DENTAL TECHNOLOGY

SECTION
EDITOR
DANIEL H. GEHL

Balancing ramps in nonanatomic complete denture

occlusion
Arthur Nimmo, D.D.S.,* and Frank J. Kratochvil, D.D.S.*+
University of California, San Francisco, and University of California, School of Dentistry, Los
School of Dentistry,
Angeles, Calif.

I wo prevailing theories pertain to balanced occlusion

for complete dentures: (1) balanced occlusion in centric
relation only’, 2 and (2) balanced occlusion in centric
relation and lateral excursions.3-5Proponents of the first
theory (neutrocentric) believe that it accommodates com-
plete seating of the denture bases and centralizes forces
on the residual alveolar ridges. They believe that
patients function in centric relation only. The second
school of thought uses balanced occlusion in excursive
movement as a means of adding to the horizontal
stability of the dentures.
Anatomic denture teeth can be balanced by two Fig. 1. Tipped second molars provide balancing con-
methods: classic bilateral balanced occlusion or lingual- tacts in protrusive movement.
ized occlusion.3~6~7Both methods take advantage of
cuspal contacts to provide balancing contacts in protru-
sive and lateral excursions.
f cg,;:.
Nonanatomic teeth have no cusp inclines; therefore
. .’..y;::;:
..:*,:*-.
:.L
..:..:.
. :,::. ‘1:;
balancing contacts must be obtained by other means.
One method is to arrange teeth (maxillary and mandib-
.*...*- 2- \c
er
ular) to a flat plane with no overbite (vertical overlap).2 \ \ \
The plane can be positioned to prevent disturbing
protrusive interferences, but it may compromise phonet-
ics and esthetics. Another method is to incline the
mandibular second molar to provide contact with the if
maxillary denture in all excursions.*-” The maxillary
second molars are similarly inclined but left out of
centric contact (Fig. 1). The inclined second molars
provide balancing contacts in protrusive movements but Fig. 2. Contact area on balancing ramp. Border posi-
tions are balancing contact (A), working contact (B), and
may lack balancing contacts in lateral excursions.
protrusive contact (C). Contact should be established for
An improvement on the inclined molar technique is intermediate excursions (shaded area).
the use of customized balancing ramps placed posterior
to the most distal mandibular molars.r2 This article netics are greatly enhanced because there is more
discussestreatment with nonanatomic teeth arranged on freedom in placing the anterior teeth (Fig. 3).
a flat plane with the use of balancing ramps. The ramps can be developed after the final try-in of
Balancing ramps provide a tripodization of the den- the waxed denture or at the time of clinically remounting
ture bases. As a patient moves the mandible from centric the dentures at the insertion appointment. The proce-
relation to protrusive or lateral positions, there is smooth dure is performed on a properly adjusted articulator.
contact anteriorly on the teeth and posteriorly on the This technique can be applied to existing dentures by a
ramps (Fig. 2). The balancing contacts give improved clinical remount.
horizontal stability to the dentures. Esthetics and pho-
TECHNIQUE
*Assistant Professor, Removable Prosthodontics. The technique requires the use of a semiadjustable
**Professor and Director. Graduate Prosthodontics. articulator. The condylar guidances are set with a
THE JOURNAL OF PROSTHETIC DENTISTRY 431
 NIMMO AND KRATOCHVIL

Fig. 3. Balancing ramps permit enhanced esthetics.

Fig. 6. Basic shape of balancing ramp developed.

Fig. 4. Wax added distal to most posterior molar.

Fig. 7. Working contact at clinical remount.

