Patient Satisfaction with Lingualized Occlusion Compared to Bilateral Balanced Occlusion in Conventional Complete Dentures: A Systematic Review

Review Article

J Dent & Oral Disord. 2023; 9(1): 1179.

Patient Satisfaction with Lingualized Occlusion Compared to Bilateral Balanced Occlusion in Conventional Complete Dentures: A Systematic Review

Neelam A Salvi, BDS1*; Janani Iyer, BDS, MDS2; Jyoti B Nadgere, BDS, MDS3; Prem R Thapar BDS4

1Post Graduate, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, India

2Professor, Department of Prosthodontics, MGM Dental College and Hospital, India

3Professor and HOD, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, India

4Post Graduate, Department of Prosthodontics and Crown & Bridge, MGM Dental College and Hospital, India

*Corresponding author: Neelam A Salvi Post Graduate, Department of Prosthodontics and crown & bridge, MGM Dental College and Hospital, Kamothe, Navi-Mumbai, Maharashtra, India. Email: Neelamsalvi03@gmail.com

Received: September 01, 2023 Accepted: October 17, 2023 Published: October 24, 2023

Abstract

Purpose: The purpose of this systematic review is to determine Lingualized Occlusion (LO) as an alternative occlusal scheme for routine complete dentures in terms of patient satisfaction and comfort.

Material and Methods: Electronic research was conducted using for articles published between January 1, 2000 and July 31, 2020, search PubMed (including MEDLINE), the Cochrane database, and Google Scholar. The inclusion criteria were used to choose studies relating different occlusal schemes for complete denture. The risk of bias was evaluated using the Cochrane’s Risk of Bias (ROB -2) tool.

Results: After applying the inclusion and exclusion criteria 12 articles were systematically reviewed. The random sequence generation domain reveals a high risk of bias in the studies with Nadira et al, Mohammad et al, Deniz et al, Kawai et al and Jiyar et al. These authors did not use computers or computer-generated random numbers or random block assessment for random sequence generation. Low risk of bias was found in the studies with Shirani et al, Hedaiat et al, Abdallah et al, Savvas et al and Caitlin et al as they have used tools such as computers or computer- generated random numbers or random block assessment for random sequence generation for random sequence generation thereby decreasing the bias and improving the quality of their study. Thus, most of the studies included in this systematic review revealed that the patient satisfaction levels were significantly higher for lingualized occlusion as compared to bilateral balanced occlusion.

Conclusion: According to this comprehensive review, BBO does not improve satisfaction or masticatory performance. Thus, in terms of quality of life/satisfaction and masticatory function, lingualized occlusion can be deemed a predictable occlusal scheme for complete dentures. As a result, additional research is required to corroborate the study’s findings.

Introduction

Health has been defined as “a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity” by the World Health Organization. The onset of edentulism is a prevalent problem in senior people [1]. Though the prevalence of edentulism is decreasing in developed countries, the number of older persons in those communities is increasing. According to the United Nations Population Division (UN 2011), the proportion of India's population aged 60 and more is expected to increase from 8% in 2010 to 19% by 2050 [2]. As a result, more patients will become edentulous as they get older, when they are less able to adapt to the constraints of a complete denture [1]. A complete denture is a removable prosthesis used when all of the teeth in a jaw have been lost and must be replaced prosthetically. In contrast to a partial denture, a complete denture is made when there are no more teeth in an arch, making it a tissue-supported prosthesis. Natural teeth, a partial or complete denture, fixed appliances, or, in some cases, soft tissues can all be used to oppose a complete denture. Because complete dentures rest on the oral mucosa and are in close contact to tissues that are continually changinglowing to muscular action, they are susceptible to a variety of displacement forces of varying magnitude.

