Complete Denture Occlusion: An Evidence‐Based Approach

Abstract

The article is associated with the American College of Prosthodontists' journal-based continuing education program. It is accompanied by an online continuing education activity worth 1 credit. Please visit www.wileyonlinelearning.com/jopr to complete the activity and earn credit. KeywordsBilateral balanced occlusion; canine guidance; conventional complete denture. Correspondence AbstractPurpose: This study involved an extensive search for randomized controlled clinical trials comparing bilateral balanced and canine-guided dentures, and questioned whether a bilateral balanced occlusion is imperative for successful denture treatment. Materials and Methods: Studies were identified by searching electronic databases (PubMed/MEDLINE, ISI Web of Science, LILACS, and BBD). The keywords "denture" and "occlusion" were used. The minimum inclusion requirements were (1) randomized controlled trials with patients of any age wearing both maxillary and mandibular conventional complete dentures (CDs), (2) comparison between bilateral balanced and canine-guided dentures, and (3) assessment of masticatory function and/or patients' satisfaction. Results: The search resulted in the identification of 5166 articles. Subsequently, 5156 articles were excluded on the basis of title and abstract. By the end of the search phase, seven randomized controlled trials were considered eligible. Conclusions: Current scientific evidence suggests that bilateral balanced occlusion is not imperative for successful treatment with conventional CDs in average patients. More studies are necessary to identify if specific clinical conditions may benefit from a balanced occlusion.According to the American Dental Association, evidence-based dentistry is an approach to oral healthcare requiring the judicious integration of systematic assessments of clinically relevant scientific evidence with the dentist's clinical expertise and the patient's treatment needs and preferences.1 Assessment of scientific evidence obtained from reliable sources may be the most challenging element for dentists to master. Clinical expertise is often obtained by practitioners engaging in clinical experiences over time. Patients' desires and preferences may be the result of many factors including perceived needs, past dental experiences, health values, and financial issues. Finally, it is essential that these three elements are present in order to obtain the greatest benefits. 2 presented examples of "old truths" in the field of prosthodontics. One of these so-called "old truths" is the bilateral balanced occlusion (BBO), held by many authors as fundamental for successful treatment with conventional complete dentures (CDs). For more than a hundred years, textbooks and undergraduate teaching have stated that canine guided dentures should be avoided, since they would result in denture instability and impaired masticatory function; however, recent research has shown that conventional CDs can function successfully without a balanced occlusion.3 Also, it is interesting to note that 1 year...

Patient satisfaction with occlusal scheme of conventional complete dentures: A randomised clinical trial (part I)

“…[9][10][11][12][13] To date, unbalanced occlusions such as canine guidance and balanced occlusions such as fully bilateral balanced occlusion (FBBO), linear or zero-degree monoplane posterior scheme, lingualised occlusion (LO) and buccalised occlusion (BO) have been suggested and their efficacy has been investigated for CCDs. 2,7,8,13 Almost all previous studies have acknowledged that balanced occlusion is a prerequisite for appropriate prosthetic rehabilitation 2,7,8 except one study that rejected this belief. 11 Most previous studies reported lower patient satisfaction rate, less favourable aesthetics and lower masticatory function for monoplane occlusion, 7,9,10,14 and more problems were reported for FBBO compared to LO and BO.…”

Occlusion and Removable Prosthodontics

“…While canine guidance has not been recommended by prosthodontists as an occlusal scheme for complete dentures, studies have shown little difference in patient satisfaction between groups of patients having complete dentures with either canine guidance or balanced occlusion (Hey decke et al 2008, Paleari et al 2012, FariasNeto & Carreiro 2013. Canine guidance is commonly present in the natural dentition of young patients; however, throughout life attrition of the natural dentition generally leads to the establishment of a unilateral group function.…”

Clinical issues in occlusion – Part I

“…When examining the true advantage of bilateral balanced tooth set up there was no detectable advantage functionally in the majority of studies examined in a systematic review [39].…”