SD-V9N1 CMYK.

qxd:Layout 1 12/18/09 5:40 PM Page 56

56 Spectrum dialogue – Vol. 9 No. 1 – January 2010

Introduction

The study from Suguru Kimoto et

Complete Denture
al.4 showed greater satisfaction of
the patient wearing dentures with a Stability During
lingualised occlusion concept.
The article “The effect of occlusal
contact localisation on the stress
Chewing
distribution in complete maxillary Max Bosshart
denture”5 describes the connections
To obtain unilateral chewing stability: forget about balanced occlusion, it
which contribute to broken doesn’t work, but: Perfect equilibrated occlusion is essential during
dentures. According to this study, it parafunctional mandibular movements to prevent unbalanced loads on the
is the form of occlusion and the supporting alveolar ridges.
positioning of the teeth in relation
to the alveolar ridge which leads to 1. Food is almost always chewed on one side only (Hiltebrandt, 1933/35)1.
an unstable load and to broken 2. During mastication the teeth of the denture wearer only finally come into
dentures. con-tact when the food load has become softened (A. Gerber, 1946)2, 3.
3. Therefore the bi-lateral equilibrium is ineffective for chewing stability.
Functional Reasons Causing 4. For the unilateral chewing stability of dentures, immobility is the key.
Broken Dentures 5. Parafunctional contacts are occurring both day and night. In order to
distribute these forces evenly, correct centric and equilibrating contacts are
Incorrect positioning of posterior necessary.
teeth – The ideal point of pressure
on the tooth is the area shown in
Figure 1 with a green arrow. The tilting action which would result in a dropping of the
chewing force is directed to the middle of the alveolar denture in the post dam region leading to a lack of
ridge. Forces directed in a more buccal direction security. Breaking of the upper denture can also be
progressively increase the deformation of the denture. The expected.
denture is no longer well fitting (blue area) and, in time,
could initiate a crack zone in the palatal part of the Conclusion: Broken dentures are a good indication of
denture. instability caused by unstable positions or wrong contacts
Also of importance is the contour of the teeth. By losing of the artificial teeth. It is in these cases that pathological
the main palatal cusps on the upper denture we get too damage is caused. We can use high-impact acrylic or just
much pressure on the buccal cusps, resulting in a crack in repair the denture, but, in both cases the pathological
the palatinal part of the denture (Fig. 2). Because of the damage will continue. The results are flabby ridges and
inclination of the occlusal surface, shown in figure 2, the increased bone resorption. The mastication efficiency is
resulting orientation of the forces, upwards and outwards, very restricted and the patient could experience pain.
is increasing the deformation of the denture base. It can To avoid these problems we need to correct the teeth
lead to crack formation in the denture base and damage contacts and to have periodic recalls every 2 years.
the alveolar bone.
Usually we can easily distinguish between a functional Tooth Position and Denture Stability
breakage and an accidental breakage of a denture. Of
course we can ask the patient what happened. For the In the past – Many years ago different authors discovered
denture construction it is important to know the the problem of the unstable denture (Hiltebrandt 19331,
functional origin of the break. Payne 19416, Gerber 19462). All of them proposed
By abrasion of the posteriors, premature contacts and an aspecific lingualised occlusal concept to solve the
anterior or canine guidance are created. It can provoke a problem.
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:40 PM Page 57

Spectrum dialogue – Vol. 9 No. 1 – January 2010 57

In Europe, 1958, Albert Gerber from Zurich developed

the so called “Gerber-Method”. It is still recognised as one
of the best systems available 7, 8.