According to Fish, complete dentures have three surfaces: the impression or intaglio surface, the polished surface, and the occlusal surface. The design of these three surfaces governs denture retention, stability, and support [3]. Among the principles considered essential for complete denture success is occlusion [3]. Occlusion is defined as the “static relationship between the incisive and masticatory surfaces of maxillary and mandibular teeth or analogues of teeth” (GPT 1994).

Occlusion is thought to have been designed to work efficiently while providing the least amount of harm to the supporting tissues. In a broader sense, a complete denture occlusion is the mechanism that involves the closure of the maxillary and mandibular teeth in centric relation. It happens throughout the mandible's functional and non-functional movements. Any occlusal force applied to one segment of the denture must be matched by force delivered to the other segment, resulting in balanced occlusion [3].

Many authors believe that bilateral symmetrical articulation is essential for treatment success. During eccentric motions, this occlusal idea depicts posterior contacts on both sides of the jaw (working side and balancing side) [9]. According to proponents of balanced articulation, this occlusal concept enhances retention and stability while also providing superior masticatory performance [8].

Bonwill pioneered the concept of balanced articulation in 1878 [10]. He believed that putting the most grinding surfaces into contact with each movement would equalize the action of the muscles on both sides at the same time [9]. As a result, pressure and force would be distributed equally on both sides of the dental arches. However, there is no balancing contact during functional activities such as eating, drinking, speaking, or singing. The term 'Enter Bolus and Exit Balance' was coined in the 1960s to describe the loss of occlusal balance during mastication. Balancing interactions are not observed during mastication and are most likely not physiologically required.

It is regarded as a perfect occlusion for complete dentures [11]. However, BBO may be difficult to attain clinically and time-consuming to master [12], thus a less sophisticated occlusal system that meets clinical needs is required. Several occlusal approaches for complete dentures have arisen to circumvent these restrictions.

Lingualized occlusion is an attempt to maintain the anatomic form's aesthetic and food penetration advantages while retaining the mechanical freedom of the nonanatomic form. In the lingualized idea, anatomic teeth are used for the maxillary denture and modified nonanatomic or semi-anatomic teeth for the mandibular denture. Gysi pioneered the concept of lingualized articulation in 1927. Payne published a report in 1941 on Farmer's posterior setup, which included 30° cusp teeth that were carefully molded to satisfy the concept of lingualized articulation and the particular needs of edentulous individuals [7].

Only the maxillary palatal cusps occlude in the mandibular central fossa with lingualized occlusion. The maxillary posterior teeth are moved slightly to eliminate all buccal cusp contact [7]. Balanced occlusion can be obtained before anterior tooth contact at maximum intercuspation if the horizontal overlap between the anterior teeth is 3-4 mm [7].

The stomatognathic system includes complete denture occlusion, which is more than just the arrangement of maxillary and mandibular teeth [7]. The primary focus is for the health and preservation of the supporting structures. To avoid deflective or excessive stresses transferred to the underlying structures, we must evaluate all biologic, physiologic, and mechanical elements that favour the stability of the denture foundation [7]. Therefore, a less-complicated occlusal scheme fulfilling clinical requirements became necessary [28]. An optimal occlusal surface design/ scheme is essential for successful complete denture retention, stability, and support [1]. The purpose of this systematic review was to determine Lingualized Occlusion (LO) as an alternative occlusal scheme for routine complete dentures in terms of patient satisfaction and comfort.

Materials and Methods

This systematic review was carried out in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement criteria. The protocol for the systematic review and meta-analysis was registered at the international prospective register of systematic reviews (PROSPERO- CRD42021276452) and followed the Preferred Reporting Items for Systematic Reviews and Meta Analysis - Diagnostic Test Accuracy (PRISMA- DTA) checklist [22]. (Also, it is available at following link. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=276452.

The research question formulated by using a patient or Population, Intervention, Comparison, and Outcome (PICO) framework [23] (Table 1) was “Is lingualized occlusion an alternative occlusal scheme for routine complete dentures in terms of patient satisfaction and comfort?”