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GOOD MORNING

CONTENTS
Introduction Important terms History Philosophies of occlusion Organization of occlusion Determinants of occlusal morphology Importance of occlusal harmony Treatment goals for occlusion to be in harmony
occlusal equilibration Occlusal interferences Occlusal Correction Therapy

Conclusion References

Introduction
oc means up
clusion means closing
occlusion

means closing up

Occlusion means to block , to shut in , to bring together (Oxford English Dictionary)

IMPORTANT TERMS

Occlusion
The static relationship between incising or masticating surfaces of maxillary and mandibular teeth or tooth analogues (GPT 8)

Acc. To Ramfjord & Ash


Occlusion =contact between teeth

Multifactorial functional relationship between teeth & other

components of the masticatory system as well as with other areas of

head & neck that directly or indirectly relate to function,


parafunction or dysfunction of the masticatory system

Centric occlusion
The occlusion of opposing teeth when the mandible is in centric

relation. This may or may not coincide with the maximal intercuspal position (GPT-8)

Maximum Intercuspation
The complete intercuspation of the opposing teeth independent of

condylar position, sometimes referred to as the best fit of the teeth


regardless of the condylar position.(GPT-8)

Articulation

It is the static and dynamic contact relationship between

the occlusal surfaces of teeth during function


GPT(8)

History

Fictional period (prior to 1900)

Hypothetical period (1900-1930)

Factual period (1930 to present )

Gliding of teeth

Edward Hartley Angle

Mathew Cryyer Calvin Case

B.E Lischer Paul Simon

Millo hellman

Concept of dynamic occlusion

Pioneers like Fuller, Clark & Imerie propagated antagonism &

meeting or gliding of teeth.


Eugene Talbots text(1900) irregularities of teeth & their treatment

Edward angle (1899) gave the key to occlusion.


Mathew Cryyer & Calvin case
Occlusion refers to the closure of teeth one upon the other & normal dental relations, normal occlusion and typical occlusion refering to the standard anatomical occlusion

B.E Lischer & Paul Simon (1922)


Broadened the concept of occlusion. Related teeth to the rest of the face & cranium.

Milo Hellaman

Advocated racial variation in occlusion

Based on facts rather than fiction.

Holly Broadbent & Haus Planer (1930) occlusion =

interdigitation

of

teeth

status

of

controlling

musculature & functional factors


1.

2 School of thoughts
Gnathology Functionalism

2.

Gnathological concept of occlusion


Dr. Beverly B. McCollum "Father of Gnathology." Dr. Harvey Stallard proposed the word Gnathology. Derived from "Gnathos," jaw + "ology," study of, or knowledge of. Dr. McCollum founded the Gnathological Society (1926).

McCollum define Gnathology as:

Gnathology is the Science that treats the biologics of the masticating mechanisms; that is, the morphology, anatomy,

histology, physiology, pathology and the therapeutics of the oral


organ, especially the jaws and teeth and the vital relations of the organ to the rest of the body."

In 1927, Harvey Stallard recognized that the teeth dictate the arc of

closure and the occluded position of the mandible. If articulators were to be used to reveal mal-occluded teeth, then "interocclusal records" would be needed to mount the casts in the centric relation position.
In 1930, Dr. Charles Stuart and Dr. McCollum developed the first

semi-adjustable articulator called the McCollum Gnathoscope.


In 1934, with the aid of Dr. Stuart, McCollum produced the first

mandibular movement recorder known as the McCollum Gnathograph.

ARNE G. LAURITZEN
Direction of occlusal stresses located close to the long axis of teeth allows

restoration of dentition in max. Intercuspation at centric relation position


Occlusal loads fall on as great no. Of teeth as possible Optimal tooth-to-tooth occlusion should reach terminal hinge-axis

intercuspation without interferences


Ideal relations obtained with canine-guided occlusion Group contact b/w upper & lower anterior teeth during protrusive

movement

NILES GUICHET & GNATHOLOGY


Explained adv. Of canine guidance by means of biomechanics

Denar articulator was used

Concept followed canines have a mechanical adv. of standing

lateral stress 8 times than 2nd premolars

FREEDOM IN CENTRIC CONCEPT


POSSELT 1st to describe its principles Functional occlusion support from Ramfjord &

Ash
Max. Intercuspation & centric relation are

concident but flat areas on the depth of fossae, on which opposing cusps occlude will allow for a certain degree of freedom in both centric & eccentric movements without guiding influences of occlusal inclines

PANKEY MANN-SCHUYLER CONCEPT

Obj: optimal health, masticatory effeciency, comfort & esthetics

Characteristics:

i.
ii. iii.

