the lingual side of a triangle from the mesial area of
the lower cuspid to the sides of the retromolar pad.
Jones [10] advocated monoplane articulation in 1972. In this concept,
a non-anatomic occlusal scheme is used with a few specific modifications. The
first departure is the articulator used. It should accommodate large casts, it
should not show lost motion, and it should possess an incisal guide pin.
Another departure is the arrangement of maxillary and mandibular teeth
without any vertical overlap. The amount of horizontal overlap is determined
by the jaw relationships. The maxillary posterior teeth are set first, and the
occlusal plane must fulfill certain requirements. First, the occlusal plane
should evenly divide the space between the upper and lower ridges. Second,
the occlusal plane should parallel the mean denture base foundation. Finally,
the plane should fall at the junction of the upper and middle thirds of the
retromolar pads. In the final arrangement of the teeth the maxillary and
mandibular teeth, except for the second molars, are in contact from anterior
to posterior in maximum intercuspation. The occlusal surface of the upper
second molar should be set parallel to the occlusal surface of the lower second
molar but 2 mm above the occlusal plane, thus well out of occlusion. This
condition is established because the first and second premolars and the first
B.R. Lang / Dent Clin N Am 48 (2004) 641–665 645
molars masticate the food. The second molars are space fillers and do not
function.
With the introduction of 0( teeth, the monoplane scheme has been used
extensively in developing the occlusion for patients requiring a complete
denture. The posterior teeth are positioned on a flat plane. The anterior teeth
are positioned with a horizontal and vertical overlap, and the emphasis in
tooth arrangement is to establish maximal tooth contact in the centric jaw
relation position. Simultaneous tooth contacts in lateral and protrusive
excursion are not a point of emphasis. Developing a curved occlusal plane
anteroposteriorly and mediolaterally during tooth arrangement can also
result in a balanced articulation when using 0( teeth. Figs 5 and 6 illustrate
a balanced articulation using 0( teeth with compensating curves.
In 1927, Gysi [11] of Switzerland introduced the concept of lingualized
articulation, and this initial article was followed by a number of articles
presenting several modifications of the original concept. In 1941, Payne [12]
reported on Farmer’s posterior setup that used 30( cusp teeth that were
selectively reshaped to fulfill the concept of lingualized articulation and meet
Fig. 7. Combinations of tooth forms that have been successfully used to establish the
lingualized articulation concept include the maxillary Trubyte Functional" mold and the
mandibular 0( or Rational mold (Dentsply International Inc., York, Pennsylvania).
648 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Fig. 8. Combinations of tooth forms that have been successfully used to establish the
lingualized articulation concept include the maxillary Trubyte Anatoline" mold and the
mandibular Monoline" mold (Dentsply International Inc., York, Pennsylvania).
Fig. 9. The MLI tooth molds were designed for lingualized articulation. The maxillary tooth is
anatomic in form with excellent cusp heights for maximum lingual cusp contact with the
mandibular antagonist.
edentulism in every decade and reported that only 90% of edentulous adults
obtain and wear complete dentures [19]. When the number of adults in each
specific age group is multiplied by the percentage that need a complete
maxillary or mandibular denture, however, the results suggest that the adult
population in need of one or two complete dentures will increase from 33.6
million adults in 1991 to 37.9 million adults in 2020. The 10% decline in
edentulism experienced each decade for the past 30 years will be more than
offset by the 79% increase in the adult population older than 55 years of age.
The clinical as well as the educational implications of these findings are
significant. First, practicing dentists will find that a sizeable minority of the
patient population will continue to need complete denture services. Second,
if dental education in complete denture prostheses is missing from the dental
Fig. 10. The cusp heights of the MLI mandibular tooth mold are low and allow good maxillary
lingual cusp contact and freedom in eccentric movements.
650 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Fig. 11. The Ortholingual maxillary and mandibular tooth molds (Ivoclar Vivadent, Amherst,
New York) were created specifically for the lingualized articulation concept. (Courtesy of
Dr. Frank Lauicello, Ivoclar Vivadent, Amherst, NY.)
Fig. 12. Lingualized articulation is based on the maxillary lingual cusp functioning as the main
supporting cusp in harmony with the occlusal surfaces of the lower teeth. The maxillary teeth
are usually more anatomic in appearance with greater cusp height. (Courtesy of Dr. Frank
Lauicello, Ivoclar Vivadent, Amherst, NY).
occlusion and must move over the surface of the opposing tooth in
a nonrestrictive manner. The mandibular antagonists for most molds
suggested for this lingualized articulation have lower cusp heights and
multiple occlusal spillways to assist in mastication.
The teeth selected must provide a natural appearance to the buccal
corridor. The facial surface and cusp for the maxillary tooth forms must
provide the illusion of naturalness.
Fig. 13. The occlusal morphology of the mandibular teeth is usually uncomplicated but
provides the opportunity for interdigitation with the lingual cusps of the maxillary teeth.
(Courtesy of Dr. Frank Lauicello, Ivoclar Vivadent, Amherst, NY).
B.R. Lang / Dent Clin N Am 48 (2004) 641–665 653
Fig. 14. Some tooth forms may require some minor reshaping and refinement. Such
adjustments are more common in the mandibular teeth.
Fig. 15. When three teeth are used in the maxillary arch, the second premolar usually is the
tooth that is dropped. The first premolar, because of its cusp tip–to–cervical margin length,
provides a more esthetic tooth following the canine in the dental arch.