Fig. 5. Articulator stepped down from protrusive posi-

tion to centric relation. Excursions are performed to
shape wax Fig. 8. Balancing contact at clinical remount.

protrusive record made at the time of the final try-in. 3. Assume an edge-to-edge position of the opposing
The horizontal guidance (Bennett angle) is set with anterior teeth. The upper member is sequentially moved
Iianau’s formula (Hanau Engineering Co. Inc., Buffalo, down the ramp to centric relation (Fig. 5) to give the
N.Y.), or it can be set for maximum movement. ramp its basic shape (Fig. 6).
1. Add wax to the surface posterior to the most distal 4. Reheat the wax and move the upper member
mandibular molars in opposition to the most posterior through lateral border excursions.
maxillary molar. Overbuild the wax slightly (Fig. 4). 5. Reheat the wax and perform intermediate excur-
2, Release the centric locks on the articulator. sions.
432 MARCH 1985 VOLUME 53 NUMBER 3
BALANCING RAMPS IN DENTURE OCCLUSION

Fig. 10. Completed balancing ramps show contact

Fig. 9. Protrusive contact at clinical remount. areas in border movements and intermediate excur-
sions.

6. Evaluate the balancing contacts to ensure contact We wish to thank Hilary Pritchard, editor, Department of Restor-
in all excursions, and add wax as necessary. ative Dentistry, for her assistance in the preparation of the manu-
script.
7. Process the dentures. Do not adjust the balancing
ramps during the laboratory remount. REFERENCES
8. Evaluate the balancing ramps at the patient- 1. DeVan, M. M.: The concept of neutrocentric occlusion as related
articulator clinical remount and adjust as necessary to to denture stability. J Am Dent Assoc 48~165, 1954.
2. Jones, P. M.: The monoplane occlusion for complete dentures. J
ensure smooth balancing contacts without interferences
Am Dent Assoc 85~94, 1972.
(Figs. 7 to 10). 3. Payne, S. H.: A posterior set-up to meet individual requirements.
Dent Digest 47~20, 1941.
Modifications of the technique for use at 4. Pound, E.: Lost-Fine arts in the fallacy of the ridges. J
clinical remount PROSTHET DENT 4~6, 1954.
The balancing ramps can be incorporated at the 5. Sears, V. H.: Centric and eccentric occlusions. J PROSTHET DENT
l&1029, 1960.
insertion appointment in conjunction with the clinical Pound, E.: Utilizing speech to simplify denture service. J
6.
remount. Final accurate centric relation and protrusive PROSTHET DENT 24~586, 1970.
records are obtained, and the condylar inclinations are 7. Ortman, H. R.: The role of occlusion in the preservation and
set as previously described. prevention of complete denture prosthodontics. J PROSTHET
DENT 26~121, 1971.
1. Roughen the denture base posterior to the most
8. Hardy, I. R.: Technique for the use of non-anatomic acrylic
distal mandibular molar with a carbide bur. posterior teeth. Dent Digest 48~562, 1942.
2. Prepare autopolymerizing resin and wet the 9. Boswell, J. V.: Practical occlusion in relation to complete
roughened surfaces with monomer. When the acrylic dentures. J PROSTHET DENT 1:307, 1951.
resin reaches a doughy stage it is added to the roughened 10. Sears, V. H.: Specifications for artificial posterior teeth. J
PROSTHET DENT 2:353, 1951.
surface.
11. Porter, C. G.: The cuspless centralized occlusal pattern. J
3. Perform all eccentric positions on the articulator PROSTHET DENT 5~313, 1955.
whiIe the resin is still soft. The denture can be placed in 12. Nepola, S. R.: Balancing ramps in prosthetic occlusion. J
a pressure pot to cure the resin. PROSTHET DENT 8~776, 1958.
4. Refine and smooth the balancing ramps after Reprznt requests to:
curing is complete, and carefully evaluate the contacts in DR. ARTHUR NIMMO
eccentric occlusion. UNIVERSITY OF CALIFORNIA
5. Correct deficiencies by adding autopolymerizing SCHOLL OF DENTISTRY, D-321 2
SAN FRANCISCO, CA 94143
resin.

SUMMARY
A simple technique for providing bilateral balancing
contacts in nonanatomic dentures has been presented.

THE JOURNAL OF PROSTHETIC DENTISTRY 433