SELECTIVE GRINDING IN COMPLETE DENTURE

SELECTIVE GRINDING IN COMPLETE DENTURE

INTRODUCTION: -
Occlusal harmony in complete denture is necessary if the dentures
are to be comfortable, to function efficiently, and to preserve the supporting
structures. It is difficult to see occlusal discrepancies intraorally with
complete denture. The resiliency of the supporting soft tissues and
displaceability of the tissues in varying degrees tend to disguise premature
occlusal contacts. The tissues permit the dentures to shift; as a result, after
the first interceptive occlusal contact the remaining teeth appear to make
satisfactory contacts. The eye cannot be relied upon to observe occlusal
discrepancies, and the patient cannot be depended upon to diagnosed
occlusal faults. It is the responsibility of the dentist to find and correct these
occlusal discrepancies and permit the patient to depart free of occlusal
disharmony. Occlusal faults can be determined by obtaining and
interocclusal record from the patient and remounting the dentures on an
articulator. These faults can be corrected by careful selective grinding
procedures. Remounting of the dentures on the articulators and selective
sliding procedures should be carried out at the time of placement of the
dentures.

DEFINITION: -
Selective gliding is defined as the, intentional alteration of the occlusal
surfaces of the teeth to change their form.
-- Glossary of the Prosthodontic terms 1999.

Teeth are altered by selective grinding to make simultaneous cusp tip to

cusp tip contact on both sides of the arch when the jaws are in left or a right
lateral position, balanced occlusion in a static eccentric position exists.
When the mandible is in a straight protruded relation with the maxilla and
the posterior teeth are altered to make cusp contacts at the same time to
anterior teeth make incisal edges contact balanced occlusion protrusion
exists.
 REVIEW OF LITERATURES: -

Schuyler, Friedrich and Vaeghan in 1935 observed the disturbances in

occlusal relationship and opening of the bite of full dentures made of acrylic
resin, even when the flask was completely closed during processing.

Osborne and Taylor in 1941 have noted the disturbance and attributed
it to over packing and the accompanying displacement of teeth in the mold.
It was felt, however, that these changes were caused in part by the
volumetric change of acrylic resin during polymerization. They used the
following method to estimate the amount of change in occlusal relationship
-
The top of the incisal guide pin was flush with the top of the articulator
at the time the cases were waxed. The distance that the pin dropped in
order to make contact with the incisal guide plane when the finished
dentures were placed in centric position on the articulator gave a rough
means of comparison of the amount of disturbance of occlusal relationship
in each case.
Avoiding remounting the dentures on articulator and selective grinding
leads to,
1) A deformation of underlying soft tissues,
2) Discomfort, and
3) Destruction of the underlying supporting bone. Later occlusal errors may
be concealed and impossible to locate and correct because of distorted
and swollen tissues.

CAUSES OF OCCLUSAL DISHARMONY: -

1) Incorrect registration of retruded contact position (RCP)
2) Irregularities in setting the teeth.
3) Tooth movement when flasking and packing
4) Incomplete flask closure.

1) Incorrect registration of retruded contact position (RCP)

This is probably the most common cause of error in the occlusion of
finished dentures. During registration considerable care is taken to obtain a
correct vertical dimension and the physiological fully retruded position of
the mandible, but often, when brought together, the record blocks exert
uneven pressure on their respective supporting alveolar ridges, and this
condition passes unnoticed. On finishing the denture the teeth are found to
occlude only in the area where the premature contact of the occlusal rims
occurred the remainder of the teeth being slightly out of degree of contact.
The degree of separation will be related the degree of premature contact
occurring between the rims.
Another fault causing errors in the occlusion of the finished dentures
results from slight movement of record blocks on the ridges during
registration due to their imperfect fit and inadequate retention. All these
errors can usually be lessened by using an accurately fitting acrylic base in
preference to a shellac base which invariably warps slightly.

2) Irregularities in setting the teeth

When setting up teeth the technician is unlikely to produce a perfectly
even contact in retruded, protruded and lateral occlusions. Some teeth will
be in good occlusion while others will be slightly out of occlusion, thus
producing areas of heavy pressure. This cannot happen when the teeth are
held firmly in the final denture base material and results in premature tooth
contacts in the occlusion and articulation of the finished dentures

3) Tooth movement when flasking and packing

Movement of the teeth may occur at the time of boiling out the wax trial
base after the dentures have been flasked and if such teeth are not
correctly repositioned they will cause occlusal irregularities. Repositioned
they will cause occlusal are not correctly repositioned they will cause
occlusal irregularities. When packing acrylic dough, teeth may be driven
into the investing plaster, particularly when packing follows soon after
flasking and the plaster has a low crushing strength. Raped closure of the
flask in the bench press will add to the hazard. Injection moulding
techniques for packing acrylic are an obvious improvement.