Fig. 16. In the mandibular arch, the second premolar tooth usually is dropped when arranging
only three posterior teeth.
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Fig. 17. A line drawn from the tips of the mandibular anterior teeth and connecting with a point
1 to 2 mm below the top of the retromolar pad establishes the plane of occlusion and serves as
the starting point for the anteroposterior compensating curve.
Fig. 18. The width of the first and second mandibular molars necessitates positioning the
central groove of these teeth slightly to the buccal of a line connecting the tip of the canines with
a point in the middle of the retromolar pads. This positioning allows space for the tongue and
avoids crowding this important anatomic structure during speech and mastication.
656 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
the amount of incisal and condylar guidance. More than 30( of elevation
from the initial occlusal plane is rarely required. The anteroposterior curve
is established to enhance balanced articulation along the protrusive pathway
(Fig. 19).
Fig. 20. The mediolateral compensating curve is a subtle curve that usually does not exceed 5(
to 10( above the horizontal plane of occlusion.
Fig. 21. Proper arrangement of the mandibular teeth is completed before arranging the
maxillary posterior teeth. In this way, the plane of occlusion and the compensating curves are
established and will influence the arrangement of the maxillary teeth.
The premolar
Because three teeth may have been set in the mandibular arch, only one
premolar tooth can be used in the maxillary arch. The first premolar is the
tooth usually selected for arrangement. The length of this tooth from cusp
Fig. 22. It is important to achieve maximum interdigitation of the maxillary teeth in the central
groove of the mandibular antagonists in the arrangement of the lingualized articulation scheme
to establish the maxillary lingual cusps as the main supporting cusp.
B.R. Lang / Dent Clin N Am 48 (2004) 641–665 659
tip to cervical margin is usually greater than the second premolar, providing
a more esthetic appearance when positioned beside the canine tooth. This
tooth must be arranged with the long axis perpendicular to the mandibular
occlusal plane. This positioning enhances the appearance along the buccal
corridor and allows better interdigitation of the premolar lingual cusp with
the mandibular occlusal plane. Contact of the maxillary tooth with the
mandibular antagonist may occur on a marginal ridge or in the central fossa
of the mandibular premolar. The interdigitation depends to some extent on
the skeletal positioning of the mandible to the maxillae. The buccal cusp of
the premolar should be arranged with approximately 1 to 2 mms of
horizontal overlap between the maxillary and the mandibular facial cusps.
When four teeth are used, the same criteria are used for arranging both
premolars.
Fig. 23. Solid contact between the maxillary lingual cusps and the mandibular central groove is
accomplished with a minimum of adjustment.
Fig. 24. Maximum intercuspation is verified in the oral environment following the occlusal
reshaping procedures.
662 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Fig. 25. Smooth, free-gliding articulation must be observed in lateral excursions. The working
movement should demonstrate light contact between the maxillary buccal cusps with the
mandibular buccal cusps in the lingualized articulation concept.
the lingual incline of the mandibular facial cusps. The balancing contact
markings may be narrow, and care must be used in reducing balancing
interferences. If the balancing contact must be reduced, only the facial
portion of the mandibular marking is altered. Selective grinding of the entire
contact area results in the loss of maximal intercuspation. The selective
occlusal reshaping procedures should be continued until a smooth, free-
gliding movement is observed.
Fig. 26. On the balancing side the maxillary lingual cusps should glide smoothly over the
lingual inclines of the mandibular buccal cusps in the lingualized articulation concept.
B.R. Lang / Dent Clin N Am 48 (2004) 641–665 663
Fig. 27. In a protrusive movement in lingualized articulation, the maxillary anterior teeth
should demonstrate only light contact with the anterior mandibular teeth. The maxillary
posterior teeth in contact with the mandibular posterior should not occlude the anterior teeth.
between the lingual inclines of the maxillary facial cusps and the facial
inclines of the mandibular facial cusps during this movement. Such contacts
may be eliminated by grinding on the mandibular facial cusp. Once again,
care must be taken, because the maxillary facial cusp is the working cusp,
and grinding this area might eliminate a working contact. When the anterior
teeth are brought into contact by a protrusive movement, it is desirable that
all the posterior teeth contact bilaterally (Figs. 27 and 28).
Fig. 28. In the protrusive movement, there should be only light maxillary buccal cusp contact
with the mandibular posterior teeth. The maxillary lingual cusps often also establish contact
with the mandibular occlusal surfaces in lingualized articulation.
664 B.R. Lang / Dent Clin N Am 48 (2004) 641–665
Summary
Lingualized articulation has been advocated by many practitioners over
the past 60 years. It can be achieved using a variety of tooth molds arranged in
a number of ways that seem to provide the least complicated approach to
occlusal rehabilitation and to satisfy the needs of the edentulous patient.
Clinical experience has supported its use during functional and nonfunctional
activities [17,18]. The different combinations of tooth molds available from
one particular tooth manufacturer, and now specific molds designed for
lingualized articulation by other manufacturers, allows the practitioner
to improve the likelihood of maximal intercuspation, avoid deflective oc-
clusal contacts, determine cusp height for selective occlusal reshaping, and
achieve a natural and pleasing appearance. The articulation and arrange-
ment of the posterior teeth in lingualized articulation assures a standardized
arrangement.
References
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