Professional Documents
Culture Documents
......................................................................... 2
3...................................................................................................... Malocclusion -
5................................................................................................................................
........................................................................................ 9
....................................19
19........................................................................................................................
23............................................................. Occlusal Interferences / Functional Malocclusion
Determinants of occlusal morphology / Occlusal Factors................................................25
...29
.................................................34
.................................................................................. 41
...................................................................................................... 48:
48........................................................................................................ :
48.............................................................................................................. :
49.........................................................................................................................
............................................................................................................................ 54
54...................................................................................
57........................................................................................................
.......................................................................................................................... 60:
Occlusion and Temporomandibular Disorders..................................................................64
)(
25.10.2006
50%
50%
Outline ,
. .
.
.
, . .
. .
Static laws.PPT :
-
- .
.
.
:
, .
" .
,
.
Sternocleidomastoid muscle- , .
Lip-Cheek-Tongue System
, . ,
. .
- .
.
, ,
.
)(
8
.
, .
,
, , .
!!! .
9
: ,
.
10
. ,
. .
. .
. .
.
12
: ,
. .
:
)( .
.
.
.
Malocclusion -
Angle
, .
Angle :
- NORMOCCLUSION .
- MALOCCLUSION . Class I, II, III :3-
.
.
- Normocclusion )" "(.
- Malocclusion .
.
.
)(
Angle class l
:
)
(.
) , , '(.
. ,
, .
.
.
Class I, II, III-.
19
Angle class ll
) Class-
.(I
) Class III- ( .
.
Angle Class ll.
" .
)(
.Angle lll
.
: .Orthognatic Surgery ,
, .
.ICP
.
ICP ) (Centric Occlusion ICP (Eccentric-
(Occlusion
.
:
.
o
.
o
:
.Outer Aspect
Inner Aspect IA- IA-
. IA-
.
Outer Aspect - 1 .
Distal Outer Aspect 2 .
Mesial Inner Aspect 3 .
Distal Inner Aspect 4 .
)(
Occlusal Table -
60% B-L- .
Inner Aspects- .
Inner Aspect- )
, (.
,
.
Bucco-Occlusal (B-O) Line
. . .
.
.
30
Linguo-Occlusal (Li-O) Line
. .
.
!!!
31
Central Fossa (C-F) Line
32
Functional Outer
Outer-
.
ICP-Contact-
.
.
.
(Aspect (FOA
.
Aspect ,
.
Inner incline-
.Movements
Marginal Ridge Area -
35
)(
37-38
.1 ) (
.2 - FOA-
.3 FOA-
.1 .
, ) ( . ICP- .
.
BOL-
. ,ICP , .
.
.
, Inner Aspect- .
.
Mesio-Distal landmark relations
. "" . .
.
Marginal Ridge Area- , :
, .
Central Fossa- .
41
)(
. .
. .
42
Malocclusion
. .
43
Class I NeutroOcclusion
.
.
:
.
(CLASS II (DISTOCCLUSION
The dental relationship in which the
mandibular arch is posterior to the
maxillary arch (the mandibular first
molar is distal to the maxillary first
molar).
Subdivision : Unilateral distal only
Marginal Ridge Area-
5 6- .
Class II 2-:
- Class II Division 1
, ,
,Open Bite , , . Class II Division
.1
- Class II Division 2 , ,
. "" .
Open Bite ,Deep Bite n . Over Bite
4" , 6-8" . .
48
(Class III (Mesiocclusion
.
,
:
SUBDIVISION: Unilaterally mesial only
Edge to Edge
(Occlusion
)(
1.11.2006
Envelope of Motion.PPT
. .
, .
" "
. :
,:
.
o
.
o
:
.
, , ,
20" .
, .
. ,
. , , ,
.
, , .
. , . :
.1 .
.
.
.2 .
.
,
Posselts Envelope of Motion
-
.
" " .
, ,
.
.
:
))
Border
Movem
ents
)(
.
."
. 50-" 7-10" ," .
1-2" )(.
) (Centric Relation - CR
:
.1 .
.2
. .
.CR-
.
.
