Comparison of the occlusal vertical dimension after processing

complete dentures made with lingualized balanced occlusion

and conventional balanced occlusion
Michael Frederico Manzolli Basso, DDS,a Sergio Sualdini Nogueira, DDS,b
and Joao Neudenir Arioli-Filho, DDSc
Araraquara Dental School, UNESP, Sao Paulo State University, Araraquara, Sao Paulo, Brazil
Statement of problem. An increase in occlusal vertical dimension (OVD) may occur after processing com-
plete dentures. Although many factors that generate this change are known, no information is available in the
dental literature regarding the effect that the occlusal scheme may have on the change in OVD.
Purpose. This in vitro study compared the increase in OVD, after processing, between complete dentures with
teeth arranged in lingualized balanced occlusion and conventional balanced occlusion.
Material and methods. Thirty sets of complete dentures were evaluated as follows: 15 sets of complete den-
tures were arranged in conventional balanced occlusion (control) and 15 sets of complete dentures were
arranged in lingualized balanced occlusion. All dentures were compression molded with a long polymerization
cycle. The occlusal vertical dimension was measured with a micrometer (mm) before and after processing each
set of dentures. Data were analyzed using an independent t test (a=.05).
Results. The mean increase in the OVD, after processing, was 0.87 6 0.21 mm for the control group and
0.90 6 0.27 mm for the experimental group. There was no significant difference between the groups.
Conclusion. After processing, dentures set in lingualized balanced occlusion showed an increase in OVD
similar to those set in conventional balanced occlusion. (J Prosthet Dent 2006;96:200-4.)

CLINICAL IMPLICATIONS
Although the 2 occlusal concepts resulted in similar increases in the OVD after processing, the
lingualized balanced occlusion may result in easier occlusal adjustments, as the less complicated
occlusal scheme uses a smaller number of centric occlusion contact points.

S everal laboratory factors may result in an alteration

of the occlusion during the fabrication of complete
dentures.1-4 These factors are related to intrinsic charac-
teristics of the materials and techniques, as well as to po-
tential extrinsic errors made by the dental technician or
dentist.5 As a result of the processing technique, incisal
pin opening may occur after compression molding.
This increase in the occlusal vertical dimension (OVD)
is corrected with a selective grinding procedure that
results in additional fabrication time. Several studies4-11
have been performed to identify improved materials
and processing techniques to minimize changes in the
occlusion. However, none of these reports have studied
the influence of the occlusal scheme on this process.
Supported by the National Council for Scientific and Technological
Development (CNPq), grant number 131167/2003-0.
a
Postgraduate student, Department of Dental Materials and Prostho-
dontics.
b
Associate Professor, Department of Dental Materials and Prostho-
dontics.
c
Assistant Professor, Department of Dental Materials and Prostho-
dontics.
Two popular schemes of occlusion for complete den-
ture construction are conventional balanced occlusion
and lingualized balanced occlusion. The conventional
balanced occlusion uses anatomic teeth.12-15 In this
occlusal scheme, the maxillary lingual and mandibular
buccal cusps occlude in the opposing central fossae
and marginal ridges, in centric relation. Lingualized bal-
anced occlusion12,15-18 may use anatomic teeth in the
maxillary denture and teeth with a more simple occlusal
surface, with lower cusp height, in the mandibular den-
ture. In lingualized balanced occlusion, only the maxil-
lary lingual cusps occlude in the mandibular central
fossae and marginal ridges, in the centric relation posi-
tion. In both occlusal schemes, simultaneous contacts
must exist on the working and nonworking sides during
lateral movements and on the anterior and posterior
teeth during protrusive movements. Cross-tooth con-
tacts are present during lateral movements with conven-
tional balanced occlusion but not with lingualized
balanced occlusion. Thus, lingualized balanced occlu-
sion is a less complicated occlusal scheme, having only
half of the centric relation contact points that are usually
obtained in the conventional balanced occlusion. In
addition, because of the procedures adopted to avoid