Conventional Set-up

In the conventional set-up, the lower buccal cusps are on

the crest of the ridge (or more lingual) in the upper, the
central groove is straight over the crest of the ridge
(Gysi 1914/17)9. Buccal cusp contact in a conventional
set-up during mastication is a handicap. Too much force is
Fig. 1: The ideal point of pressure on the tooth is the area shown with a exerted buccal of the ridge, resulting in an unstable
green arrow. The chewing force is directed to the middle of the alveolar denture (Fig. 3). With the reduction of the buccal cusps
ridge. Forces directed in a more buccal direction, as the red arrows show, (minimum 2mm) we have the mastication force directed
progressively increase the deformation of the denture. The denture is no
longer well fitting (blue area) and in time, could initiate a crack zone in over the lingual-palatal area and over the centre of the
the palatal part of the denture. ridge. This way the denture is stable during mastication
(Fig. 4). A correlation of denture instability and
progressive resorption of the alveolar bone4 exists.
A personal observation, made by the author of the
anatomic situation of Japanese edentulous patients showed
a significantly better situation in comparison with the
Caucasian population. Their alveolar ridges are showing
significantly less resorption in width. Also, the width of
the dental arch is distinctly greater. These characteristics
are clearly favouring the transversal denture stability. It
may explain the reason, why Kumutu et al. found little or
no difference in the mastication performance of the
patients. Long term results could show different results
when the fit of the dentures deteriorates.
Fig. 2: The lower teeth exert pressure on the upper teeth in a buccal
direction (red arrow). This multiple cyclic reaction can lead to a crack in The Gerber System
the denture and a gap developing between the denture and the torus
palatinus.
In this system we put the upper vertical direction to the
crest of the ridge (Fig. 4). The denture will remain stable
with the advantage that the teeth can be placed more
buccally. This not only provides better cheek contact and
more tongue space but also stops food from slipping under
the denture.

The Lower Denture

The lower denture bearing area can have a difficult shape

with many different inclined levels.
Everyone knows what happens if you stand on an
inclined slope on ice or snow in Switzerland, we slide
downhill without any effort, known as skiing! Teeth
Fig. 3: Buccal cusp contact during mastication is a handicap. Too much standing on the retro-molar ascending part of the ridge
force is placed buccally of the ridge during mastication, resulting in a push the denture forward during mastication (Gysi 1917)9.
tilting upper denture and furthermore an unsupported direction of
masticatory force. Figure 5 depicts a common case. The last molar is
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:41 PM Page 58

58 Spectrum dialogue – Vol. 9 No. 1 – January 2010

positioned in the area of the ascending part of the ridge

and the force to the lower denture hits the inclined area.
The force will be deflected forward and as a result the
denture will slip down the slope and will lift up at
the front.

The Upper Denture

Can this also happen with the upper denture? Yes! This
case shows that both dentures are unstable. As the patient
chews food the dentures move making it virtually
impossible to masticate. Pressure areas are preassigned and,
with time, cause resorption of the ridge. Fig. 4 : With the reduction of the buccal cusps (minimum 2mm) we have
Under mastication force the upper denture slips forward the mastication force in the lingual/palatal area, which is orientated
and only the patient’s lip holds the denture in position. almost vertically. Sagittal Stability
This has a negative effect on Aesthetics, making the lips
appear tensed.

Model Analysis

Anyone building a house knows that he has to analyse the

ground it will be supported on. When setting up a denture
we need to do the same, we call it model-analysis.
We draw on the side of the model the different zones,
positive, neutral and negative/unstable areas. We use
different colours to get a quick analysis of the situation
(Fig. 7).

Posterior Tooth Position

Fig. 5: In a ‘textbook conventional set-up’ the last molar is positioned
The second upper molar in figures 8a and 8b is 3mm out of correctly; the occlusal level and curve of Spee have been observed.
However, the masticatory force is not at 90° to the ridge, thus the
contact to its antagonist and therefore it is not possible to denture moves down the sloping ridge and moves forward and upward.
chew with it. These last teeth serve only as a support to
the cheeks, prevent food slipping up or down under the
denture and prevent cheek biting 10.
If sufficient space is lacking, we recommended not to
place any upper molar at all (Figs. 9a and 9b)

Balanced Occlusion

The arrangement of the teeth is still recognised as being a

balanced occlusion and the molar teeth are important in
parafunctional jaw movement. (Figs. 10a and 10b). Apart
from unilateral chewing stability as described above,
continuous posterior contacts are important during non-
functional tooth contacts. The even distribution of the
forces over the complete upper and lower alveolar ridges
will protect the natural tissues from overload or at least
diminish the forces to a minimum. During all functional Fig. 6: This image shows in which direction the mastication force on the
and parafunctional movements, the elimination of all upper jaw is directed. As a consequence of the poor position of the teeth,
according to the Spee curve, the force is in a disadvantageous angle to
prematurities is indispensable. the ridge and the pressure pushes the upper denture forward
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:43 PM Page 60