Stable & static contacts over greatest no. Of teeth in centric relation
Long centric Group function during lateral excursions No contact on balancing side During protrusive movements, an immediate disocclusion of post. Teeth might occur

iv.
v.

DAWSONS CONCEPT
CRITERIA FOR IDEAL OCCLUSION:
i.

Stable contacts on all teeth at the level of centric relation with positioning of condyles at highest point aganist eminentia Anterior guidance must be in harmony with border movements of envelope of motion Disocclusion of all post. Teeth during protrusive movements & on balancing side Gp. Function on working side

ii. iii. iv.

For development of an ideal occlusion ant. Teeth are more capable of


supporting stress than posterior bcoz of:

1.

Mechanical position in relation to the fulcrum (tmj) & force


(masticatory muscles)

2.

Higher density of bone surrounding ant. Long roots

3.

Better crown to root ratio

Dawson presented his theory of nutcracker The nut ant. Teeth is from fulcrum (condyles), lesser would be the

force exerted on the nut.

European conceptual model


Also k/a Gerbers Condylar Displacement Theory
Any deviation related to this mandibular centralization

constitutes a condylar displacement.

Concepts of occlusion

Bilaterally balanced occlusion

Unilaterally balanced occlusion/ Group function

Mutually protected occlusion

Not used in FPD

Anterior protected articulation

Canine protected articulation

Bilaterally balanced occlusion


Based on the work of Von Spee & Monson.

Not used in fixed prosthodontics today.


It states that a maximum numbers of teeth should contact in all

exursive positions of mandible


Advantages

Useful in complete denture . Increases stability

Disadvantages

Increases rate of occlusal wear


Accelerated periodontal breakdown Neuromuscular disturbances

Unilaterally balanced occlusion/ Group Function


Its origin is in the work of Schuyler. Who demonstrated the destuctive nature of tooth contacts on the non-working side and

concluded cross-arch balance not required in natural teeth.


Teeth on non- working side are not in contact Most desirable group function consists of canines, premolars & sometimes the mesio-buccal cusp

of the first molar on the working side.


Any laterotrusive contacts more posterior than the mesial portion of the first molar are not

desirable because of the increased amount of force that can be placed as they are near the fulcrum and force vectors.

Advantages
Distributes occlusal loads better Absence of contacts on non-working side prevents those teeth from

being subjected to the destructive


Saves centric holding cusps from excessive wear. Maintains occlusion

Disadvantages
Excessive load on posterior teeth of working side.

Mutually Protected Occlusion


During the early 1960s the occlusal scheme called Mutually

Protected Occlusion was advocated by Stuart & Stallard


Based on earlier work of DAmico This concept states that anterior teeth bear all the load and posterior

teeth are disoccluded in any excursive position of the mandible.


Centric relation coincide with maximum intercuspation. Anterior teeth contact very lightly or slightly out of contact (approx.25

micron)
Anterior teeth protect posterior teeth in excursions & post. Teeth

protects ant. Teeth in intercuspation.

An occlusal scheme in which the posterior teeth prevent

excessive contact of the anterior teeth in maximum intercuspation, and the anterior teeth disengage the posterior teeth in all mandibular excursive movements. Alternatively, an occlusal scheme in which the anterior teeth disengage the posterior teeth in all mandibular excursive movements, and the posterior teeth prevent excessive contact of the anterior teeth in maximum intercuspation

( GPT -8)

FRONTAL VEIW WITH MOLARS IN CENTRIC RELATION

CONTACT ON WORKING SIDE

DIS OCCLUSION ON NON WORKING SIDE

LATERAL EXCURSION

CENTRIC OCCLUSION VIEWED LATERALLY

IN PROTUSION ONLY MAXILLARY AND MANDIBULAR INCISORS ARE IN CONTACT

ANTERIOR PROTECTED ARTICULATION


Also k/a ORGANIC OCCLUSION
A form of mutually protected articulation in which the vertical and

horizontal overlap of the anterior teeth disengages the posterior teeth in all mandibular excursive movements(GPT-8)
Centric relation position and maximum intercuspation are coincident .

