INTRODUCTION

“The perpetual preservation of what remains is much more important than
the meticulous replacement of what is missing”
-De Van.
Occlusion is fundamental to the practice of dentistry, in providing a
biologically functional restoration and for comprehensive patient care.
In 1899, Edward Angle made the first description of the occlusal
relationships of teeth. As restorability and replacement of teeth became more
feasible, occlusion became a topic of interest and discussion. In all fields, an
understanding of occlusion is paramount for enhancing aw function, defining
lower face height, ! aesthetic needs, more so in restorative dentistry !
prosthodontics.
Earlier dental occlusion had been described as the way in which teeth
contact. A modern understanding of occlusion includes the inter"relationship of
teeth, #$%, aw muscles, nerves, as well as the relationship of ma&illa !
mandible when they are in functional contact during activity of mandible. #his
whole system is referred to as “Masticatory or Stomatognathic System”..
A dental restoration after being attached to the tooth becomes one of the
essential components of the stomatognathic system. 'erhaps the most neglected
phase of restorations (esp., individual restorations) is the re"establishment of
occlusion. *ence, any restoration (from intracoronal direct restoration to
comple& crown and bridge wor+) must be planned to conform to the e&isting
occlusal pattern and not to disturb it unless for very specific purposes such as
pre"e&isting occlusal instability. ,estorations must be designed to restore
occlusal harmony without introducing cuspal interferences ! establish occlusal
harmony in non"e&istent cases -Occlusal therapy.. /rom single amalgam filling
to the restoration of two complete arches, changes will invariably ta+e place in
occlusal function. 0hen minor, adaptation to these changes by the patient1s
tissues will ta+e place.
" 1 "
DEFINITION AND TERMINOLOGIES
Occlusion literally means “closing”. 2orland1s Illustrated $edical
dictionary defines to occlude as 3to close tight, as to bring the mandibular
teeth into contact with the teeth in the maxilla.”
In dentistry, occlusion has been defined as4
 3Any contact between the incising ! masticating surfaces of the ma&illary
and mandibular teeth.5 6 G.P.T
0hen the aws are closed and teeth are in contact, this is termed as
“static” occlusion.
*owever, occlusion mainly occurs as momentary contacts during
mandibular movements and is termed as “Dental Articulation” or “Dynamic
occlusion”. /or convenience sa+e, occlusion ! articulation have been grouped
as a single phenomenon, referred to as Occlusion.
 Articulation is defined as 3the dynamic contact relationship between the
occlusal surfaces of the teeth during function5 6 G.P.T.
 3#he contact of teeth in opposing dental arches, when they are in contact
(static) and during various aw movements (dynamic)5 6 STURDEVANT.
,ecently, interactions between the components of stomatognathic
system (787) have been ta+en into consideration and occlusion has been
defined as4
 3An integral part within the 787 that relates teeth not only to other
teeth, but importantly to the other components of the 787 during normal
function, parafunction ! dysfunction. #he 787 therefore combines the
#$%, muscles, periodontium and teeth into one functional unit.5 6
ALEX MILOSEVIC (DENTAL UPDATE 2003.
A variety of occlusal schemes can be found in healthy individuals
resulting in different terminologies of occlusion, which seem to co"e&ist. #hese
include4
9
IDEAL OCCLUSION!
#he :ideal1 occlusion, described by orthodontists