200 THE JOURNAL OF PROSTHETIC DENTISTRY VOLUME 96 NUMBER 3

BASSO, NOGUEIRA, AND ARIOLI-FILHO
Fig. 1. Schemes of occlusion for complete dentures: A, Con-
ventional balanced occlusion. B, Dotted lines indicate selec-
tive grinding areas for transformation of conventional to
lingualized balanced occlusion. C, Lingualized balanced
occlusion.
contacts in the mandibular buccal cusps, such as raising
of the maxillary buccal cusps, the occlusal surfaces of the
maxillary and mandibular teeth are not as close as they
are in conventional balanced occlusion.
Considering the level of complexity of each occlusal
scheme, it is not clear whether alterations in tooth posi-
tion occurring as a result of the processing technique
may result in deflective contacts that could produce a
greater increase in OVD in dentures arranged in conven-
tional occlusion than in dentures arranged in lingualized
occlusion. Wesley et al19 found a definite shift of the
tooth contacts in the more posterior teeth after process-
ing, and commented that the magnitude of pin opening
appears to be dependent on the amount of shift. The
purpose of this in vitro study was to compare the increase
in OVD, after processing, for complete dentures ar-
ranged in lingualized balanced occlusion with complete
dentures arranged in conventional balanced occlusion.
MATERIAL AND METHODS
Two test groups, each with 15 sets of complete den-
tures, were evaluated. In the control group, dentures
were set in conventional balanced occlusion (n=15)
(Fig. 1), with maximum intercuspation between maxil-
lary central fossaemarginal ridges and mandibular
buccal cusps, and between mandibular central fossae
marginal ridges and maxillary lingual cusps. In the exper-
imental group (n=15), dentures were set in lingualized
balanced occlusion (Fig. 1), with maximum intercuspa-
tion between mandibular central fossaemarginal ridges
and maxillary lingual cusps. Dentures from both groups
were compression-molded with 1 trial packing, using
denture base acrylic resin (Lucitone 550; Dentsply
Intl, York, Pa), and polymerized in a water bath at
1658F (728C) for 9 hours. Only 1 investigator was in-
volved in the fabrication of the complete denture speci-
mens and data gathering.
SEPTEMBER 2006
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 2. Jig 1 used to guide mounting position of maxillary
casts in articulator. Mandibular casts were mounted in articu-
lator in similar manner.
Denture fabrication
The complete dentures were fabricated according to
the methodology described by Nogueira et al.5 Thirty-
one sets of identical maxillary and mandibular stone
casts (Velmix; Kerr Corp, Orange, Calif) were obtained
from a silicone mold (RTV 3120; Dow Corning do
Brasil Ltda, Sao Paulo, Brazil). One set of casts was
mounted on a semiadjustable articulator (Dentatus
ARL; AB Dentatus, Hagersten, Sweden). Master maxil-
lary and mandibular dentures were waxed with acrylic
resin denture teeth (Anterior maxillary mold 3N, ante-
rior mandibular mold 3N, and posterior maxillary and
mandibular 30M, occlusal type 33 degrees - Biotone;
Dentsply Intl) arranged in conventional balanced occlu-
sion. The palatal thickness of the maxillary master waxed
denture was maintained at 2 mm using a silicone mold
duplication technique, to be described.
To reproduce the 30 sets of test dentures in the same
spatial position that the master dentures occupied on the
articulator, and to reproduce the same denture base con-
tours and positions of the teeth, special jigs and molds
were made with the master dentures mounted on the ar-
ticulator as a guide. Jigs 1 (Fig. 2) and 2 contained auto-
polymerizing acrylic resin (Jet; Artigos Odontologicos
Classico Ltda, Sao Paulo, Brazil) fixed with dental stone
on mounting plates of the articulator to guide, respec-
tively, the mounting positions of maxillary and mandib-
ular casts. Jigs 3 (Fig. 3) and 4 contained, respectively,
the dental stone matrices of the occlusal surface of the
maxillary and mandibular master dentures fixed with
dental stone on mounting plates of the articulator.
Molds 1 (Fig. 4) and 2 were, respectively, silicone
(Zetaplus Putty and Indurent Gel catalyst; Zhermack
SpA, Rovigo, Italy) molds of the wax surface of the
maxillary and mandibular master dentures. Before these
molds were made, teeth were carefully removed from
201
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 3. Jig 3 used to orient position of teeth of maxillary den-
tures. Mandibular teeth were oriented in similar manner.
Fig. 5. Reference point on upper extremity of articulator used
to measure occlusal vertical dimension with micrometer.
the master dentures, leaving definite sockets. The sili-
cone molds also had a sprue hole and a vent hole.
Each maxillary and mandibular test denture was
fabricated by first mounting the cast on the articulator
by the split-cast mounting technique,20 with the jig
guiding its position. The mountings remained at room
temperature for 24 hours for drying.21 After drying,
the silicone mold was positioned on the cast, and hard
wax (Wilson; Polidental Industria e Comercio Ltda,
Sao Paulo, Brazil) was melted and slowly poured in
the sprue hole. After cooling, the wax sprues were cut
off at the appropriate position, the occlusal surface stone
matrix was fixed on the opposite arm of the articulator,
and teeth were positioned in their sockets. The incisal
pin of the articulator was locked at .0.5 mm, the artic-
ulator was closed, and the occlusal surface of the teeth
was oriented against the stone matrix until the incisal
pin made contact with the incisal table. The teeth were
202
BASSO, NOGUEIRA, AND ARIOLI-FILHO
Fig. 4. Mold 1 used to reproduce maxillary denture base
contour. Mandibular denture base contour was reproduced
in similar manner.
fixed in their positions by melting the wax around their
necks with a wax spatula, and the test dentures remained
at room temperature for 24 hours to allow the wax to
equilibrate with the room temperature. Next, each set
of test dentures was mounted on the articulator and
the incisal pin was locked at the zero position. In the
control group, occlusal adjustments were made by cor-
recting premature contact points until the incisal pin