The posterior teeth are in a cusp fossa relationship, one tooth to one

tooth contact .

Each functional cusp contacts the occlusal fossa at 3 points ,

while the anterior teeth disocclude .

In protusive movement , the maxillary 4 incisors guide the

mandible and disclude the posterior teeth (Boderson 1978)

CANINE PROTECTED OCCLUSION

Also k/a CANINE GUIDED OCCLUSION A form of mutually protected articulation in which the vertical and

horizontal overlap of the canine teeth disengage the posterior teeth in the excursive movements of the mandible (GPT-8)

Canine acts as natures stress breaker.

Mandibular eccentric movements are guided by the canines except in

protusive movement, so the canine are a key element in occlusion .

Cuspid rise - right side. No posterior teeth in contact.


Nicely aligned teeth.

CanineGuided Occlusion
During crossover, guidance is from anterior teeth. Cuspid rise in other direction. No posterior contacts. During crossover, none of the posterior teeth on other side are contacting either.

CANINE GUIDANCE ON WORKING SIDE

NO CONTACTS ON NON-WORKING SIDE IN LATERAL EXCURSION

LINGUAL OFCANINE THE CANINE RISE LINGUAL VIEW VIEW OF THE RISE

ANATOMICAL EVIDENCE IN SUPPORT OF CANINE GUIDED OCCLUSION


Canines are best suited to accept horizontal forces because: Longest & largest roots Best crown-root ratio

Surrounded by dense compact bone


the location far from T.M.J Many receptors are present in the periodontal ligament , so it

controls lateral pressure by directing vertical masticatory


movements .

Advantages: Absence of frictional wear Minimizes horizontal loading of post. Teeth as they come in contact at

the very end of chewing stroke.


In intercuspation, no obliquely directed forces on anterior teeth. Ease of fabrication

Greater tolerance by patients

Disadvantages
Good periodontal health of anterior teeth must Angles class II or III can not be guided by ant. Teeth Cannot be used in Crossbite situations Missing / prosthetic canine

Posterior determinants
Right & left TMJ & associated structures.

Posterior determinants of occlusion. A, Angle of the articular eminence (condylar guidance angle). 1, Flat; 2, average; 3, steep. B, Anatomy of the medial walls of the mandibular fossae. 1, Greater than average; 2, average; 3, minimal sideshift.

A shallow protrusive condylar inclination requires short cusps (A), while a steeper path permits the cusps to be longer(B)

A pronounced immediate lateral translation requires that the cusps to be short (A), while gradual lateral translation allows the cusps to be longer (B).

The angle between the working (W)and the non-working path(NW) is greater on teeth located farther from the condyle

Anterior Determinants

PATIENT ADAPTABILITY
There may be differences in the adaptive response of a patient to

occlusal abnormalities.

Individuals with a lower threshold will be unable to tolerate even trivial

occlusal deficiencies

Patient with raised threshold may adapt to distinct malocclusions.

IMPORTANCE OF OCCLUSAL HARMONY

Ideal mandibular function results from a harmonious relationship of all

the muscles that move the jaws.

If intercuspation of tooth is not in harmony with the joint- ligament-

muscle balance, a stressful and tiresome protective role is forced onto the muscle

Williamson using EMG procedures showed that


interfering contacts on posterior teeth in any eccentric position causes hyperactivity of the elevator muscles. (JPD 1983;49;816-823)

Mongini showed direct relationship between the shape of

the condyle after remodelling & abrasion patterns on the

teeth.

Muscles must have complete freedom to function with no

extended demands on any muscle or group of muscles.

Ligaments must be permitted to assume their bracing roles

to permit muscles to rest.

If occlusion is in harmony, then least horizontal stresses

fall on teeth.

IF OCCLUSION IS NOT IN HARMONY


Pain, tenderness Teeth may exhibit hypermobility, open

contacts or abnormal wear.


Widened periodontal ligament space .
Periodontal defects. Extensive bone loss. Rapid tooth migration.

