Monoplane posterior teeth are generally used in bruxers, and patients with arch discrepancies, poor neuromuscular control and with poor residual ridges. This program describes the arrangement of monoplane posterior teeth to achieve bilateral balanced occlusion. The separation of the posterior teeth during excursive movements is overcome with balancing ramps.

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Complete Dentures – Occlusal Schemes – Lingualizied Opposing Monoplane with Balancing Ramps — Course Transcript

  • 1. Occlusal Schemes – Lingualized Opposing Monoplane with Balancing Ramps John Beumer III, DDS, MS and Michael Hamada DDS Division of Advanced Prosthodontics, Biomaterials and Hospital Dentistry UCLA School of Dentistry This program of instruction is protected by copyright ©. No portion of this program of instruction may be reproduced, recorded or transferred by any means electronic, digital, photographic, mechanical etc., or by any information storage or retrieval system, without prior permission.
  • 2. Lingualized Opposing Monoplane with Balancing Ramps
  • 3. Lingualized Opposing Monoplane with Balancing Ramps Begin by positioning the appropriate protrusive insert. Check to ensure that the incisal guide pin is set at zero and in contact with the incisal guide table. Protrusive inserts Zero setting Protrusive insert
  • 4. As previously mentioned (13c, 1a), the wax rim is ideally contoured on the patient and used to mount the upper cast with a facebow transfer record. When the lower cast is mounted on the articulator with a centric relation record, the plane of occlusion is readily seen. The three landmarks used to identify the plane of occlusion are: The midpoint of the retromolar pads bilaterally as previously marked on the mandibular cast. The incisal edge of the maxillary central incisors Setting the Maxillary Anterior Teeth Midpoint of retromolar pad Midpoint of retromolar pad
  • 5. Mark the casts indicating midline, crest of the ridge, and the retromolar pad . These landmarks will be used to check your denture setup. Maxilla Midline Anterior land Mandible Ridge Retromolar pad Cast Landmarks
  • 6. To set the remaining maxillary anterior teeth a clear glass or plastic slab is positioned on the mandibular record base to represent the plane of occlusion. Setting the Maxillary Anterior Teeth Mark indicating midpoint of the retromolar pad
  • 7. Setting the Maxillary Anterior Teeth Soften some baseplate wax and attach some to the ridge lap portion of the other maxillary central incisor and attach it to the record base as shown. Set the lateral incisors and cuspids as shown previously (Section 13c, 1a Lingualized occlusion).
  • 8. Setting the Maxillary Anterior Teeth Note the angulations of the anterior teeth in relation to the occlusal plane when viewed in profile. Occlusal plane
  • 9. Setting the Maxillary Anterior Teeth “ Toed-in” Position Note how the cervical and incisal edges of the cuspid are aligned vertically (yellow line). The facial surface of the cuspid however, is canted inward and appears “toed in” (red line) due to the prominence of the cervical area of the tooth (yellow arrow). The centrals and laterals are inclined slightly towards the distal.
  • 10. Vertical overlap (0-1mm)* Horizontal overlap (1-2 mm ) No contact is centric occlusion *When using monoplane teeth with balancing ramps the the vertical overlap is kept to a minimum. Setting Mandibular Anterior Teeth Patients with skeletal Class I relationships
  • 11. Magnitude of horizontal overlap ? In Class II patients the mandible tends to travel farther anteriorly in function than the typical Class I patient and consequently more horizontal overlap is necessary to allow for this functional movement. In contrast Class III patients often demonstrate little or no anterior movement of the mandible during function. Consequently, little or no horizontal overlap is developed in the set up. Setting Mandibular Anterior Teeth Patients with skeletal Class II or Class III relationships
  • 12. Setting the Mandibular Anterior Teeth Positions of the anterior teeth. The lateral incisors should be placed similar in angulation and position to the central incisors. Note that the cuspids are towed out at the cervical.
  • 13. Setting the Mandibular Anterior Teeth The horizontal overlap should be consistent throughout the anterior region. In this setup it is about 1.5 mm.
  • 14. Background – Setting the posterior teeth The number and combination of the denture teeth utilized varies depending on the arch length of the patient. The mandibular occlusal table should end prior to the ascending ramus. The distal surface of most posterior maxillary denture tooth should extend one half 1-2mm distal to the most posterior mandibular denture teeth. Lingualized Opposing Monoplane with Balancing Ramps
  • 15. Lingualized Opposing Monoplane with Balancing Ramps Position the posterior mandibular teeth over the crest of the ridge. Check to ensure they are set to a flat plane and on the plane of occlusion. Make corrections as necessary
  • 16. Lingualized Opposing Monoplane with Balancing Ramps Position the maxillary posterior teeth. The tips of the maxillary lingual cusps should contact the central groove of the mandibular posterior teeth as shown.
  • 17. Lingualized Opposing Monoplane with Balancing Ramps Note that the distal surface of the most posterior maxillary tooth extends 1-2mm distal to the distal surface of the most posterior mandibular tooth.
  • 18. Lingualized Opposing Monoplane with Balancing Ramps By properly centering the lingual cusps of the maxillary teeth over the central grooves of the mandibular teeth the horizontal overlap should be ideal and should be sufficient to prevent biting of the cheek and corner of the mouth. Horizontal overlap
  • 19. Lingualized Opposing Monoplane with Balancing Ramps Note that the maxillary premolars in the of the Ivoclar Ortholingual denture teeth are of sufficient length to harmonize with the cuspid.
  • 20. Lingualized Opposing Monoplane with Balancing Ramps Verify that all the maxillary teeth, with the exception of the lateral incisors and perhaps the cuspids, are on the plane of occlusion. Make corrections by manipulating the maxillary teeth. When you have completed this step, thoroughly cool the wax before proceeding to the next step.
  • 21. Lingualized Opposing Monoplane with Balancing Ramps Reestablish centric contacts as necessary by manipulating the mandibular posterior teeth. Make sure that the incisal guide pin maintains contact with the incisal guide table when you have completed this step.
  • 22. Lingualized Opposing Monoplane with Balancing Ramps The balancing ramps are added as shown. Note that the maxillary 2 nd molar extends slightly posterior to the mandibular 2 nd molar in order that it may engage the balancing ramps during lateral excursions.
  • 23. Lingualized Opposing Monoplane with Balancing Ramps In all lateral excursions you should observe at least three points of contact bilaterally to maintain bilateral balance. Bilateral balance with balancing ramps Working Balancing