.CR- 20-
" .CR-
:
!
(- TMJ , ' (
CR - .
) (Hinge Axis
, .
.CR- ,CR
. CR- .
)(
10
.
) .(Centric Relation
, Terminal Hinge Axis-
.CR
:
Retruded Contact Position
, .Centric Relation
:
.1 ,CR- .
CR .2.
. . ,
, .CR- ,Terminal Hinge Axis
.THA-
-
.1 .ICP
.ICP Inter Cuspal Position
Central Fossa Line- .
.ICP
, .
, .
.2 .RCP
.CR-
,
.
RCP- .
, .
ICP .RCP
3 . ) .CR) = Terminal Hinge Axis
ICP CR .
.4 ) + (
.
)(
11
, .
.
. -
Maximal Protrusion ,ICP-
. . ,
.
.5
)) Contact Movement
" " .
. .ICP-
RCP , .
, .
)(
12
, .
, .
:
ICP . -
Fossa Line .
.RCP :
.1 , ICP .
.2 )
.Terminal Hinge Axis
.
Centric Rrelation 50" )
(
.
) .... (.
, ,
.
, .
17
Anterior Guidance -
,
) (.
:
.1 .
.2 .
.
, . .
.
18
Incisal Guidance
,
) (
, , .
,edge to edge class 3- , ,
.
19
Condylar Guidance
) (translation .
) , , '(
, .
) Recurrent Spontaneous Dislocation ( ,
20
)(
13
)(Over Bite
. , . ICP
,
, Deep Bite . 10" ,
Over Bite . 3-4-".
)(Over Jet
,
.ICP
.
22
Incisal Guidance: IDEAL
Or Class I with normal OB and OJ
: . ICP-
.Edge to Edge
ICP . .Edge to Edge
. .
- Class II div 1 , .edge to edge
, ,
.
- class II div2 , .
, , ICP- ,
.
:
Slide in Centric
( 1-" ) - RCP -ICP.
.RCP-ICP Slide : ICP
RCP .
, ICP .RCP .
Clinical Rest Position
, .
. ) Postural Rest Position : (
, , , ,
, . 20 .
Vertical Dimension of the Face
) (.
,.
:
:Vertical Dimension of Occlusion ICP
:Vertical Dimension at Rest rest position
Interocclusal Rest Space
)(
14
) :(1 ,
) . (clinical rest position ,
.
?
) (occlusal vertical dimension
)(rest vertical dimension
: 2-4".
:
Interoclusal Distance Freeway Space
.CO-
- ,CR ,
. , .
interocclusal distance- freeway space .
Working Side -
.
: working condyle -
, .
.
:
" .
- .
.
)(
15
ICP - , .
, , .
.
, . ,
, . , .
) , ) ( (
Bennett Angle
,
.
.
ICP - , ,
. .
, ,
, -.
, ,
.
.
, , eminence .
, . eminence , .
Bennett Movement
. -1
" , .
.immediate shift :
, ,
, .
, .
- semiadjustable ,
.full adjustable
)(Canine Guidance
: . - DB
-MP
.
.canine protected occlusion :
)(
16
. . ,
.
- , edge to edge . .
- , . .
)(Group Function Occlusion
) ( : ,
.
FOA inner aspect ,
, .
- .
, , .
.
Ideal Protrusion
) ( ) ( "
) (disclusion .
, 4 , 6.
.1 .
.2 , !!
-
, , .
, .
,
.
-
, .
.
, , .
)(
17
.1
ICP .2 ) RCP- 2"(.
.3 .
.4 .
.5 .
.6 .
.7 .
.
)(
18
7.11.2006
).(ICP
) (ICP , .
. .
" " . ,,
.
, ,
.
.
:
.
-
-
. .
, )
.
, .
, .
.
. Class 1 .Class 1
1 .
' ' ,
' '.
.
: over bite and over jet ,
, , .cross bite
, . Over Bite Over Jet-.
,Cross Bite , .
.
1 .
,
. Inner Aspect- .
Outer Aspect .High of contour-
.
.