4) Incomplete flask closure

Such an occurrence not only causes an increase of vertical dimension
because of the alteration in tooth / cast relationship but also result in
derangement of the occlusion which usually necessitates the total remake
of the denture.
Remounting dentures with check records --
 It can be appreciated that even with care on the part of dentist and
technician errors may occur which influence the finical occlusion and
articulation of finished dentures. In some instances these errors may
corrected by careful use of marking paper or tape at the chair side, but
such correction is often proved false when check records are taken for
confirmation. It is far satisfactory, and often less time-consuming clinically,
to register the retruded contact position of the finished denture with check
record, mount the finished dentures on an adjustable articulator and then
refine the occlusion either at the chair side or in the laboratory.

OBJECTIVES OF CORRECTING OCCLUSAL DISHARMONY : -

The objectives as stated by Schuyler in 1935 are,

1) Maximum distribution of stress in centric maxillo-mandibular relation.
2) Retention of the maxillo-mandibular opening.
3) Harmony of guiding inclines, which distributes eccentric occlusal stresses.
4) Reduction of the incline of guiding tooth surfaces, that occlusal stresses
may be more favorably applied to the supporting tissues.
5) Retention of sharpness of cutting cusps.
6) Increase in food exits.
7) Decrease in contact surfaces.

It must be remembered that the occlusion of the natural dentition and

the occlusion of the complete denture may differ in many respects, to the
advantages and convenience of the dentures. For instance, a denture is a
unit of 14 teeth fastened rigidly together, while natural teeth are anchored
independently of each other. The natural teeth must be considered
individually for occlusion, while the 14 teeth can be treated as one whole
unit. We can have balanced occlusion in complete denture with some teeth
out of contact or some inclines out of contact. The dentures would be
balanced as far as 3 point contact is concerned if only the cuspids and
second molars worked in harmony.

ELIMINATING OCCLUSAL ERRORS IN ANATOMIC TEETH: -

 Articulating paper of minimum thickness is used for marking the actual
contacts of the teeth. Paper is interposed between the teeth and marking
are obtained by tapping the teeth together. This can be done on both sides
at the same time.
Grinding is done with mounted chayes stones no. 16, 11, 05.
The marking process and the grinding are repeated until practically all the
teeth contact in Centric Occlusion. During this grinding procedure, the
incisal pin is relieved of contacts on the incisal guidance table to allow for
the slight reduction in Vertical Dimension that must necessarily take place.
After centric deflective occlusal contacts have been removed the pin is
placed in contact with the incisal table and is kept in contact through the
remainder of the grinding procedure.

I] TYPES OF OCCLUSAL ERROR IN CENTRIC OCCLUSION AND THEIR

CORRECTION: -
3 types of occlusal errors can exist in Centric Occlusion, and each can
be corrected by specific grinding for that error.

1) Any pair of opposing teeth can be too long and hold the other teeth out of
contact.
Correction: - The fossae of the teeth are deepened by grinding so the
teeth will in effect, telescope into each other. The cusps are not shortened.

2) The upper and lower teeth can be too nearly end to end.
Correction: - For correction of this error grinding in such a way as to move
the upper cusp inclines bucally and the lower cusp inclines lingually. In the
process the central fossae are made broader, the lingual cusp of the upper
 tooth is made more narrow when it is ground from the lingual side, and the
buccal cusp of the lower tooth is made more narrow when it is ground from
the buccal side. The cusps are not shortened

3) The upper teeth can be too far buccal in relation to the lower teeth.
Correction: - The lingual cusp of the upper tooth is made more narrow by
broadening the central fossa, and the buccal cusp of the lower teeth is
moved buccally by broadening the central fossa.
In effect, the upper lingual cusps is moved lingually and the lower
buccal cusp is moved buccaly so the tooth telescope into each other.
Cusps are not shortened.

II] TYPES OF WORKING SIDE OCCLUSAL ERRORS AND THEIR

CORRECTION: -
6 types of errors can exist in the occlusal contacts on the working
side. Each of these will cause other teeth to be hold out of contact in
working occlusion, and each requires selective grinding of specific cusp
inclines for its elimination.

