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Functional Occlusion and Orthodontics: A Contemporary Approach
Functional Occlusion and Orthodontics: A Contemporary Approach
Abstract
The authors have undertaken a deep review on funcional occlusion, from historical to contemporary
concepts. Also the interrelationship between occlusion and orthodontic treatment was described, proposing
objectives that should be achieved to establish good harmony with the stomatognatic system.
Keywords: Functional occlusion; Orthodontics; Treatment goals.
Resumo
O primeiro objetivo deste trabalho foi realizar uma reviso de literatura sobre ocluso esttica e dinmica,
revisando desde conceitos histricos at os conceitos mais aceitos atualmente. O segundo objetivo foi unir
estes conceitos com o tratamento ortodntico, definindo, a partir da, como o ortodontista deve tratar seus
casos, assegurando a harmonia de todo o aparelho estomatogntico.
Palavras-chave: Ocluso funcional; Ortodontia; Objetivos de tratamento.
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Evolution of a concept
The word occlusion comes from the latin expression occludere which means to close.
According to Galvo (1) this term is related to the
estatic or dynamic arrangements that exist between opposed teeth. Occlusion also means the functional relationships of all components of the mastigatory system, such as bone, TMJ, muscles and
supporting tissues.
Other authors (2,3) state that the initial
concept of occlusion was related to fixed relations
of the jaws, but a correct analysis has to take into
consideration all tissues involved, including the
TMJ, as well as all stimuli that derives from the
oclusal contacts like curve of Spee, cusps height,
condilar guidance and the occlusal plane.
Primary studies on occlusion include the
area of prosthodontics (4, 31) because early specialists needed to know how teeth should get in
contact. Therefore the development of the concepts of occlusion are directed related to the evolution of articulators. Since Phillip Pfaff in Germany
in 1756 (1) has registered the bite thus obtaining
plaster models, many other pioneers studied dental contacts through the use of articulators (4,5),
including parameters to the position of the condyles into the fossae and the concept of balanced
occlusion .
As time occurred, some of early concepts
became tested principles thus originating philosophies, the main ones consisting of the balance
and the non-balanced occlusion. The first followed principles of Bonwill (5),Monson (6), Wadsworth (7), Gysi(8) and others, and its main foundation included multiple contacts of opposing teeth both in centric as well as excentric mandibular
movements.
In 1926 a new and organized school of
occlusion was criated, the Gnatological Society of
Califrnia (9, 10), defining gnatology as the science that treats the biology of the masticatory apparatus . This masticatory system should be considered as a functional unit, thus providing: 1. the
coincidence between centric relation (CR) and centric occlusion (CO); 2. a well balanced occlusion
during slidind movements, with bilateral multiple
balanced contacts (11).
In 1950 (12), opposed to the gnatological principle, eroded the concept of the long
centric (12), which would mean freedom of man-
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health periodontium
accepted esthetics
good masticatory function
normal phonetics
absence of parafunctional habits
no TMJ pathological evidence
oclusal loads distributed along the vertical axis of teeth.
adequate anterior guidance
good bilateral balance
minimum muscular tension plus maximum efficiency.
minimum dental wearing
During all functions of the masticatory
system, the mandible assumes a variety of positions from centric to excentric movements. In
order to analyse all the aspects involved we
should consider occlusion from maximum intercuspation to all mandibular movements.
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Mandibular movements
During ideal mandibular movements two
factors are of umost importance : freedom of movement and economy of muscular energy. These
conditions are provided by anterior guidance in
protrusive movements and by canine protection
or group function in lateral excursions.
According to Fantini (39) one must
differenciate total from partial group function, the
latest meaning that not all teeth in the working
side are involved with the disoclusion process.
Neverthless, many patients include only the canines and bicuspids in such gnatological approach.
In ideal occlusions anterior guidance
orients mandibular movements and shall be able
to provide MIP without articular or neuromuscular
accommodation, which by all means represents
economy in muscular energy .
According to Kahn (40), canine guidance
is the main mechanism to disoclude posterior teeh
from the working side. On the other hand, the key
factor for disoclusion in the balance side is the
sliding movement of the condyle through the posterior slope of the articular eminence. The canine
protected occlusion concept (41,42,43) is based
upon the fact that the canine tooth is the most
appropriate element to guide mandibular lateral
excursion due to crown morphology, root and
periodontal strength plus superior proprioceptive
mechanism.
Other authors (44) did some eletromiografical studies on elevator muscles relating them
to group function or canine protection. Results
demonstrated in group function there was a clear
reduction in muscle action when compared to intercuspal position, mainly to the temporal muscle
from the balance side. When analyzing canine protected occlusions, reduction in muscle activity was
greater than in group function.
According to Lee (23) canine guidance is
optimum to :
avoid excentric lateral interferences of
posterior teeth.
provide freedom of condilar movements.
orient mandibular closure in a more
vertical pattern.
According to Roth (35), incisal guidance should be established by all six upper and
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eight lower anterior teeth, thus dividing protrusive load. Smooth anterior guidance are vital not
only to appropriate function during mandibular
excursions but are strongly related to occlusal stability after orthodontic treatment. He stresses that
excessive lateral load on the canines may result in
lingual movement of the lower cuspids with subsequential anterior crowding.
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the balance side, as well as smooth anterior contacts in protrusive is of utmost importance to achieve good functional occlusion (50).
Case presentation
chform assimetry, anterior aesthetics and some difficulty in chewing. There was no significant medical history. His oral hygiene was good and he
had received routine dental care since early childhood. Despite presenting some interferences no
significant signs or symptoms of temporomandibular joint were related.
lateral incisors in working side; c) Some interferences in the balance side, right and left.
Treatment objectives
Treatment objectives were primarily dentoalveolar, improving dental positions, midline
correction, overbite correction and a very accurate
interarch coordination. This last procedure is a key
factor to achieve a good functional occlusion, namely proper incisal guidance, desoclusion by canines in lateral movements and a final reciprocal
protected occlusion.
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Treatment progress
Maxillary and mandibular .022 preajusted Edgewise mechanism / Roth prescription was placed. Initial alignment and leveling
were achieved with a sequence of thermoactivated niti wires. Vertical control and deep-bite
correction was achieved by using one set of
reverse Curve of Spee arches. After a sequence
of round stainless steel arches, proper arch form
and coordination was reached through rectangular .019 x .025 SS arches, with individual
torque control plus finishing detailing.
Appliances were removed after 22 months of active treatment. The patient was instructed to wear upper and lower Hawley retainers
Treatment results
The observed dentoalveolar alterations are
seen in postreatment figures. Little skeletal modifications occurred, as expected. Good teeth positions were achieved, with proper overjet and overbite, midline correction and nice upper and lower
arch forms. Important to note the solid intercuspal
relationship obtained as well as adequate incisal
guidance. The key factor in eliminating posterior
interferences was the strong canine contact in the
working side, sufficient enough to provide good
guidance and protection in lateral movements.
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Conclusions
Good functional occlusion was achieved
in a moderate crowed Class I malocclusion, with
good patient cooperation. Timely and contemporary orthodontic procedures based on solid gnatological principles changed a poor functional occlusal environment into a nice, pleasant and functional interarch relationship, probably preventing
many potential problems in the years to come.
References
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