Balanced occlusion and its Advantages

Balanced occlusion in complete dentures can be defined as stable simultaneous contact of the opposing upper and lower teeth in centric relation position and a continuous smooth bilateral gliding from this position to any eccentric position within the normal range of mandibular function.

 Dentists point of view on occlusion :

Do you have a headache? Do you have migraine attacks? Neckaches, shoulder pains, etc…..? Have these been long drawn with lifetime dependence on medications? And still these aches keep coming back to you, don’t they?

Well, a very important anatomical aspect of the head has always been discarded by the medical practitioners who you would normally go for treatment. That point is the Tempero Mandibular Joint. It is just in front of your ear and can be felt like a hinge when you palpate with your finger. The mobile lower jaw articulates with the skull at that point. It undergoes wear due to excessive use either due to single side chewing or bruxism or clenching. This creates tension in the joint which refers as radiating pain to areas nearby.

80% of all long standing and untreated headaches are due to TMJ disorders, a fact that is always forgotten by doctors. Neuromuscular dentistry is the only option for these patients. 

Bite registration decides the fate of the patient. If done correctly, he's going to be the happiest patient. But the smallest occlusal discrepancy could see him visiting the ENT specialist, the neurosurgeon, the orthopedician and finally the psychiatrist. Almost 80% of the patients come to me with TMD (Tempero-mandibular joint disorder) as a result of discrepancy. They are there as a last resort and that, too, after being advised to meet a psychiatrist to get their aches treated which according to them ( the ENT, orthopedics, et al) are mental illusions!

Centric occlusion (CO) is defined as….well, we all know what it is defined as, don’t we? But for a TMD patient, isn’t it that very same CO that has led to the problem? What all we do, to try and coerce that patient into CO….the Dawson’s technique, the forced Dawson’s technique, the hand in mouth technique! Have you ever given it a thought that while forcing the patient to bite into that CO, you may be actually pushing the mandible and hence the condyles backward and upward into the retrodiscal pad of the glenoid fossa? That CO may only be his habitual occlusion which his body may have self repaired to compensate for that small occlusal discrepancy which we always tend to overlook. The muscles that act upon the mandible have been trained by our CNS to keep the condyles in that position to avoid that high point! And that’s how we create TMD! And help our ENT and orthopedic friends!

We need to deprogram those muscles of mastication by relaxing them with a TENS. Then with a highly sophisticated mandibular tracking device (K7), we create the actual occlusion by finding the myocentric occlusion. The difference is that, since the muscles are relaxed, the mandible, more often than not, drops. This exposes the Freeway Space, which has been the real culprit all the while trapping the oral tissues and the condyle. The TENS helps free the mandible from this grip. When the mandible gets free, it has the freedom to move forward. How much forward, is decided by the tracking device. That position is then maintained with a splint or jigs or even crown build-ups and orthodontic treatments.

Forget the sophistication….lets keep it simple…TMD is common in deep bites, midline discrepancies, narrow arches, tongue thrusts, etc. These patients invariably suffer from headaches, neck aches, shoulder aches, tinnitus, pain around eyes, migraines, facial asymmetry, etc. Just think of it – 80% of all those uncured headache patients queueing up at the ENT’s clinic are your patients. Identify these problems and solve it even without the equipments. For example: clear deep bites by giving crown build ups on either side of the posterior arches after bringing the mandible downward and forward to an inter incisal position with an overbite of 1.5mm and overjet of 1mm. Another case would be clearing the midline discrepancy by manually shifting the mandible laterally so that the lower labial frenulum is aligned with the upper labial frenulum.

Types of Balanced occlusion

• Bilateral occlusal balance – this is present when there is equilibrium on both sides of the denture due to simultaneous contact of the teeth in centric and eccentric occlusion. It requires a minimum of three contacts for establishing a plane of equilibrium.
• Protrusive occlusal balance – this is present when the mandible moves essentially forward and the occlusal contacts are smooth and simultaneous in the posterior both anterior teeth.

Advantages of Balanced Occlusion

1. Distribution of load
2. Stability
3. Reduced trauma
4. Functional movement
5. Efficiency
6. Comfort