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Dr.Sarah Qadeer

Introduction: Advancement in science and cutting edge technology in the last few decades has transformed the approach to meet with the challenges posed to doctors and dentists around the world, yet edentulism rates persists and complete dentures both fixed and removable, remain a common treatment modality.

 Numerous guidelines have been proposed to deal with edentulism to restore normal functions like speech, mastication and aesthetics as well as to promote psychological wellbeing to aging patient. The focus of the dentist is to provide a denture that offers balanced functional and anatomical harmony to the stomatognathic system. The motivation behind this case report is to add to the already existing knowledge of occlusal relationship, intercuspal positioning, centric relation, harmonious teeth, muscle and joint functions in a complete denture that was refined and stabilized with bilaterally balanced occlusal forces on either side of the arch using clinical remounting and computerized occlusal analysis.

Loss of teeth causes adverse predicament which leads to drastic changes in the overall wellbeing of the patient who loses the ability to perform necessary functions. The clinician’s role is not just to help restore the functions and appearance but to ensure that the dentures have no harmful effect on the remaining tissue (1).  A complete denture is a removable dental prosthesis that replaces the entire dentition and associated structures of the maxilla and mandible to provide retention, stability and support (2). Equal distribution of loading forces to the supporting tissues is one of the most significant factors affecting stability, patient comfort, and acceptance of complete dentures by the patient (3,4).

This brief report outlines the use of computerized occlusal analysis to achieve evenly balanced occlusal forces during a complete denture case delivery. Laboratory Remounting is done to eliminate processing error due to material properties and to replicate jaw-relations satisfactorily in order to reestablish the functional occlusal relationship to ensure no contact between posterior teeth during protrusion. Clinical Remounting procedure is recommended during final delivery of the complete denture to increase the patient’s comfort level and reduce post insertion follow-up visits. This procedure further helps to establish centric relation after final processing and check for inter-arch relationship of maxillary lingual cusps to mandibular fossae, guided by subjective grinding using articulation paper mark interpretation to achieve simultaneous bilateral contacts.           

Having completed both the necessary steps satisfactorily using conventional methods, an additional step was done to objectively analyze the occlusion using T-Scan III Digital Occlusal Analysis System (Tekscan Inc. South Boston, MA, USA) for a 72 year old male Korean patient at Gangdong University Dental Hospital in Seoul. T-Scan computerized occlusal recording provides quantifiable force and timing variance data to refine and precisely balance the occlusion bilaterally and ensure evenly distributed occlusal contacts throughout the arch.

Initial recording on the day of final delivery following the Clinical Remounting procedure using T-Scan III Occlusal Analysis shows anterior contacts only with 66% force on Left side and 33% occlusal force on the Right side of the arch (Fig. 1).

   

Fig. 1: Initial recording showing anterior contacts only with 66% on left side with only 33% force on the right side of the arch

Occlusal Adjustments were made guided by T-Scan recording data in conjunction with articulation paper marks in order to eliminate excessive contact areas and minimize occlusal discrepencies to ensure balanced occlusal force distribution on either side of the arch. By the fourth recording occlusal contacts are visible in the entire arch with some excessively high force represented in RED columns seen anteriorly (Fig. 2) that required further adjustments to achieve the desired harmonious well-balanced treatment outcome.

Fig. 2: Fourth recording showing occlusal contacts visible in the entire arch with red columns showing unbalanced forces anteriorly.

The goal here was to achieve a bilaterally balanced occlusion with evenly distributed occlusal contacts that was satisfactorily achieved by the eight recording with 49% force on the left side of the arch and 51 % on the right side of the arch (Fig. 3) using computerized occlusal analysis data. This Computerized Adjustment took an additional 25 minutes following clinical remount procedure from initial to final recording to achieve a well balanced occlusion at the time of complete denture delivery.

Fig. 3: Bilaterally Balanced Occlusion achieved with 49% occlusal load on Left side and 51% on the right side of the arch with evenly distributed occlusal contacts throughout the arch.

Conclusion:

Over the years, a plethora of ideas, hypotheses, theories and practical concepts about occlusion-associated topics have been accumulated and propagated in the dental literature (5). Until recently, prosthodontic therapy focused mainly on the technical skills and clinical judgment required to fabricate complete dentures using static subjective occlusal indicators such as articulation paper marks and patient’s “feel” feedback.  T-Scan computerized occlusal analysis can provide quantifiable occlusal force and timing data that can aid in achieving bilateral simultaneity during the delivery of prosthesis, which adds to the satisfaction of delivering a denture to precision and accuracy. The centre of force trajectory and percentage of force present on either side of the arch and on individual teeth seen as vibrant colours and columns on 2D and 3D window of T-Scan occlusal recording helps the clinician in properly locating the excessive contact areas in the arch to make precise adjustments, thereby aligning the occlusal forces to provide a harmonious well balanced prosthetic treatment outcome.

References:

Schelb E, Kaiser D. Thickness and marking characteristics of occlusal registration strips: J Prosthet Dent1985; 54: 122-6.

Jacobson TE, Krol AJ.  A contemporary review of the factors involved in complete dentures. Part II: stability. J Prosthet Dent 1983 Feb;49(2):165-72.

Jason P. Carey, Mark Craig, Robert B. Kerstein. Determining a relationship between applied occlusal load and articulation paper mark area. The Open Dental Journal 2007; 1: 1-7.

Kerstein RB. T-Scan III applications in mixed arch and complete arch, implant -supported prosthodontics. Dent Implantol Update 2008 Jul;19(7):49-53.

5.  Turp JC., Greene CS., Strub JR. Dental occlusion: a critical reflection on past, present and future concepts. Journal of Oral Rehabil 2008 Jun; 35(6):446-53.

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