)(
19
:
5 ,Inner Aspect of Guiding Cusp Mesial Inner :
.Guiding Incline
Outer Aspect - 3 .Mesial Outer Supporting Incline .
,
The Functional outer Aspect
. , OA-
.
4 :ICP
.1 .
.2 .
.3 .
.4 .
. .
, .
.
, . ICP-
. :
)-(
)-(
Protrusive Contacts
.
. , :
Distal Inclines- Mesial Inclines- .
:
Distal Upper Mesial Lower
"
.
.Distal Upper , Mesial Lower :
Retrusive Contacts
, . Mesial Upper, Distal .
.Lower
,
.
Working Movements
.
)(
20
" ".
. "Laterotrusive ,
MedioTrusive , .Non-Working
.
, .
FOA.Inner Guiding Incline-
.Group Group
, . . .
. FOA .Inner Guiding Incline
Working- FOA .IGI
Non-Working Contact
, . Inner
Supporting Incline Inner Supporting Incline- .
ISI .ISI
Inner Supporting Incline- ) ( Inner Supporting Incline-
)(.
)(
21
MU/DL
Post. component
WORKING
RETRUSION
DU/ML
Ant. component
PROTRUSION
NON - WORKINGN
FOA/IGI
Lat. Component
ISI/ISI
Med. component
.
.
, .
,
.
, 1-
2 , .
FOA. FOA ,
.
.
:
.
, .
.
, ,
. ....
)(1
.
MB-
, .
. .
)(2
.
, .
)(3
DB-
.
?
?
)(
22
Working .2
Non Working- . , -
?Working Working
Non- ,Working-
, , .
Working Occlusal Interference
:Distal Incline-
.3
.
. .
. ,
)(
23
, . .
.
.
- Retruded Contact Position ICPRCP -
.Premature contact may occur on one or several teeth
RCP , .
.
:ICP RCP
2-".
RCP- , , .
: , , ,
.RCP- , . ISI ISI- Mesial
Upper.Distal Lower-
, , .
. .
.
:
(1 : , ,
. balancing interferences, mesio-obtrusive .cross arch
ISI ISI , , UD
LM . .
, ? - ,
, . , -
.
(2 : , - , .
FOA ,IGI FOA LD IGI
.UM
(3 : .
. .
- . " .
.
(4 :RCP-ICP , RCP .
, .
, , .
. :
2"
.a
RCP , ,
.b
, .
.c
, , , ,
. ICP " . -
.MU/DL , .
, , .
)(
24
15.11.2006
,
. .
. .
.
) ( ) ( ,
. .
-
Condylar Guidance .
. .
. ,
.
, :
.1
.2 .
.
, .
, ,,
. .
-.
- .
.
) , (
. , . -
, .
)(
25
. Over Lap- .
.
,
.
?
.
.
.
, 4
. .
45 45 .
45 . 4
45.
.
. 45
Over Bite- 6 .
Over Bite .Over Jet
Over Bite:Over Jet-
Over Jet- Bite
. '
,
, .
, .
, .
.
' .
.
, .
Class 2 Div 1 '
. Div 2- .
, .
, .Madibular Lateral Translation Movement ,
Plane of Occlusion
.
.
.
)(
26
.
.
.
.
POB .POA
45 45 .
45.
.POA
.
.
. , 45
25
.
, 3 POB 45-
, .60
.
,
. ,
, .
,
.
:
45 , 45.
45- ,
.
.
)( , .
, .
Curve of Spee
.
.
A .B-
, .
?
A , , 45
.
, 45
.
.
.
)(
27
- Bennett Angle , .
.
- Bennett Movement . ,
. .
:
?
.1 . .
.2 . .
. -
..Temporomandibular lig
Inner Horizontal , ,
.
, .
" .
? ?
- ' ,
.
, .
.
.
,
.
.
.
.
.
. Grooves- .
, , "
.
)(
28
22.11.2006
Neuro-physology of muscles.ppt :
.
6.12 .
- Motor Unit . .
, .
.
Cilliary Muscle- . ,
, .
2-3 1000- .
4
.Masseter M .