Unstable occlusion. Removal of a tooth without replacement has led to tilting and drifting.

Widened periodontal ligament space and increased mobility of mandibular molars. Occlusal premature contacts were noted in lateral and protrusive movements

Bruxism & clenching.


Muscle spasm & pain. Excessive deviation in closing & opening

of mandible due to asymmetric muscle activity.


Restricted opening & trismus due to

mandibular elevator muscles spasm.


Pain, clicking or popping in TMJ.

Midline deviation during opening and closing movements can be indicative of asymmetric muscle activity or joint derangement. Here, during opening, less than optimal translation occurs on the patient's left side.

MYOFACIAL PAIN DYSFUNCTION


Diffuse unilateral pain in pre-auricular area with muscle tenderness,
clicking or popping noises in the contra lateral TMJ & limitation of jaw function .

TREATMENT GOALS FOR OCCLUSION TO BE IN HARMONY

The Objectives of occlusal treatment are as follows:


1. To direct the occlusal forces along the long axes of the teeth

2. To attain simultaneous contact of all teeth in centric relation


3. To eliminate any occlusal contact on inclined planes to enhance the positional stability of the teeth

4. To have centric relation coincide with the maximum intercuspation


position 5. To arrive at the occlusal scheme selected for the patient (e.g., unilateral

balanced versus mutually protected)

Occlusal treatment should be: tooth movement through orthodontics, elimination of deflective occlusal contacts

through selective reshaping of the occlusal

surfaces of teeth,
the restoration and replacement of missing

teeth resulting in more favorable distribution of occlusal force.

The modification of the occlusal form of the teeth with the


intent of equalizing occlusal stress, producing simultaneous occlusal contacts or harmonizing cuspal relations ( GPT 8)


1.

EQUILIBRATION PROCEDURES :
Reduction of all contacting tooth surfaces that interfere with terminal hinge axis closure

2.

Selective reduction of tooth structure that interferes with lateral excursions

3.

Elimination of all post. tooth structure that interferes

with protrusive excursions


4.

Harmonization of ant. guidance

Interferences are undesirable occlusal contacts that may

produce mandibular deviation during closure to maximum intercuspation or may hinder smooth passage to and from the intercuspal position. (GPT-8)

Types of occlusal interferences. 1. Centric 2. Lateral

Working
Nonworking Protrusive

LOCATING OCCLUSAL INTERFERENCES


The centric relation position for each condyle must be

confirmed before tooth contacts are marked

Firm pressure must be used to test the position

Pressure should not be applied until after the condyles have

been gently manipulated to the suspected CR seat

Loading pressure should be directed to seat the condyles against

the eminence while firm upward pressure is also being applied


Distalization of condyles should be avoided CR located at open position Now hold mandible on its terminal axis & close on that arc by

increments of a mm or two at a time


Continue a slow opening closing movement until the first tooth

contact occurs 1st INTERFERENCE


Let pt. Feel the first contact, hold that position for a sec. & Then

squeeze it determines direction & degree of slide from CR

The CENTRIC INTERFERENCE is a premature contact - occurs when the mandible closes with the condyles in their optimum

position in the glenoid fossae .


It will cause deflection of the mandible in a posterior, anterior, and/or lateral

direction.

ELIMINATING INTERFERENCES TO CENTRIC RELATION

Differentiated into two types :

1.

INTERFERENCES TO THE ARC OF CLOSURE

2.

INTERFERENCES TO THE LINE OF CLOSURE

If the patient slides his mandible to obtain tight closure it indicates the presence of occlusal discrepancies.

INTERFERENCE TO THE ARC OF CLOSURE


As condyles rotate on their terminal hinge axis, each lower tooth follow

an arc of closure all the way to the most closed occlusal position without any deviation off this arc.

Any tooth structure that interferes with this closing arc has the effect of

displacing the mandible forward of interference to reach the most closed occlusal position

Primary interferences that deviate the condyle forward produce

Anterior Slide

CORRECTION MUDL : Grind the mesial inclines of upper teeth or distal

inclines of lower teeth

INTERFERENCE TO LINE OF CLOSURE

Interferences that cause mandible to deviate

to left or right from 1st point of contact to

most closed position


1.