mainly, is derived from
the wor+ published

by Angle (19;;) and Andrews (19<9, 1989), and focuses on
specific

anatomical relationships of the teeth and dental arches i.e.= static
relations. It is a pre"conceived theoretical concept of occlusal structural and
functional relationships that include ideal characteristics that an occlusion
should have.
T"# c"$%$c&#%is&ics o' $n i(#$l occlusion $%#!
a. 7table aw relationships on occlusal contact in centric relation
and centric occlusion.
b. #here should be even pressure on central parts of dis+s in both
#$%s in centric relation and centric occlusion.
c. >etween centric relation and centric occlusion, there should be an
unrestricted glide with maintained occlusal contact
d. ?omplete freedom for smooth gliding occlusal contacts during
e&cursive movements.
e. Occlusal guidance should be only on the wor+ing side.
f. #here should be no soft tissue impingements from occlusal
contacts.
FUNCTIONAL ) P*+SIOLOGIC OCCLUSION!
#his refers to an occlusion which may deviate from ideal but is well
adapted to that particular environment with no pathologic manifestations or
dysfunctions.
@
It is an occlusion where the teeth and periodontium do not destroy
themselves and patient e&hibits adeAuate comfort, highest masticatory function,
good phonetics, esthetics with absence of myofascial pain syndromes. #hus,
these criteria are more subective and vary with patient1s needs and are affected
by psychic or emotional stress and non functional habits.
This definition of occlusion is the one most commonly followed by
operative dentists and periodontists.
PAT*OLOGIC OCCLUSION!
It is defined as one in which sufficient disharmony e&ists between the
teeth ! the #$% to result in symptoms that reAuire intervention.
7ometimes, when adaptive capacity of physiologic occlusion is
decreased, it may become pathologic.
COMPONENTS INVOLVED IN OCCLUSION
%ustification of the need to e&amine the patientBs occlusion will initially
involve a study of the influences of components of masticatory system and
mandibular locomotive systems.
$andibular movement is influenced by two hard tissue guidance
systems, -controlled by the neuromuscular system.. #hey include4
• Occlusal surfaces of teeth (anterior guidance) " teeth are in contact.
• #emporomandibular oints (posterior guidance)"when teeth are out of
contact.
#hey also involve the interactions of the ma&illa ! mandible.
TEET*!,.
Incisor 6 contribute significantly to function, esthetics and phonetics.
C
?anines 6 7erve as important guides in occlusion because of their
anchorage and strategic position.
'remolars ! molars 6 function in final mastication of food !
maintaining vertical dimension of face.
#he teeth provide a stable vertical and distal relation of the mandible to
the ma&illa by virtue of intercuspal relation of opposing teeth. #hey play a
maor role in determining occlusion and malocclusion.
MAXILLA!,
#he ma&illary teeth are aligned in the alveolar process of the ma&illa
fi&ed to the anterior portion of the s+ull. #he ma&illary arch is slightly larger
than the mandibular arch which usually causes the ma&illary teeth to overlap
the mandibular teeth both vertically and horiDontally when in occlusion. the
ma&illary teeth are considered to be a fi&ed part of the s+ull ! therefore ma+e
up the stationary component of the masticatory system.
MANDI-LE!,
#he mandible is a E"shaped bone suspended below the ma&illa by
muscles, ligaments, and other soft tissues which therefore provide the mobility
necessary to function. It supports the lower teeth. #he condyle is the portion of
mandible that articulates with the cranium, around which movement occurs.
?ondyle from the anterior view has a medial ! lateral proection called
the medial and lateral poles respectively. #he medial pole is generally more
prominent than the lateral. #he total mediolateral length of the condyle is 1F"
9;mm and the anteroposterior width is 8"1;mm.#he articulating surface of the
condyle e&tends both anteriorly and posteriorly to the most superior aspect of
the condyle with the posterior articulating surface greater than the anterior
surface. #he articulating surface of the condyle is Auite conve&
F
anteroposteriorly and only slightly so mediolaterally. #he anterior and superior
articular surfaces of the condyle are covered by fibrocartilage.


TEMPOROMANDI-ULAR .OINT /TM.!,
#he #$% is one of the most comple& oints in the body and forms the
articulation of the mandible to the cranium.
#he #$% is formed by two articulating surfaces4
 Articulating surfaces of the temporal bone
 Articulating surfaces of the mandibular condyles.
7eparating these two bones from direct articulation is the :Articular
disc.1