- Lateral Ptergoid ) ,(
:
Type 1 . .
Type 2 . . .
Type 2 a .
o
Type 2 b . .
o
Type 2 ab .
o
Type 1 .
Type 2 .
Type 2 .Type 1-
Type 1 .Type2-
.
.Type 1
.Type 1
)(
29
.
, .
, .
Human Jaw Elevators Muscles
Contain whole fascicles of same type
Size: Type I > Type IIA > Type IIB Type 1 2a - .2b-
Type IIA are rare
Type I predominate in anterior parts Type 1
Anterior Temporalis : .
Type II predominate in posterior parts - Type 2 .
.
Human Lateral Pterygoid
Contain whole fascicles of same type
Size: Type I > Type IIB
Type IIA are absent
- Contain 85% Type I .
Human Digastric Muscle
.
.
Functional Correlation
:
Size Principle of Henneman et al
Mechanical Advantages
Evolution
The Size Principle
Type 1- ,
, Type 1-
.
.
Levator- .Type 1 .
Ant. Temporalis- .Massetter- .Type 1-
Posterior Temporalis - ,
.
: .
)(
30
. ,
Type 2a .
.
Type 2 Type 1- 60%.
, ,
Type 2b 2a- .1-
2a- , .
Jaw Muscles of Herbivores
.
Size: Type I= Type II " , " Type 1 -
.Type 2
(Type I predominate (90% . Type
.2b
Type IIB are not found
-
: Fatigue " .
.
. .
. .
:
:Central Fatigue .
.
.
: Peripheral Fatigue :
)"
.(".Transmission F
)"
.( .Contraction F ,
.
:Exhaustion . .
) .Failure Point) - .
.
: Endurance Time - ' . .
.
, :
) (Voluntary Contraction .
.
.
.
. - .
Peripheral Fatigue
)(
31
:
.
- , .
' ,
.
.
75-".
7-".
NOCICEPTORS
PROPRIOCEPTORS
MUSCLE SPINDLES
GOLGI TENDON ORGANS
PACINIAN CORPUSCLES
Nociceptive (flexor) reflex
.
. ?
.
) PDL- ( .
A E.
)(
32
:
.1 "".
.2 )( "".
.
Polysynaptic to noxious stimulus
Activated by unexpectedly biting on a hard object
:Afferent neurons stimulate both
Inhibitory efferent neurons to openersExcitatory efferent neurons to elevators -
Muscle Spindle
An encapsulated proprioceptor arranged parallelly to extrafusal muscle fibers that detects
changes in length
. .
. .
.
. A .
Intra Fusal Fibers Extra Fusal .
.
:
Efferent .
Intrafusal-
.
:
.
Muscle Spindle- Trigeminal Nucleus - .
Motor Nucleus- :
E .
E .
. .
. .
. Fright or Flight- .
Golgi Tendon Organ
. .
.
.Golgi Tendon Organ
.
)(
33
Masticatory Muscles -ANATOMY.ppt :
The harmony of all the head and neck muscles is essential to the normal function of the
!!!stomatognathic system
. -
.SternoCleidoMastoid .
Muscles of the Stomatognathic System
Jaw closing group . Hyoid Bone-
.
Jaw opening group
Suprahyoid group
Infrahyoid group
Facial group
Cervical group ..
THE TONGUE
Temporalis Muscle
.
Masseter Muscle
: .
' . .
.
Medial Pterygoid
. , .
.Medial Angle Mandible-
.
. .
Tempororalis Muscle
: .
.Coronoid Process-
: .
.
Rest Position- .
.
, Type
1 ) (.
, Type 1 ,
.
)(
34
12
.Temporalis Posterior, Anterior, Medial
.
Masstter- .
.
.