1) Both the upper buccal cusp and the lower lingual cusp are too long.
Correction: - The length of the cusps is reduced by grinding to change the
incline extending from the central fossa to the cusp tip. The central fossa is
not made deeper, but the upper buccal cusps and the lower lingual cusps
are made shorter so the other teeth will touch in that position.

2) The buccal cusps make contact but the lingucal cusps do not.
Correction: - Buccal cusps of the upper teeth are ground from the central
fossa to the cusps tip to shorten the cusp and change the lingual incline of
the cusps so it will be less steep.
 3) The lingual cusps make contact but the buccal cusps do not.
Correction: - The lower lingual cusps are shortened by changing the
buccal incline of the lower lingual cusp so it is not as steep. Upper lingual
cusp is not shortened and the central fossa is not made deeper.

4) Upper buccal or lingual cusps are mesial to their intercuspative positions.

This error may occur along positions. This error may occur along with any
of the 3 above listed.
Correction: - Grinding is done so the mesial inclines of the upper buccal
cusps are moved distally when the cusps are narrowed and the distal
inclines of the lower cusps are moved forward. The same cuspal inclination
is maintained in this procedure.

5) Upper buccal or lingual cusps are distal to their inter cusping positions.
This error may occur along with the bucco-lingual errors.
Correction: - Grinding is dome from the distal of the upper cusps and from
the mesial of the lower cusps.

6) Teeth on the working side may not contact.

Cause of this error is excessive contact on the balancing side.

III] TYPE OF BALANCING - SIDE ERRORS AND THEIR CORRECTION: -

There are 2 types of balancing side errors

1) Balancing side contact is so heavy that the working side teeth are held
out of contact
Correction: - Paths are ground through the buccal cusps of the lower teeth
to reduce the incline of the part of the cusp that is preventing the teeth on
the working side from contacting.
No grinding is done from the lingual cusps that may be involved in this
contact.

2) There is no contact on the balancing side.

Correction: - Shorten the buccal cusps of the upper teeth and the lingual
cusps of the lower teeth on the working side. In this process, the lingual
inclines of the buccal cusps of upper teeth and buccal incline of lingual
cusps of lower teeth are made less step. No grinding is done on central
fossae.

ELIMINATING OCCLUSAL ERRORS IN NON ANATOMIC TEETH:-

An Interocclusal Centric Relation record is made in a bite registration
material with the opposing teeth just out of contact. Dentures are mounted
on articulators and the following procedures are undertaken.

1) After being detected by articulating paper between the teeth, gross

premature contact in Centric Relation are removed by grinding. Same
procedures are used to locate and remove all occlusal interferences lateral
and protrussive movements. The grinding is done that appear to have been
ripped or elongated in processing. In Centric Occlusion no grinding is done
on the distobuccal portion of the lower second molar. All balancing- side
grinding is done on the lingual position of the occlusal surfaces of the upper
second molar.

2) Abrasive paste is placed on the teeth on the articulator. These teeth are
milled when the upper member of the articulator moves in and out of
protrusive and right and left lateral excursions. When the teeth slide
smoothly through all excursions, the dentures are removed from the
 articulators and washed. Seldom is any correction necessary to attain a
bilaterally balanced occlusion.

3) Spot grinding is done to correct any small discrepancies in Centric

Relation that remain after the grinding with abrasive paste. The dentist
adjust them after identifying the discrepancies with articulating paper
using a light tapping motion with the articulator and grinding the marks to
ensure even occlusal contact in Centric Occlusion.

SUMMARY AND CONCLUSION :

Selective grinding in complete denture Prosthodontics is an important
laboratory procedure which is carried out by remounting of the dentures
after processing is completed. This remounting may either be laboratory
remount or patient remount.
Inspite of carrying out each step in denture construction very carefully it
is seen that in the end when the dentures are remounting there is an
occlusal prematurities or interferences may be needed.
 REFERENCES

1. I George, Charles, Judson: Bouchers Prosthodontic Treatment for

edentulous Patients. U.S.A. 1997, Mosby Company, ed 10; 500-503.

2. Charles Heartwell: Syllabus of Complete Denture. U.S.A. 1992, ed 4; 394-

406.

3. Merrell Swenson: Complete Dentures. U.S.A. 1959, Mosby Company,

ed 4: 273-294.

4. Holt J : Research on remounting procedures.

J Prosthet Dent 1977, 38:388.

5. Moore P : Indicate pastes - Their behavior and use.

J Prosthe Dent 1979, 41:258.