Innovative JournalInnovative Journalhttp://www.innovativejournal.in/index.php/ijmhsInnovative Journal of Medical and Health Science2589-9341https://doi.org/10.15520/jcmro.v3i07.313Case ReportLingualized Occlusion – A Hope for Prosthodontist: Case ReportLingualized Occlusion – A Hope for Prosthodontist: Case ReportSharmaAbhishekabhi16febabhi1992@gmail.com1DhallRupinder Singh2SinghaJagriti3RakhejaBhawna4PG Student, Department of Prosthodontics, Crown Bridge and Implantology, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal PradeshProfessor, Department of Prosthodontics, Crown Bridge and Implantology, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal PradeshMDS, Prosthodontics, Crown Bridge and Implantology, ChandigarhDental Surgeon, Panchkula, Haryana03075312020Abstract:
As we all know that the success of complete denture restoration depends on the occlusion given in the specific patient, as occlusion plays a major role in retention, stability, support of the denture. Occlusion is a very fine and complex topic to be taken into consideration while fabricating a complete denture.Occlusion has a considerable influence on the outcome of every Prosthodontic treatment modality. There are various occlusalschemes in the literature foe complete denture fabrication, but none of the one accepted universally. In patients with resorbed ridges, special care is to be taken for fabrication of complete denture occlusion, as there is less retention, stability and support. In order to overcome these problems lingualizedocclusal scheme has gained favor. So the success of a stable denture depends more on the occlusal scheme given on the denture.
Occlusion is defined as static relationship between the incisive and the masticatory surfaces of the maxillary and mandibular teeth or analogues of teeth (GPT-9). There are various concepts, philosophies and techniques have been documented for complete denture occlusal scheme. There are different schoolof thought on occlusal schemes in complete denture for e.g. bilateral balanced occlusion, monoplane occlusion,and lingualized occlusion.11Lingualized occlusionrepresents an established method for the development of functional and esthetic completedenture articulation. During the past 25 years, lingualized occlusion has gained popularity forcomplete denture applications.2, 3, 4, 5 The premolars and molars are arranged in such a fashion that only palatal cusp of maxillary premolars and molars contact the central fossa of the lower posterior teeth.6 Gysi was the first to report the advantages of lingualized tooth form.7 So the Concept of lingualized occlusion was introduced by Alfred Gysi in 1927. In 1941, Payne introduced a more clear form of lingualized occlusion. Payne credited Farmer with development of this technique, and provided a brief description of the required laboratory procedures.Pound: Finally introduced the term 'lingualized occlusion.8, 9
Edentulous Maxillary Ridge
Edentulous Resorbed Mandibular Ridge
<bold id="s-bbde97d0b7c9">Case Report:</bold>
A 66 years old male patient reported to department of prosthodontics with chief complaint of inability to eat food, due to missing teeth in upper and lower jaw since 2 years and wanted the replacement of the same. On intraoral examination, the maxillary and mandibular ridges are completely edentulous with well rounded maxillary ridge Figure 1 and resorbed mandibular ridge Figure 2. Esthetic was not the primary concern for patient only mastication was the primary concern. The treatmet planned for the patient was the maxillary and mandibular complete denture with occlusal philosophy of lingualized occlusion.
Facebow transfer
FacebowTransfer done
Mounting at Centric Relation done
Teeth Arrangement Showing Left Side LingualizedOcclusion
Teeth Arrangement Showing Right Side LingualizedOcclusion
Try in Showing Right Side Lingualized Occlusionat Centric Relation
Try in Showing Left Side Lingualized Occlusionat Centric Relation
Frontal View Showing Denture Deleivered andOcclusion At Centric Relation
DentureDeleivered Showing Right Side LingualizedOcclusion at Centric Relation
DentureDeleivered Showing left Side LingualizedOcclusion at Centric Relation
Frontal Smiling Profile
<bold id="s-c85f454f7027">Procedure:</bold>
Primary impression of maxillary and mandibular arch were made using non perforated stock metal edentulous trays with impression compound casts were poured with dental plaster. For the secondary impression special tray were fabricated using self cure acrylic resin using a single spacer for maxillary and mandibular arch and border moulding was performed using type I green stick impression compound and the final wash impression was made with zinc oxide eugenol impression material. Secondary impressions were poured and the master cast were retrieved. Denture base with occlusal rims was fabricated and jaw relation was done using conventional method. A hanaufacebow transfer was done Figure 3, Figure 4 and the casts were mounted in centric relation on semiadjustable Hanau articulator Figure 5. Teeth selection according to the patients skin tone and facial shape was carefully done. Teeth arrangement was done Figure 6, Figure 7 in such a way that palatal cusp of all upper posterior teethcontact the central fossa oflower posterior teeth and on the same time there is no contact on the buccal side. Set up trial arrangement was done and centric relation as well as lingualizedocclusal scheme was verified intraorally during try in procedure Figure 8, Figure 9. Denture was finished, polished and delivered to the patient Figure 10, Figure 11, Figure 12, Figure 13. Post denture delivery instructions were given and recall visit was planned post 24 hours, 1week and 6 months after delivery.
<bold id="s-aa6eed0f8514">Discussion:</bold>
Arranging teeth in lingualized occlusion is an attempt to maintain the esthetics and food penetration advantages of anatomic form. This form utilizes semianatomicteeth for maxillary denture while non anatomic teeth for mandibular denture with slight modification of the mandibular posterior teeth accompanied by selective grinding of the central fossa of the mandibular teeth, lowering marginal ridges.Arranging teeth in lingualized occlusion should not be confused with placing mandibular teeth linguallyto the crest ridge. In normal class I jaw relationship, with a conventional denture made with anatomical occlusion concept, the denture during lateral excursions; both the buccal and lingual cusps of the upper and lower denture on the working side come in contact, that indicates a large number of articulating contacts during eccentric jaw movements seen on the denture. In comparison with the lingualized occlusion concept, the number of occlusal contacts is highly reduced, it’s only in centric relation that the palatal cusps of the posterior teeth in the upper denture make contact in the central fossa of the lower posteriors and buccal cusps are not in contact. It can be advantageous to slightly rotate the maxillary posteriors teeth bucallyto achieve slight clearance of buccal cusps and reduce the need for extensive grinding. Various advantages of choosing lingualized occlusion is use of both anatomic and non-anatomic teeth forms, good penetration of food bolus possible, bilateral mechanical balanced occlusion obtained around centric relation, vertical forces are centralized on the mandibular arch. Lingualized occlusion is indicated in patients with high demand esthetics but a semi- anatomic occlusal scheme is suggested because of severe ridge resorbtion, in class II jaw relationship or highly unstable or displaceable supporting tissues, used when complete denture opposes a removable partial denture or in patients with para-functional habits.10, 11
Conclusion:
The cuspal relationship as seen with the lingualized occlusion is achieved with variety of moulds and anatomy of teeth that seem to provide the minimal occlusal adjustments and greater benefits to the patients. This occlusal scheme provides greater support to the denture base area as the forces are well directed to the centre of the ridge.
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