Prospective clinical study of bilateral balanced occlusion (BBO) versus canine-guided occlusion (CGO) in complete denture wearers

Determination of intercanine distance from a proportion calculation: A pilot clinical study

STATEMENT OF PROBLEM

The optimal positioning of artificial teeth is essential for long-term success when providing removable complete dentures. However, information about the original tooth positions may be lacking, especially the canine teeth, which play a key role in the tooth arrangement.

PURPOSE

The purpose of this pilot clinical study was to determine if the mandibular and maxillary canine position can be determined by proportioning to certain anatomic landmarks.

MATERIAL AND METHODS

Fifty participants (32 women, 18 men) with a mean age of 19.18 years and Angle class 1 and 2 malocclusions were selected randomly from patients who had completed their orthodontic treatment. The distance between the sagittally bisecting lines of the maxillary tuberosity and the distance between the sagittal bisecting lines of the retromolar pads in the mandible were measured from casts and recorded in millimeters. The expected distances between the canine cusps in both jaws (e-DCCmand and e-DCCmax) were calculated, and the distance between the canine cusps in both jaws (DCCmand and DCCmax) was measured. The measurements and the calculated expectation values for maxillary and mandibular cast models were recorded and statistically compared.

RESULTS

The mean ±standard deviation value of the maxillary intercanine distance was 35.5 ±1.4 mm, and the calculated value was 35.52 ±1.43 mm. In the mandible, the mean ±standard deviation value of the mandibular intercanine distance was 26.73 ±1.25 mm, and the calculated value was 26.69 ±1.33 mm. The difference between the means of expected DDC for the maxilla and mandible was within the equivalence interval (P<.001).

CONCLUSIONS

The proportions evaluated were determined to provide accurate canine positions and should be suitable for use in the treatment of edentulous patients.

Comparison of Canine-Guided Occlusion with Other Occlusal Schemes in Removable Complete Dentures: A Systematic Review

Choosing an adequate occlusion is challenging during the construction of artificial dentures, and critical for patient satisfaction. However, there is no conclusive evidence to support which occlusal design is more appropriate. The aim of this systematic review was to evaluate canine-guided occlusion in comparison to other occlusal schemes in removable complete denture wearers. The review was conducted according to the Preferred Reported Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. An extensive search was carried out on (PubMed (National Library of Medicine)), Scopus (Elsevier), Cochrane collaboration (Wiley), Science Direct (Elsevier) and Europe PMC (European Bioinformatics Institute). English and non-English studies were identified using keywords on canine-guided occlusion, denture occlusion, dental occlusion and artificial occlusal schemes. Out of 1759 articles searched, 18 were selected based on the inclusion criteria. The included studies were interpreted for the descriptive analysis for the calculation of occlusal schemes, occlusion assessment parameters, the outcome of the occlusal schemes and types of removable prosthesis used. The systematic analysis of occlusal schemes revealed that canine-guided occlusion is viable compared with other occlusal designs in terms of patient satisfaction, mastication, retention, esthetics, phonetics, oral-health-related quality of life and muscle activity. The type of occlusal scheme influences the complete denture patient’s’ masticatory efficiency, satisfaction, retention, phonetics and esthetics. Nevertheless, physical, physiological, mechanical and psychological factors play a vital role in the success of removable complete dentures. The canine-guided occlusal scheme is preferred because of its simplicity, less time consumption, good masticatory performance, ease of fabrication and modification into bilateral balanced occlusion if required. Further studies are required to reduce the controversies related to jaw relations, gnathology and occlusal schemes in complete dentures.

Complete Denture Occlusion: Best Evidence Consensus Statement

PURPOSE

The occlusal scheme required for an edentulous patient is controversial. The purpose of this Best Evidence Consensus Statement was to evaluate the existing complete denture literature related to occlusal schemes.

MATERIALS AND METHODS

A literature search was limited to Meta-analyses, Systematic Reviews (SR), Randomized Controlled Studies (RCT) and Clinical Trials. Key Words were: Complete dentures, occlusion, harm; Complete dentures, occlusion alveolar bone loss; Complete dentures, occlusion, stability; Complete dentures, occlusion. Additional related articles were culled from the authors' library and reference lists in the articles found in the PubMed searches.

RESULTS

Of the 165 articles that met the initial search criteria, 34 related to the focus questions and were evaluated and rated.

CONCLUSIONS

There is strong support that the average denture patient, with good residual ridges and no neuromuscular problems, will function adequately with a properly fabricated complete denture regardless of the occlusal scheme. There is neither strong support for or against bilateral balanced occlusal schemes as it relates to patient satisfaction, preference or chewing ability. There is some support for increased alveolar bone loss with complete dentures that have a non-balanced occlusion. There is a need for bilateral balanced occlusal schemes for patients presenting with loss of stability and retention as a result of their presenting conditions (PDI III and IV).

Choosing the denture occlusion - A Systematic review

Aim:

The aim of the study is to acquire evidence for the choice of occlusion with anatomic/modified anatomic teeth in complete denture prosthesis.

Settings and Design:

Systematic review following PRISMA guidelines.

Materials and Methods:

The study reviewed original articles on various occlusal schemes bilateral balance occlusion (BBO), lingual occlusion (LO), Canine guided occlusion (CG), posterior group function occlusion (PGFO) have been applied to the complete dentures and were analyzed for the objective or subjective or both evaluations. The data were collected in standard format with the needed information such as year of publication, type of study, occlusal schemes compared, test methodology used, sample size for experiment and control, assessment of retention, stability, and other factors which determine the quality of life and period of follow-up. The risk of bias was calculated using tools RoB2.0 and robvis. At all stages, the inclusion and exclusion of studies were discussed among the reviewers.

Statistical Analysis used:

Due to the heterogeneity in the data of the included studies no statistical analysis was used.

Results:

Of the 1896 articles screened only 17 studies were included in the systematic review. These were discussed amongst the reviewers regarding the various occlusion schemes used. The subjective and objective criteria used in the studies was tabulated separately. They were then analyzed for the risk of bias using the robvis 2 tool.

Conclusion:

No scheme is more superior to the other with the anatomic tooth forms. The use of alternative unbalanced schemes produces a similar satisfactory clinical outcome. The ridge classification also has a significant role to play in the preference for an occlusal scheme.