60 Spectrum dialogue – Vol. 9 No. 1 – January 2010

Fig. 8a

Fig. 7:
1. The positive zones are mostly in the pre-molar area (green).
During mastication the axis of the pre-molars pushes the
denture backwards to the respective ridge, giving a ‘super’
stable situation.
2. The deepest area in the lower jaw and the highest part of the
upper jaw are the neutral zones (blue). In this area we set the
first molars (largest teeth).
3. We can recognise on figures 5 and 6 that the retro-molar Fig. 8b
area is critical (red). The directions of the upper and lower
ridge in the posterior part are not parallel to each other. We Figs. 8a and 8b: In this set-up the second upper molar is 3mm out of
cannot set any teeth in this area that will be stable during contact. Therefore it is not possible to chew with it. Also we can observe
masticatory function. the large gap between upper and lower buccal cusps on the first molar.
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:55 PM Page 62

62 Spectrum dialogue – Vol. 9 No. 1 – January 2010

For instance, the registration of a physiological centric underneath the artificial joint. It shows an amazing
relation is of major importance. The stability of dentures is similarity between, the artificial and the natural elements.
directly related to it. It is symptomatic that upper dentures
drop down irrespective of a perfect impression, when Final Remarks
centric is not correct. Especially in edentulous patient
cases it is difficult to obtain a reliable centric relation. The In order not to detract from the principles of the Gerber
intraoral gothic arch tracing (Fig. 11) has given most System we have, on purpose, not gone into too many
satisfaction, especially in full denture cases, for implant details. It is important to understand the forces during
work, extensive reconstructions11 and in TMD cases12. mastication and the way they interact. (Who knows why,
knows how!). Of course many other factors are to be
The Articulator, an Important Instrument in observed, from medical history to the very important
Prosthodontics aesthetics, impression taking and many more.
The method developed by Professor Gerber15 guarantees
An incorrect centric or a straight-line commonly used success when all the relevant aspects are respected. Those
articulator cannot reproduce an immediate side shift, a aspects contain all steps of a treatment, beginning with
Fischer angle or a correct protrusive movement. Lateral the first appointment, continuing with the preprosthetic
movements, simulated without an ISS produce too steep treatment, first and second impressions, centric
buccal facets on the lower molars (hyper-balances)13. The registration, set-up of the teeth poviding aesthetic and
Fischer angle is due to the transversal angulations of the static/dynamic requirements, trying-in, properly executed
TMJ (Fig. 13). The mandibular movement back and down
occurs during swallowing and together with a lateral
displacement during chewing. (Gibbs Lundeen 14)

Retrusive Movement

A simple test shows, if a retrusive movement exists. With

the head in an upright position and by keeping the teeth
slightly closed, incline the head backwards, a slight sliding
of the lower teeth can be observed.
With the condyle centred in its physiologic place (due
to the form of the glenoid fossa) the retrusive movement is
also oriented downwards. There is no other way for the
condyle than down because of the posterior wall (Fig. 14).
Denture occlusion must be balanced; the correct
simulation allowing the physiologic mandibular
movements is of major importance. Fig. 9a

The Fischer Angle

During lateral movements, the roof shaped TMJ (Fig. 13),
i.e. the medial wall, is providing, together with the
condyle path inclination, an additional guidance down of
the condyle.
The pure protrusive movement and the added
inclination of the movement inward, are producing the so
called Fischer angle.
This angle becomes of importance during the simulation
of the ISS. If these angles of the medial and the external Fig. 9b
wall are missing, the occlusion becomes too flat. Figure 15
has been composed by the transversal picture of Gerber’s Figs. 9a and 9b: If sufficient space is lacking, we recommended not to
place any upper molar at all.
first articulator from 1948 with picture 13, placed just
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:56 PM Page 64

64 Spectrum dialogue – Vol. 9 No. 1 – January 2010

Fig. 13: Frontal view of a left

Condyle. The roof shape is
clearly visible.

Fig. 10

Fig. 11

Figs. 10 and 11: Beside the static orientation of the posterior teeth, Fig. 14: Sagittal view of a TMJ. By the form of the posterior wall
balanced occlusion is an absolute must to protect the soft and hard it is obvious that the retrusive movement must also be directed
natural tissues from local overload, occurring specially during downward.
parafunctional jaw movements.

