Give reasons why you would consider using lingualised occlusion as an occlusal concept for complete dentures.
We have discussed this matter in one of our lectures. One reason could be because the patient has a severely resorbed mandibular ridge, this type of occlusal concept is considered to be ideal for this type of situation. This mainly because it is adaptable to so many different clinical situations.
Please continue with the discussion and points of view.
We have discussed this matter in one of our lectures. One reason could be because the patient has a severely resorbed mandibular ridge, this type of occlusal concept is considered to be ideal for this type of situation. This mainly because it is adaptable to so many different clinical situations.
Please continue with the discussion and points of view.
Lingualized Occlusion is a setup technique developed to enhance denture stability for patients with severe alveolar bone resorption resulting in little or no ridge, or resulting in a discrepancy between the size of the narrowing and reced-ing upper ridge compared with the widening and receding lower jaw.
ReplyDeleteThis setup technique is also indicated for pa-tients with implant-supported overdentures to eliminate lateral forces that can rock abutments loose over time.
Ad-ditionally, lingualized occlusion is appropriate for free-end attachment cases to reduce stress on distal extension, or for intra-coronal attachments to avoid breakage.
For denture setups in a conventional occlusal scheme, both the buccal and lingual cusps of the upper and lower denture come into contact on the working side during lateral jaw movement. This achieves balance and distributes the bite force over the widest area of the jaw. By contrast, in a lin-gualized occlusion scheme, the objective is the elimination of buccal cusp contacts in order to alleviate lateral stresses or lateral dislodging forces. In lingualized occlusion, the lin-gual cusps of the upper posteriors make contact in centric relation in the central fossae of the lower posteriors.
The buccal cusps are out of contact; however the lingual cusps are in contact in centric, working and balancing movements. For this reason, all the stresses created during working and balancing motions are of a downward nature, thus creating stability.
As was previously mentioned, lingualized occlusion is used for patients with resorbed ridges. There are however more than one reason why lingualized occlusion is preferred and these are:
ReplyDelete1. Flat ridges
There is no ridge to stabilise the denture and as a result of this, the mandibular denture moves around and with the used of lingualized occlusion, the movement of the mandibular denture is reduced and better mastication is acquired.
2. Knife edge ridges
A knife edge ridge is a thin ridge, meaning that the patient does not have a lot of bone to support the denture and the bone is not very strong or dense. With the use of lingualized occlusion, the amount of forces applied to the ridge during mastication is reduced, thus the resorbtion of the ridge is minimized.
3. Large inter-ridge space
With a large inter-ridge space, the dentures are more likely to tilt during occlusion. With lingualized occlusion this phenomenon is reduced, because the maxillary teeth are in contact with the mandibular teeth most of the time during all the excursions.
4. Milling type of chewing pattern with broad excursions
With the milling type of chewing, a larger occlusal surface is required to grind the food. The use of monoplane teeth on the mandibular ridge increases the occlusal surfaces of the teeth during excursions and promotes continues contact during the long excursions.
5. Where debilitation has reduced the patient’s coordination needed to handle a cusped type of occlusion
Only the maxillary teeth are cusped and as a result of this the teeth do not have a interlocking occlusion. As a result of his mastication is made easier.
Lingualized occlusion has been studied with Complete Dentures and I believe the majority of the studies show no general superiority of one concept of occlusion over another. Its value can be seen in the way it helps accomplish well established standards of occlusion. It is easier to do and provides stable contacts. By limiting contact to the Mandibular central fossa/marginal ridge areas and the Maxillary lingual cusps, it avoids more facially located contact on the Mandibular Buccal cusps and the Maxillary central fossa/ marginal ridge areas
ReplyDelete1. It is very efficient for mastication, and this
leads to much better intake of nutrients for
the patient.
2. This form of occlusion is much easier to
manage clinically because the number
of contact points to control it is greatly
reduced compared to a functional type of
arrangement.
3. Once understood, it is much easier to
produce in the laboratory
I need torestore a lingualized occluson that was set up on my live teeth (not a denture).
ReplyDeleteFoes anybody know a dentist who is an expert in lingualized occlusion in Europe?
Please let me know.
Email: info@leonardmazza.com
When I was 18 years old my left superior canine had not erupted and a dentist in Amsterdam adjusted my occlusion with 3 crowns, 2 gold inlays and 9 almogam fillings with a lingualized setup.
It is something very unusual as it is a setup which is usually adopted only on full dentures. On the other hand, all my teeth are alive and in place.
I was unaware of having such a rare occlusion set up. 20 years later, I had a 3 year orthodontic treatment that successfully placed the impacted canine in its place.
Up to this point in my life (43 years), I was a triathlete, running almost on a daily base 10 k and swimming 1k.
Then, I proceeded to replace the almogam fillings and gold inlays with composite fillings. That is when I started having occlusion problems and instability of the stomatognatic system. I had to stop running and having strong pain and muscular and skeletal stability problems.
The dentist who treated me had flattened out with a drill all of the lingual cusps of the maxilary and fillied in all the fossae of the mandibular molars.
I was left with no support whatsoever for my occlusion as my maxilary bone is extremely asimetric.
After a year trying unsuccesfully to stabilize it, I started studying occlusion and realized what the problem was: I had had a lingualuzed occlusion setup for the past 30 years and it was gone. The document attached to my mother's email is a set of pictures taken after the end of my orthodontic treatment where you can appreciate that indeed the occlusion setup was lingualized.
I live in Spain and I have not been able to find a single dentist who has at least heard or read about lingualized occlusion.
I have been teaching my current dentist about lingualized occlusion, which is obviously a less than ideal way and leads to trial and error treatments on my live teath. It has already been one year of multiple drilling and compisite reconstruction of my teeth.
Working with my dentist, we have been able to recover the correct jaw position and minimize the stomatognatic instability syntoms (and no atm pain or sandy popping sounds at all), but I need a dentist who can adjust the central contact, protrusion and lateral excursion movements of the jaw in a solid, lasting and functionally sound way.
It is of the utmost importance for me to recover occlusive stability and maintain for the rest of my life. My job depends on it.
I live in Spain but I an willing to travel anytime to visit a specialist who knows what he is doing and has worked with lingualized occlusion.
Do you know any dentist who is an expert in lingualuzed occlusion?