MOVEMENTS OF T*E TM.!
G
#he movements at the #$% can be divided into those between the
articular surface and the condylar disc and those between the disc and the head
of the mandible. $ost movements occur simultaneously at the right and left
temporomandibular oints.
#wo types of movements occur in the #$% 6
1. ,otation 9. #ranslation
otational Movement!
It is the :'rocess of turning around an a&is= i.e. movement of a body
about its own a&is.1 It is mainly seen to occur within the inferior cavity
between superior surface of the condyle and inferior surface of disc, as only an
opening and closing motion i.e. hinge movement. In centric relation the
mandible is free to rotate around a fi&ed terminal horiDontal hinge a&is of
rotation. It is the only :pure1 rotational movement seen in
mandibular activity.
T#%0in$l *in1# A2is /*o%i3on&$l 4 0hen the condyles
are in their most superior position in the articular fossae
and the mouth is purely rotated open, the a&is around
which movement occurs is called the :#erminal *inge A&is1.
Translational Movement!
#ranslation can be defined 3as a movement
in which every point of the moving obect has
simultaneously the same velocity and direction5.
It occurs within the superior cavity of the
oint, between the superior surface of the articular
disc and the inferior surface of the articular fossa.
#he movements of #$% seen in=
a) /orward movement or protrusion  disc glides forward over the upper
articular surface, head of mandible moving with it. In straight protrusive
<
movement from centric relation, the mandible illustrates a pure
translatory movement.(,eversal of this movement is called retraction)
b) 2epression of mandible (slight opening)  head of mandible rotates on
undersurface of disc li+e a hinge.
c) 0ide opening of the mouth  this hinge li+e movement is followed by
a forward gliding of the disc ! head of the mandible as in protraction.
At the end of this movement, the head comes to lie under the articular
tubercle. #hese movements are reversed in closing of the mouth(or
elevation of the mandible)
$andibular movements occur as a combination of translation and
rotation resulting in very comple& movements. As the mandible is a rigid bone
with oints on both ends, movement of one oint will produce reciprocal
movement in the other oint.

a) view of condyle in protrusion
b) Rotation of condyle in centric
relation round in the terminal hinge axis:
8