of the articulator contacted the incisal table. The ob-
tained denture occlusion had at least 10 contact points
on each side of the arch. If the expected number of con-
tact points was not achieved, the specimen was rejected
and replaced. The experimental group was fabricated in
an identical manner using a lingualized balance concept
of denture occlusion (Fig. 1).14 The denture occlusion
obtained had at least 5 contact points on each side of
the arch. Manufacturer recommendations were fol-
lowed for all materials used in this study.
Increase in OVD
The OVD was measured for all specimens at a refer-
ence point on the upper extremity of the articulator
(Fig. 5) using a micrometer (Tesa; Tesa Technology;
Renens/Lausanne, Switzerland), which was accurate to
0.001 mm. After the occlusal adjustment was completed
and immediately before removing each set of waxed
test dentures from the articulator for the investing
procedures, the articulator was positioned on the table
of the measuring device and the baseline measurement
of the OVD was recorded (Fig. 6). Following comple-
tion of the polymerization cycle, the flasks were allowed
to stand on the bench top for 24 hours at room temper-
ature. Immediately after deflasking, the maxillary and
the mandibular dentures were remounted on the artic-
ulator, the articulator was repositioned on the table
of the measuring device, and the final measurement of
VOLUME 96 NUMBER 3
BASSO, NOGUEIRA, AND ARIOLI-FILHO
Fig. 6. Measuring device used to measure changes in
occlusal vertical dimension at upper extremity of articulator.
(A) Table of measuring device; (B) micrometer; (C), (C), and
(C), locator jigs.
the OVD was recorded. All measurements were made in
triplicate, with the articulator being removed from the
measuring device between each measurement. Locator
jigs (Fig. 6) made with type IV stone (Velmix; Kerr
Corp) fixed on the table of the measuring device guided
the position of the articulator in all measurements.
The mean value of the final measurement minus the
mean value of the baseline measurement indicated the
increase in OVD. The average increase in OVD was
compared between groups using an independent t test
(a=.05).
RESULTS
The results did not indicate a significant difference
between groups (t0=0.28, df=28, P..05). The control
group (conventional balanced occlusion) showed a
mean increase in the OVD similar to the experimental
group (lingualized balanced occlusion). Mean values
(SDs) were 0.872 (0.214) and 0.897 (0.271) mm,
respectively.
DISCUSSION
The results demonstrate that the increase in OVD
did not appear to be affected either by the number of
centric occlusion contact points or by the proximity of
the occlusal surfaces observed in the studied occlusal
schemes. In this in vitro study, standardized and sound
procedures were utilized in denture fabrication.
Despite this, the remounting sequence may have inflated
the measured change in OVD in both groups. When the
baseline OVD was quantified on the articulator, the casts
and the mounting plaster were dry. After processing,
when the final OVD was quantified, casts with some level
of moisture were remounted on the articulator using the
dry plaster indices. The effects on change in the OVD
SEPTEMBER 2006
THE JOURNAL OF PROSTHETIC DENTISTRY
when moist casts are remounted by the split-cast tech-
nique are unknown, although it is known that there
may be a negligible expansion when a dry cast is
immersed in water.21
The mean increase in OVD, after processing by com-
pression molding for both groups, was less than 0.9 mm.
The mean increases in OVD were greater than those
found by Dukes et al (0.76 mm),7 Strohaver (0.63
mm),10 and Wesley et al (0.56 mm)19 but less than
Nogueira et al (1.16 mm).5 Differences in the metho-
dology, such as anatomy of the casts, acrylic resin
used, and number of trial packing(s), may explain the
different results among these studies.
Despite the fact that the 2 denture arrangements re-
sulted in similar increases in the OVD, the lingualized
balanced occlusion may be easier to adjust after process-
ing because of the reduced number of centric occlusion
contact points. Clinicians may consider this occlusal
scheme to reduce adjustment time during insertion of
the dentures.
Limitations of this in vitro study include the fact
that changes in OVD are affected by multiple factors
in denture construction. It is possible that some of these
factors, or an interaction among them, may affect the
change in the OVD in a different manner in dentures
constructed with lingualized versus conventional occlu-
sal schemes. Also, variations in cusp height and tooth
form (noncusp teeth) may be used to develop the stud-
ied occlusal schemes. Future studies should incorporate
the influence of clinical casts, different processing tech-
niques and materials, and variations in cusp height and
tooth form.
CONCLUSION
Within the limitations of this study, complete den-
tures arranged in lingualized balanced occlusion showed
a similar increase in OVD, after processing, as those
arranged with conventional balanced occlusion.
REFERENCES
1. Anthony DH, Peyton FA. Dimensional accuracy of various denture-base
materials. J Prosthet Dent 1962;12:67-81.
2. Phoenix RD. Denture base resins. In: Anusavice KJ, Phillips RW, editors.
Phillips science of dental materials. 11th ed. Philadelphia: WB Saunders;
2003. p. 721-58.
3. Woelfel JB, Paffenbarger GC. Dimensional changes occurring in artificial
dentures. Int Dent J 1959;9:451-60.
4. Woelfel JB, Paffenbarger GC, Sweeney WT. Dimensional changes occur-
ring in dentures during processing. J Am Dent Assoc 1960;61:413-30.
5. Nogueira SS, Ogle RE, Davis EL. Comparison of accuracy between com-
pression- and injection-molded complete dentures. J Prosthet Dent 1999;
82:291-300.
6. Barbosa DB, Compagnoni MA, Leles CR. Changes in occlusal vertical
dimension in microwave processing of complete dentures. Braz Dent J
2002;13:197-200.
7. Dukes BS, Fields H Jr, Morris JC, Jewell A. A comparative study of changes
in vertical dimension of occlusion using different investing mediums.
J Prosthet Dent 1983;49:568-71.
203
THE JOURNAL OF PROSTHETIC DENTISTRY BASSO, NOGUEIRA, AND ARIOLI-FILHO