Fig. 12: Gothic arch

registration of an
edentulous case to
determine centric
relation.

Fig. 15: This figure is a combination of two

pictures. The upper picture shows the artificial
fossa and the lower second picture a condyle. The
medial and external angulations of both elements
are very similar.
SD-V9N1 CMYK.qxd:Layout 1 12/18/09 5:57 PM Page 65

Spectrum dialogue – Vol. 9 No. 1 – January 2010 65

lab procedures and remounting with perfect selective 6. PAYNE S.H.: A posterior set-up to meet individual requirements, >Dent.Dig.
1941,47: 20-22
grinding-in. All these basic rules are valid whether it’s 7. GERBER, A.: Okklusion und Artikulation in der Prothetik; 1960. Published by
for over-dentures on implants, over-dentures on natural Condylator Service; Zurich.
8. GERBER, A.: Progress in full denture prosthesis. Int. Dental Journal 2/1957;
roots and by partial denture cases with free end saddles16. 325.
9. GYSI, A.: Montage d'Appareils avec les Dents Anatoform et les Blocs Gysi,
Acknowledgements
12.7.1917; S. 28. De Trey & Co. Ltd. (A. Gysi, Sammelband III); Londres.
10. BOSSHART, M.: Funktion des zweiten Molaren. Das Dental Labor, Heft
The author’s acknowledgements go to Dr. A. Johnson, Mr. M. Boxhoorn and Mrs.
6/2007 (853-854); München.
A. Bruelhart for their assistance with the translation of this article.
11. GOBERT, B.: Variations cliniques implantaires avec l’Enregistrement Intra-
Oral Gerber. Revue Implantologie, Mai 2006; 39-46. A. Girot, Megève France.
References
12. GERBER, A.; STEINHARDT G.: Dental Occlusion and Temporomandibular
Joint, 1989. Quintessence Publishing Co. Chicago.
1. HILTEBRANDT, C.: Die physiologischen und statischen Grundlagen der
13. GERBER, A.: Condylator Modell 4. Der Zahntechniker r. 6, 1959; 2 -19;
totalen Prothese. Published byVita Zahnfabrik GmbH Essen; 1935.
Schw. Zanhtenchnikervereinigung, Zürich.
2. GERBER, A.: Die artikuläre Funktion und die Schleimhautbelastung beim
Kauen von Prothesen, Vortrag am SSO-Kongress in Lugano, 1946.
14. GIBBS, C., LUNDEEN, C., MAHAN, P., Fujimoto, J.: Chewing movements
3. GERBER, A.: Beiträge zur Technologie in der totalen Prothetik I & II.
in relation to border movements at the first molar. J Prosth. Dent. 1981:
Quintessenz der Zahntechnik12/ 1976; 11-21 & 3/1977; 12-21. Quintessenz
46(12); 308-322. Mosby (Elsrevier, Amsterdam).
Verlags GmbH Berlin. As well pblished 1977 by Quintessenz Chicago in
15. HAMPSON, E.L.; M.S.D., F.D.S.; ASKEW, P.A., B.D.S., F.D.S.; TANNER,
english language.
A.N., B.D.S.; WHITE, G.E.: A technique for constructing full dentures using
4. KIMOTO, S., Gunji, A.; YAMAKAVA, A.; AJIRO H., KANNO, K.,
the Gerber articulator and Condyloform teeth (I and II). Quintessence
SHINOMIYA, M., KAWARA, M., KOBAYASHI, K.: Prospective Clinical
International 4 and 5, 1973 (45 – 54, and 45 – 51); Chcago/Berlin.
Trial Compairing Lingualized Occlusion to Bilateral Balanced Occlusion in
16. GEERING; A., KUNDERT, M., KELSEY, Ch.: Complete Denture and
Complete Dentures: A Pilot Study. Quintessence Publishing Co. Inc., Volume
Overdenture Prosthetics. Thieme Medical Publishers, Inc., New York. 1993
19, Number 1, 2006; 103-109
5. ATES, M., CILINGIR, A., SÜLÜN, T., SÜNBULÖOGLU, E. BOZDAG, E.:
The effect of occlusal contact localisation on the stress distribution in complete
maxillary denture. Journal of Oral Rehabilitation, 2006 33; 509-513. Blackwell
Publishing Ltd.; Oxford