c) in wide opening of mouth
MUSCLES OF MASTICATION!,
$andibular movements are produced by a comple& interaction of the
muscles of mastication, the postural muscles of nec+ and thora& and the facial
muscles.
/our pairs of muscles are generally regarded as :'rimary $uscles Of
$astication1, namely=
 $asseter
 #emporalis
 $edial 'terygoid
9
 Hateral 'terygoid
$uscles concerned with forced depression of the aw, movements of the
tongue, elevation of floor of the mouth, placing and retaining of the bolus of
food between the dental arches can be considered as :7econdary $uscles of
$astication1. #hese muscles include=
 2igastric muscle
 $uscles of tongue (8eniohyoid)
 $ylohyoid
 >uccinator and Orbicularis oris.
FUNCTIONS OF MUSCLES
1;
TEMPORALIS
MASSETER
MEDIAL PTER+GOID
DIGASTRIC
GENIO*+OID
LATERAL
PTER+GOID
M+LO*+OID
El#5$&ion
D#6%#ssion
R#&%$c&ion P%o&%$c&ion
CONCEPTS OF OCCLUSION
?oncepts of occlusion vary with almost every specialty of dentistry.
Early ideas regarding occlusion were often based on complete dentures and
later on orthodontic reAuirements.
 -ALANCED OCCLUSION !
#his was the first significant concept of occlusion, which was developed
primarily for complete dentures and evolved from 18;;s to19@;s. It was widely
accepted as it increased the functional stability and effectiveness of complete
dentures.
It is defined as 3the simultaneous, bilateral contacting of ma&illary and
mandibular teeth in anterior ! posterior occlusal areas in centric and eccentric
positions 6 8.'.#
#his concept was applied to restoration of natural dentition by $c
?ollum, 7chuyler and others from 19@;s until the 19G;s.#his type of occlusion
is also seen sometimes, in cases of advanced attrition. It was later discarded by
the gnathology group as not suitable for natural dentition.
In natural teeth which have fi&ed bases, balancing side contacts are
inappropriate and potentially harmful as they constitute premature contacts and
were proposed to cause occlusal wear, pdl brea+down, ! #$% disturbances.
*ence, this concept became obsolete as far as natural dentition was concerned.
*owever, some of the principles of balanced occlusion as related to condylar
and incisal guidance, cusp height, curve of spee and plane of occlusion have
been useful in restoration of natural teeth.
 MORP*OLOGIC OCCLUSION !
#his concept, mainly followed by orthodontists, relates to a
consideration of specific tooth to tooth contacts with respect to a pre
determined ideal cusp"to"fossa and inclined plane to inclined plane
relationship.
11
According to this concept, the mesio"buccal cusp of ma&illary first
molar shall fall into the mesio"buccal groove of mandibular first molar. Only in
this relationship is the dentition said to be strong and stable and not causing any
trauma to the periodontium and this occlusion was considered ideal. Angle
further considered any deviation from this relationship to be malocclusion and
further classified them.
*owever, it was found in most people with deviations from
morphologic occlusion that the teeth could function efficiently with no pain or
pathologic manifestations in the stomatognathic system and could be
considered biologically normal. Any modification of such a functionally
satisfactory occlusion to meet the characteristics of this concept is highly
obectionable and contraindicated. *ence this concept was not applied in other
fields of dentistry.
7oon after the gnathology group declared the concept of balanced
occlusion obsolete, there was an emphasis on two aspects i.e.
1. Elimination of posterior contacts on non"wor+ing side-?oncept of
group function occlusion.
9. Immediate disclusion of all posterior teeth by canines -?anine
protected occlusion..
 UNILATERAL -ALANCED )GROUP FUNCTION
OCCLUSION !
It is a widely accepted and used concept in restorative dental procedures
today. #his concept had its origin in the wor+ of 7chuyler and others who
observed the destructive nature of tooth contact on non"wor+ing side and
concluded that cross arch balance was not necessary in natural teeth. In this
type of occlusion=
i. In ?.,.O 6 posterior teeth should be in contact and anterior teeth
may or may not contact.
19
ii. In Haterotrusive movements 6 contact of posterior teeth should
occur only on wor+ing side, with immediate disocclusion on
mediotrusive (non wor+ing) side. #he most desirable group function
consists of canine, premolars ! sometimes mesiobuccal cusp of the first
molar. ?loser the contacts are to the #$% (fulcrum), greater the force
created. >uccal cusp"to"cusp contacts are more desirable.
iii. In 'rotrusive movements 6 only the anterior teeth, not the
posterior teeth, should contact. #he anterior teeth should provide
adeAuate contact or guidance to disarticulate the posteriors.
#he obvious advantage of this concept is the maintenance of occlusion
and prevention of e&cessive wear of centric holding cusps.
 CANINE PROTECTED OCCLUSION 7CUSP TO FOSSA
TRIPODI8ATION9!
Also +nown as “"rganic occlusion”, it had it1s origin by the members
of 8nathological society in the 19G;s. #his concept is the most widely accepted
because of its ease of fabrication ! greater tolerance by patients.
According to this concept, at position of ma&imum intercuspation, all
posterior teeth are in contact with forces directed along their long a&is and all
anterior teeth are slightly out of contact relieving them of obliAuely directed
forces. In any e&cursive position of the mandible, the anterior teeth bear the
entire load while posterior teeth are disoccluded -canine on wor+ing side,
guides e&cursive movements and causes disocclusion of posteriors.. #he
desired result is absence of frictional wear.
As a result of the anterior teeth protecting the posterior teeth in all
e&cursive movements and posterior teeth protecting the anteriors at position of
ma&imum intercuspation, this type of occlusion came to be +nown as
“Mutually protected occlusion”.
Other features of this type of occlusion include4
1@
 Eniform contact of all teeth when the condyles are in their
most superior position.
 7table posterior tooth contacts on vertically directed forces.
 ?,I?O or I?'
*owever the reconstruction of mutually protected occlusion is
sometimes limited by=
 $issing canines.
 'eriodontally wea+ anterior teeth.