Grinding rules are :


Interfering incline causing mand. To deviate off the line of closure towards the cheek

Grind the buccal incline of the upper or the lingual incline


of the lower, or both inclines

2.

If interfering incline causes the mandible to deviate off the line of


closure towards the tongue : Grind the lingual incline of upper or buccal incline of lower, or

both inclines

If interferences produce deviations off both arc of closure & the line of closure at same time : Upper inclines are adjusted on inclines that face the same direction as slide. Lower teeth are adjusted by grinding off inclines that face the opposite direction from path of slide.

LATERAL EXCURSION INTERFERENCES

Path followed by lower posterior teeth as they leave CR &


travel laterally is dictated by :

1.

Border movements of condyle which act as the post. Determinant

2.

Anterior guidance, which act as ant. Determinant

A WORKING INTERFERENCE
may occur when there is contact between the maxillary and mandibular

posterior teeth on the same side of the arches as the direction in which the mandible has moved.

If that contact is heavy enough to disocclude anterior teeth, it is an interference.

A NONWORKING INTERFERENCE is an occlusal contact


between maxillary and mandibular teeth on the side of the arches opposite the

direction in which the mandible has moved in a lateral excursion .

The nonworking interference is of a particularly destructive nature.

The potential for damaging the masticatory apparatus has been attributed to

changes in the mandibular leverage, the placement of forces outside the long axes of the teeth, and disruption of normal muscle function.

LOCATING LATERAL INTERFERENCES


Manipulate mand. To CR

Teeth to be closed on terminal axis arc until they contact, hold onto

this position
On working side, thumb is released & all 4 fingers used to exert upward

pressure on working condyle

On balancing side pressure to be exerted towards working condyle

While maintaining pressure with both hands, ask pt. To slide jaw to left

or right

Assistant should insert marking ribbon in dry mouth to record

interferences

ELIMINATING LATERAL INTERFERENCES

Balancing side interferences


Eliminate all contact on inclines as soon as lower teeth move out of CR & start towards the tongue

Grinding rule :
BULL - grind the buccal inclines of upper or lingual inclines of lower

Protrusive interferences
A premature contact Only front teeth should touch in protrusive excursions
Occurring between the mesial aspects of mandibular posterior teeth and the

distal aspects of maxillary posterior teeth.

Grinding rule DUML : grind

distal inclines of upper or,

mesial incline of lower teeth

Occlusal splints, occlusal appliances or orthotics Used extensively in the management of TMJ disorder & bruxism Helpful in determining where a proposed change in a patients occlusal

scheme will be tolerated


Fabricated in an acrylic resin overlay

Fabrication of the device: Direct procedure with a vacuum-formed

matrix(autopolymerized)
Indirect procedure with autopolymerizing acrylic

resin
Indirect procedure with heat-polymerized acrylic

resin

CONCLUSION
Most restorative procedures affect the shape of occlusal surfaces.

Proper dental care ensures that functional contact relationships are restored in harmony with both dynamic & static conditions.

Therefore, maxillary & mandibular teeth should contact to allow

optimum function, minimal trauma to supporting structures, & an even load distribution throughout dentition

References
Books Iven klineberg,rob jagger; Occlusion And Clinical Practice-an Evidence-based Approach John Dos Santos Jr; Occlusion- Principles & concepts Dawson; functional occlusion From TMJ To Smile Design Dawson; Evaluation, diagnosis & treatment of occlusal problems Okeson; Shillingburg , Hobo, Whitsett, Jacobi, Brackett; Fundamentals Of Fixed Prosthodontics Rosensteil, Land, Fujimoto; Contemporary Fixed Prosthodontics

Journals
JPD1983;49;816-823 Ogawa, Ogimoto: Pattern Of Occlusal Contacts In Lateral Position:

JPD 1998;80;67
Schuyler: Factors of Occlusion As Applicable To Restorative

Dentistry; JPD 1953;3; 772-715


Pokorny, Weins,Livtak: Occlusion For Fixed Prosthodontics A

Historical Perspective of the Gnathological Influence; JPD 2008;99;299-313


Johnson: Variations in Organic Occlusion ;JPD 1979;41;625-629 Clark, Evans: Functional Occlusion: A Review; JO 2001;28;1;76-81 Stuart: Good Occlusion For Natural Teeth; JPD 1964;14;716-724