)(
35
Digastric Muscle
Posterior Belly
Origin: Mastoid notch
Insertion: hyoid bone (intermediate tendon)
Anterior Belly
Origin: Lingual surface of mandible (midline)
Insertion: hyoid bone (intermediate tendon)
Main action: Opener, hyoid elevator
36
( )
Suprahyoid Group
Mylohyoid
Digastric,
Ant. Belly
Stylohyoid
Digastric,
Post. Belly
Infrahyoid Group
SternoHyoid
Levator
Scapulae
Omohyoid
SternoThyroid
Omohyoid
Tendon
Inf. Belly of
Omohyoid
37
SternoCleidoMastoid
SternoCleidoMastoid
( )
Cervical Group
Sterno-CleidoMastoid
Scaleneus
Trapezious
38
( )
Facial Group
Open
Close
Protrusion
Retrusion
Lateral
Movement
Agonists
Ant. belly of Digastric
Supra Hyoid
Inf. Lat. Pterigoid
Elevators
Sup. Lat. Pterygoid
Inf. Lat. Pterigoid (both)
Synergists (stabilizers)
Infra Hyoid
Antagonists
Elevators
Infra Hyoid
Post. Temporalis
Contra-lateral Lat. Pterigoids
(protrude non-working
condyle)
Ipsi-lateral Post. Temporalis
(retrude working condyle)
Elevators
Elevators
Supra Hyoid
Inf. Lat. Pterigoid
Post. Temporalis
Sup.Lat. Pterigoid
Inf. Lat. Pterigoid
Ipsi-lateral Lat. Pterygoid
Contra-lat. Post. Temporalis
Elevators
The Tongue
Extrinsic Muscles
Intrinsic Muscles
Extrinsic Muscles
Styloglossus
Hypoglossus
39
( )
Genioglossus
Intrinsic Muscles
Longitudinal Ms
Transverse Ms
Vertical Ms
40
( )
29.11.2006
ANATOMY and REMODELING.PPT :
.
:
.1 .
.2 .
.3 .
.4 2.
.5 .
. .
, .
MRI .
.
.1 ICP , .
,RC . .
)(
41
.2 - .
. -
. .
.3 ) (.
.
.4
.
.
.1 .
.2 .
,
.
Antero-Posterior size = 0.8 - 1cm
Mediolateral = 2 Cm
!
-
.
- . .
, 14-
70 ".
)(
42
:
) (Insertion .
.
Lateral Pterygoid Muscle , .
.
.
: ICP-
.
Deep Bite . Deep Bite
.
.
.
,
.
.
.
.
- .
-
- .
- .
-
- :- -.
)(
43
, . , .
:
Upper Compartment
Lower Compartment
.
.
.
, . , 30
.
:
- Sprain Stretch .1
. ,
.
40- . .
.2 .
.
12
,
:
-A B
"
- C .
- D -
.
13
.
14
- ,
. -
.
.
.
15
- A .
B
C
C
B
16
)(
44
- A
- B
- C
- D . .
- F .
.
- G ' . .
- H .
- I
- J .
17
- Retrodiscal pad- posterior slope-posterior band
.
:
,
.
. .
.
.
.
Rretrodiscal Pad-
- .
-
-
:
19
Retrodiscal Pad
.
- .
- , .
20
Retrodiscal pad
;
.
)
(
.
.
.
)(
45
" .
.
.
, ,
.
.
.
.
, .
Posterior
Slope .
Postglenoid Process
, ,
.
25
-E .
-P -
-.
26
Anterior Posterior
Medio lateral
" .
.
"
.
:
:
.1 .
.2
.
.3
.
)(
46
28
-
-
-
, .
-
- .
.
, .
=S
= H
= L
= D
.
-
- .
-
- .
, , .
)(
47
- :
6.12.06
:
: 6 ,
, .
: , ' .
- , ,
.
: + , .
, ,4-6 , ,
.
FOA IGI , . ,
.
: : , -
.
.
, .
:
.1
.2
.3
:
.
:
:
onlays and inlays -
:" ) (
-
:
:Hinge type , .
, , , .
:Freeplane
.
"
)(
48
.
.
:Semi-adjustable:AR-CON, non AR-CON
, .. .
.....
ARticulator-CONdyle type
An articulator that simulates the anatomical shape and describes an analogue of the
mandibular movements
The Whip Mix articulator is an ARCON type
Non ARCON type
An instrument that simulates movements but not anatomy
The Hanau articulator is a Non ARCON type
,ARCON - ,
- , , .