 ?lass IIJ III malocclusions where mandible cannot be guided
by anterior teeth.
 ?rossbite cases (reverse occlusion).
In such cases, the most favorable alternative is 8roup function
occlusion.
 CONCEPT OF GNAT*OLOG+!
#his concept was proposed in the 19F;"19G;s by a group of researchers
headed by $c ?ollum. #he study of Gnathology has come to be +nown as 3the
e&act science of mandibular movement and resultant occlusal contacts5.
#his concept was based on the belief that if the hinge a&is (rotational
centers of condyles) could be located ! their border movements recorded (by
pantographic tracing)and reproduced on a fully adustable articulator, then all
functional movements for the patient can also be reproduced by that articulator.
#hus, any number of restorations can be done together.
#he characteristics of gnathology are4
♦ 'oint centric relation (i.e.= ?,I?O).
♦ Ese of a fully adustable articulator
♦ #ripodiDed occlusal contacts (cusp ridge occludes between the
two ridges of opposing cusp).
1C
♦ ?anine disclusion.
♦ All restorations are done together.
 P$n:#;,M$nn,Sc"ul;#%/P.M.S S+STEM OF OCCLUSION!
In opposition to the :point centric1, 2r ?lyde 7chuyler suggested that it
is advantageous to allow a certain amount of freedom of movement in antero"
posterior direction ! proposed this as 3?oncept of long centric5 or 3freedom in
centric5.
/reedom in centric is achieved by an occlusal adustment or by
restorative dentistry and it allows the mandible to close into an intercuspal
position without the need for gross neuromuscular responses to premature
contacts. In this, the supporting cusps ma+e contact with flat areas prepared in
the restored teeth, when condyles are in centric relation and also when slightly
anterior to centric relation.
2r H.2.'an+ey ! 2r Arvin $ann utiliDed this principle and along with
2r 7chulyer adapted the $eyer1s functionally generated path along with
concept of long centric ! proposed the '.$.7 7ystem. #he principles of this
concept include=
♦ Hong centric (freedom in centric).
♦ Anterior guidance is all important.
♦ 'osterior teeth are flatter (>alancing side contacts were
eliminated).
♦ Hower posteriors are restored first then functionally generated
path techniAue is used.
♦ Initial group function then canine rise after 1mm of movement.
♦ Anterior teeth ledged to provide occlusal stops.
#he '.$.7 philosophy of occlusal rehabilitation can fulfill the most
e&acting demands of optimal occlusion and can be adapted to any occlusal
problem. #his concept is also applied to the occlusal bite plane splint.
 OPTIMAL FUNCTIONAL OCCLUSION!
1F
In addition to these philosophies, in the 19<;s, a new concept 6 the
<D+NAMIC INDIVIDUAL OCCCLUSION=6 emerged. #his concept
centers around the health and function of each individual1s masticatory system
! not on any specific occlusal configuration.
If the structures of masticatory system are functioning efficiently and
without any pathology the occlusal configuration is considered acceptable
regardless of specific tooth contacts ! no change in occlusion is indicated.
7uch an occlusion that reAuires minimum adaptation by the patient and is least
li+ely to create any pathologic effects for most people is +nown as “O6&i0$l
'unc&ion$l occlusion.>
#he criteria for :optimal functional occlusion1 has been described by
Oeson. #hese are=
I. 0hen the mouth closes, the condyles are in their most superoanterior
position resting on the slopes of the articular eminences with the discs
properly interposed. In this position, even and simultaneous contact of
all posterior teeth e&ists. #he anterior teeth also contact but they do so
more lightly than the posterior teeth.
II. All tooth contacts provide a&ial loading of occlusal forces.
III. 0hen the mandible moves into laterotrusive positions, adeAuate tooth
guided contacts on the laterotrusive side are present to disocclude the
mediotrusive side immediately. #he most desirable guidance is
provided by the canines(canine guidance)
IK. 0hen the mandible moves into a protrusive position, adeAuate tooth
guided contacts are present to disocclude all posterior teeth
immediately.
K. In the upright head position and the alert eating positions, the posterior
tooth contacts are heavier than the anterior tooth contacts.
1G
#he implication of this concept is that individuals do not necessarily fit
into a prescribed occlusal concept but that each occlusion should be considered
separately and treatment needs to be tailored to individual1s reAuirements.
#his concept is most commonly practiced now"a"days by operative
dentists in the placement of restorations or in correction of occlusion related
disorder.
NORMAL OCCLUSION4ANDRE?S= @E+S OF OCCLUSION
Andrews during the 19<;s observed si& significant characteristics in a
study of 19; casts of non"orthodontic patients with normal occlusion and put
them forward as 3si& +eys to normal occlusion5. *e considered the presence of
these features essential to achieve an optimal occlusion. #hese si& +eys
contribute individually and collectively to the total scheme of occlusion.
@E+ I 4 Mol$% %#l$&ions"i6!
#he mesiobuccal cusp of upper first permanent molar should occlude in
the groove between the mesial and middle cusps of the lower first permanent
molar. It was also consistently demonstrated that the closer the distal surface of
the distobuccal cusp of upper first permanent molar approaches to the mesial
surface of the mesiobuccal cusp of lower second molar, better the opportunity
for normal occlusion. -#he canines and premolars enoyed a cusp"embrasure
relationship buccally, and a cusp"fossa relationship lingually..
1<
@E+ II 4M#sio(is&$l c%oAn $n1ul$&ion!
#he gingival portion of long a&es of all crowns was more distal than the
incisal Jocclusal portion. #he long a&is of crown for all teeth, e&cept molars, is
udged to be the mid developmental ridge (most prominent and centermost
vertical portion of the labial or buccal surface of the crown).#he long a&is of
the molar crown is identified by the dominant vertical groove on the buccal
side of the crown.
Lormal occlusion is dependant upon proper distal crown tip
(angulation), esp. of upper anteriors as it determines the amount of mesiodistal
space they consume, and therefore has a considerable effect on anterior
esthetics as well as posterior occlusion.