8. Keenan PLJ, Radford DR, Clark RK. Dimensional change in complete 19. Wesley RC, Henderson D, Frazier QZ, Rayson JH, Ellinger CW, Lutes MR,
dentures fabricated by injection molding and microwave processing. et al. Processing changes in complete dentures: posterior tooth contacts
J Prosthet Dent 2003;89:37-44. and pin opening. J Prosthet Dent 1973;29:46-54.
9. Nelson MW, Kotwal KR, Sevedge SR. Changes in vertical dimension 20. Nogueira SS, Russi S, Compagnoni MA, De Assis Mollo F Jr. A variation on
of occlusion in conventional and microwave processing of complete split-cast mounting for complete denture construction. J Prosthet Dent
dentures. J Prosthet Dent 1991;65:306-8. 2004;91:386-8.
10. Strohaver RA. Comparison of changes in vertical dimension between 21. Anusavice KJ. Gypsum products. In: Anusavice KJ, Phillips RW, editors.
compression and injection molded complete dentures. J Prosthet Dent Phillips science of dental materials. 11th ed. Philadelphia: WB Saunders;
1989;62:716-8. 2003. p. 255-82.
11. Zakhari KN. Relationship of investing medium to occlusal changes and
vertical opening during denture construction. J Prosthet Dent 1976;36: Reprint requests to:
501-9. DR SERGIO SUALDINI NOGUEIRA
12. Becker CM, Swoope CC, Guckes AD. Lingualized occlusion for remov- FACULDADE DE ODONTOLOGIA DE ARARAQUARA-UNESP
able prosthodontics. J Prosthet Dent 1977;38:601-8. DEPARTAMENTO DE MATERIAIS ODONTOLOGICOS E PROTESE
13. Brudvik JS, Howell PG. Evaluation of eccentric occlusal contacts in RUA HUMAITA 1680
complete dentures. Int J Prosthodont 1990;3:146-57. CEP 14801-903, ARARAQUARA
14. Folz S, Byars B. Lingualized bilateral balanced occlusion complete SAO PAULO, BRAZIL
dentures constructed on fixed articulators. Tex Dent J 1981;99:12-7. FAX: 55-16-33016406
15. Parr GR, Ivanhoe JR. Lingualized occlusion. An occlusion for all reasons. E-MAIL: nogueira@foar.unesp.br
Dent Clin North Am 1996;40:103-13.
16. Clough HE, Knodle JM, Leeper SH, Pudwill ML, Taylor DT. A comparison 0022-3913/$32.00
of lingualized occlusion and monoplane occlusion in complete dentures. Copyright 2006 by The Editorial Council of The Journal of Prosthetic
J Prosthet Dent 1983;50:176-9. Dentistry.
17. Lang BR, Razzoog ME. A practical approach to restoring occlusion for
edentulous patients. Part II: arranging the functional and rational mold
combination. J Prosthet Dent 1983;50:599-606.
18. Massad JJ, Connelly ME. A simplified approach to optimizing denture sta-
bility with lingualized occlusion. Compend Contin Educ Dent 2000;21:
555-70. doi:10.1016/j.prosdent.2006.08.005

204 VOLUME 96 NUMBER 3