Fully adjustable
, .
.
.1
.2
)( terminal hinge axis -
.3 -
, : imprint
.
.4 - )Whip-
(Mix ) ,(Hanau
-
.5 ) (
3 Small, Medium : .Large
) ,(Frankfurt horizontal ,
, ,
.
.
.
.
3 , . 90 .
:
.
, , ,
.
)(
49
-26 .
:
.1
.2
.3
, ,
. ," ,
.
)(
50
, .
, .
':
':
:
:
.
':
':
) ( ,
':
:
RCP - CR
ICP
':
RCP
2-3 -
)(
51
) , , ICP-
(
ICP-
RCP Vs ICP :
-ICP
-
RCP
. ,
20 TERMINAL :
HINGE AXIS
ICP RCP - 2-
:
) Edge to Edge(
':
) ( "
ICP
ICP
RCP
ICP , " .RCP
RCP Vs ICP
RCP
POSSELT
ICP
RCP- ICP - 2,
RCP -ICP . -.
:
)(
52
30
'
) (S M L
'
':
':
30
'
) ICP (RCP
)(
53
:
13.12.06
.1
.2
.3
.
, .
" =
CPG = CENTRAL PATERN GENERATOR BRAIN STEM - SUB NUCLEUS
CAUDALIS .
)(
54
. - -
.
, .
- :
]" [ CPG
.
= = . .
2-:
.1 -
OPENING PHASE
.2 CLOSING PHASE
:
.2 . CRUSHING PHASE
.2 . GRINDING PHASE
.
.
:
,1 :
ICP
16-18" , , 5-6-"
.
)(
55
.2 :
.2 . : CRUSHING PHASE ,
2.
3"
3-4"
,
2.
. :GRINDING PHASE "
ICP-
SHEARING GRINDING
: :
OPENING PHASE :
CLOSING PHASE :
ICP.
, .
.
, . -
.
.
.
CRUSHING PHASE
.
-Tongue thrust ) open bite , . - ,
( - ) .
(lisping .. , ,
. , 4
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ICP -
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ICP-
ICP
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LATERAL MOVEMENT
.
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CPG -
-SENSORY INPUT
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57
2 :
Gliding Contact : "
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MAXIMUM BITING FORCE
"
53.6-64.4KG>35.8-44KG
443KG
)(
58
13.2-23.1KG<41.3-89.8
"
NORMAL CHEWING FORCE = 40%MAXIMUM BITING FORCE -
:
14"
" 7.
,
.
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:
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.2
.3
.
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.
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. 2 .
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60
20.12.2006
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13:00 .
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, Class II
Class III, Open Bite'.
.
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RCP
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RCP- .
.RCP=ICP
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.
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. ICP- .
.
RCP .
. Centric Relation . 20".
RCP :
.
.Centric Relation
CR- .Terminal Hinge Axis
.Centric Relation
" ?RCP Over Jet-) ICP- 2"( .
.ICP " ,RCP- Over Jet- 4" , -
RCP 2".
)(
61
.
. RCP-.Terminal Hinge Axis-
. ) 20-25"(.
Edge To Edge Over Bite , .Over Bite- -
Over Bite .
. . .
ICP. 2" ) RCP-(.
, RCP
.
, ICP- -
, RCP .RCP-
RCP- 20-25-" ) Centric Relation
, (.
Over Bite- , Over Jet- .
- Maximal Protrusion Over Jet- . Over Jet- Cross Bite-
.Max. Protrusion- . Over Jet-
.
.
.Edge to Edge- Over Bite-
.Over Jet-
, .
- Inter Occlusal Distance . rest-
Position . , -
.Vertical Dimension at rest .Vertical Dimension at occlusion-
Vertial Dimension at rest- ,
.rest position- .Vertical Dimention at occlusion-
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6-10" Maximal Working- .
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.
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. . ICP-
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62
:
,RCP- " .ICP- .Maximal Protrusion -
ICP- .
?Class I, II or III
.
.
.
ICP .
)(
63
27.12.2006
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64