@E+ III 4 L$Bio,lin1u$l ) -ucco,lin1u$l c%oAn inclin$&ion!
#he crown inclination is determined from a mesial or distal view. If the
gingival area of the crown is more lingually placed than the occlusal area, it is
referred to as positive crown inclination. In case, the gingival area of the crown
is more labially or buccally placed than the occlusal area, it is referred to as
negative crown inclination.
ANTERIOR CRO?N INCLINATION 6 $a&illary and mandibular
crown inclinations are complimentary and significantly affect overbite and
posterior occlusion. #he contact points move more distally in concert with the
increase in positive upper anterior crown inclination.
18


POSTERIOR CRO?N INCLINATION 6 $a&illary and mandibular
posteriors have a negative crown inclination, right from canines through to the
second molar.
@E+ IV 4 Ro&$&ions!
#he teeth should be free of undesirable rotations. A tooth if rotated
would occupy more space than normal, as well as alter normal tooth contacts,
creating a situation unreceptive to normal occlusion.

@E+ V 4 Ti1"& con&$c&s!
19
• $a&illary incisors 6 positive crown
inclination.
• $andibular incisors 6mild negative crown
inclination.
#o consider an occlusion as normal there should be tight contact points
between adacent teeth (no spaces).


@E+ VI 4 Occlus$l 6l$n#!
A normal occlusal plane ranges from flat to a slight curve of 7pee.
Intercuspation of teeth is found to be best when the plane of occlusion is
relatively flat.
?E,KE O/ 7'EE" It refers to the antero"posterior curvature of the
occlusal surfaces beginning at the tip of the lower cuspids and following the
cusp tips of the bicuspids ! molars continuing as an arc through the condyle.

#hese characteristics have been consistently found in people with
normal occlusion. *ence, these nature1s guidelines are a measure of the static
relationship to be achieved or maintained on providing treatment.

