Use of Anatomical Landmark in Locate Occlusal Plane.
Condition: Dentulous
Study type: Interventional

Summary: 
      Occlusal plane "the average plane established by the incisal and occlusal surfaces of the
      teeth -The glossary of prosthodontic terms. Generally, it is not a plane but represents the
      planar mean of the curvature of these surfaces".

      Correct orientation of the occlusal plane plays a vital role in achieving optimal aesthetics,
      occlusal balance and function of complete dentures. Faulty orientation of occlusal plane in
      fixed or removable prostheses will affect the interaction between tongue and buccinator
      muscle resulting in food collection in sulcus and cheek or tongue biting.

      The occlusal plane is normally established anteriorly according to aesthetics of patient and
      posteriorly parallel to camper's plane.

      In the mandibular arch there are few landmarks which could be used to orient the occlusal
      plane like the retromolar pad, commissure of the lips and lateral borders of the tongue.

      Various landmark have been used to orient the occlusal plane in the maxillary arch e.g.
      parotid papilla, hamular notch- incisive papilla plane, ala-tragus line.

      There is no single method seems entirely accurate to locate the occlusal plane in edentulous
      patients. Therefore ,Investigators need a stable anatomic landmark can be used as a guide to
      determine occlusal plane (OP).

      Material and Methods:

      Forty Dentulous patients will be selected. All subjects had natural maxillary and mandibular
      teeth. In addition all subjects exhibited Class I skeletal and dental relationships with no
      prosthetic dental replacement. Subjects with Claa II or Class III relationships,fractured or
      abraded edges of the teeth,ankyloglossia and orthodontic treatment were excluded from the
      study. The mandibular posterior occlusal plane was determined according to the level of
      coronoid notch{CN} (greatest concavity anterior border of the ramus) by measure the distance
      between the occlusal plane and CN.
    

Detailed description: 
      The plane of occlusion refers to an imaginary surface that theoretically touches incisal
      edges of the incisors and the tips of the occluding surfaces of the posterior teeth". A plane
      usually signifies a flat surface; however, it is not so where the occlusal plane is
      concerned. Two areas comprising of anterior and posterior teeth constitute the occlusal plane
      and must be considered individually. Anterior tooth position is governed by esthetics,
      phonetics and the required anterior guidance. On the contrary, functional needs predominantly
      determine the position of posterior teeth and this position is also affected by the
      incorporation of the anteroposterior and mediolateral curves. Optimal function, aesthetics
      and phonetics following prosthodontic rehabilitation is dependent on the establishment of
      physiologically accurate vertical dimensions of occlusion, palatal contours, positioning of
      the teeth and the level of occlusal plane.

      The occlusal plane orientation is lost in patients with mutilated dentitions or those
      rendered edentulous and needs to be re-established for optimal function and comfort.

      Different intra- and extra-oral landmarks used by clinicians to define the level of the
      occlusal plane include the upper lip, corners of mouth, lateral margins of tongue, Camper's
      plane and interpupillary line, the parotid papilla and the retromolar pad (RMP).

      Any discrepancy in establishing the optimal level of occlusal plane causes adverse effects on
      periodontal tissues in dentate individuals and may result in vague symptoms such as
      headaches, migraines or stiffened shoulders and in edentulous patients, compromising the
      stability of the prosthesis, ultimately leading to alveolar bone resorption.

      A combination of various landmark along with a judicious clinical judgment should be taken
      into account for the location of the occlusal plane in edentulous patients.

      If the level of occlusal plane is too high, the tongue is unable to lie on the lingual cusps
      of the mandibular denture teeth and hence, fails to counter the movement of the denture. It
      may also result in food accretion in the labial and lingual sulci. In contrast, a low level
      of occlusal plane will promote tongue and cheek biting. Therefore, it is mandatory for the
      prosthodontist to re-establish the lost occlusal plane, both while dealing with multiple long
      span posterior restorations as well as in complete denture prosthodontics.

      Material and Methods:

      Forty dentulous patients. The mandibular posterior occlusal plane was determined on the level
      of coronoid notch (CN) on the anterior part of ramus. Then We will measure the occlusal plane
      in all forty a participants determined to the level of CN at the anterior border of ramus in
      mandible.

      Inclusion :

        -  Stable systemic health, including absence of a history of cardiovascular disease

        -  No evidence of infection or trauma in oral region

        -  Negative history of TMJ disorders

        -  All subjects had natural maxillary and mandibular teeth.

        -  All subjects exhibited Class I skeletal and dental relationships with no prosthetic
           dental replacement.

      Exclusion criteria:

      Subjects with Claa II or Class III relationships,fractured or abraded edges of the
      teeth,ankyloglossia and orthodontic treatment The mandibular posterior occlusal plane was
      determined according to the level of coronoid notch{CN} (greatest concavity anterior border
      of the ramus) by measure the distance between the occlusal plane a with ages beyond the
      accepted age range
    

Intervention name(s): Dentulous subjects
Intervention type(s): Device
Intervention description(s): Determine the occlusal plane using CN in anterior border of ramus
Intervention model: Single Group Assignment
Intervention model description: No evidence of infection or trauma in oral Negative history of TMJ disorders
Masking: None (Open Label)
Primary purpose: Treatment