9;
TOOT* MORP*OLOG+ AND ALIGNMENT IN
DENTAL ARC*
0hen teeth come in contact with one another, it is in a predetermined,
orderly pattern with specific tooth surfaces occluding with each other. #his
contact relationship between the opposing teeth when stationary (seen in
centric occlusion or sometimes in the very lateral and protrusive (or
combinations) border locations of the mandible) is called 7tatic occlusion.
#he morphology, the positional factors (alignment) and contact and
contours of teeth all play a pivotal role in establishing static occlusion.
TOOT* MORP*OLOG+!
An&#%io% &##&"! In upper anterior teeth there is always a lingual concavity
starting from the cingulum and reaching the incisal ridge. #his anatomic feature
is essential for non"interfering gliding protrusive and lateral protrusive
movements of the mandible. In anterior teeth the wor+ing inclines are the
lingual inclined planes for the uppers (inclines toward the lingual concavity or
the tooth end of the ridges). #hey are also the labial inclines on the labial
surface of the lower anterior teeth including parts of the incisal ridges.
Pos&#%io% &##&" /cus6 c"$%$c&#%is&ics! /or teeth to remain stable there must
be certain barriers against their displacement. #hese barriers are provided by
the vertical overlaps of the teeth (occlusoapically by the opposing teeth) and
mesio"distally by the contact areas. #his is achieved by a "ol(in1 cus6$l
#l#0#n& (usually a cusp in posterior teeth"supporting cusp#stamp cusp) to
match a reciprocating fossa (central fossa occlusal line) in the opposing tooth
and non,"ol(in1 cus6$l #l#0#n& $non-centric or non-supporting cusps% that
overlap opposing teeth.
Su66o%&in1 cus6s 4 In a centric occlusion relationship (ma&imal
intercuspation between the opposing teeth), these holding elements (e.g., cusps
and fossae) interdigitate, preventing any movements in any of the three
possible directions and also ta+e up the highest forces during mastication.
91
0hen viewed from occlusal their cusp tips are located, appro&imately one"third
the distance into the total buccolingual width of the tooth.
/or the upper posterior teeth in normal occlusion, these supporting cusps
are usually the lingual cusps occluding in opposing fossae while for lower
posterior teeth, they are usually the buccal cusps. Other anatomical features
could be the holding elements, provided they are not detrimental to the normal
function at that location.
7upporting cusps can be identified by five characteristics4
1. #hey contact opposing tooth in $a&imum Intercuspation.
9. 7upport the vertical dimension of the face.
@. Are closer to the faciolingual center of tooth than non"supporting cusps.
C. *ave broader, more rounded cusp ridges than non"supporting cusps.
F. #heir outer incline has potential for contact.
2uring fabrication of restorations it is
important that supporting cusps do not contact the
opposing teeth in manners that result in lateral
deflection= rather contacts should be on smoothly
concave fossae so that forces are directed
appro&imately parallel to the long a&is of the
teeth.
Non,su66o%&in1 cus6s C #hese cusps do not
contact the tooth and are usually located in the embrasures or developmental
grooves of opposing teeth. #hey have sharper cusp ridges and form a
separation between the soft tissues and occlusal table. #he maor roles of non"
centric cusps are to minimiDe tissue impingement and to maintain the bolus of
food on the occlusal table in mastication. #hey also give mandible stability by
acting as guiding contacts (also called Guiding cusps).
99
Occlus$l &$Bl# 4 #he occlusal surfaces of the teeth are made up of numerous
cusps, grooves, and sulci. #he area of the tooth between the buccal and lingual
cusp tips of the posterior teeth is called the occlusal table. #he maor forces of
mastication are applied on this area. #he occlusal table represents
appro&imately F;M to G;M of
the total buccolingual dimension
of the posterior tooth and is
positioned over the long a&is of
the root structure. It is considered the inner aspect of the tooth, because it falls
between the cusp tips. Hi+ewise, the occlusal area outside the, cusp tips is
called the outer aspect.
#he inner and outer aspects of
the tooth are made up of
inclines that e&tend from the
cusp tips to either the central
fossa (?/) areas or the height of the contour on the lingual or labial surfaces of
the teeth. #hus, these inclines are called inner and outer inclines.
a) Inner and outer incline are further identified by describing the cusp of
which they are a part of. /or e&ample, the inner incline of the buccal cusp
of the ma&illary right first premolar identifies a very specific area in the
dental arch.
b) #he inner and outer inclines are further identified with respect to the surface
toward which they are directed (i.e., mesial or distal). $esially inclined
surfaces are those that face the mesial portion of the tooth, and distally
inclined surfaces are those that face the distal portion.
In posterior teeth every cusp has four inclines, i.e., 9 facial and 9 lingual.
#hese are classified as wor+ing and balancing types. #he wor+ing inclines face a
wor+ing (functional) cusp side, e.g., buccal cusps of the lower and lingual cusps
of the upper. #he balancing inclines face a balancing (non"functional) cusp side,
e.g., lingual cusps of the lower and buccal cusps of the upper.
9@
Interocclusal relationship of teeth 6 ?ertain landmar+s help in understanding
the occlusal relationships of teeth. #hese are4
I. -UCCOLINGUAL,OCCLUSAL CONTACT RELATIONS*IP 4
0hen viewed from occlusal=
1. An imaginary line through all the buccal cusp tips of the mandibular
posterior teeth, establishes the bucco"occlusal line. In a normal
occlusion this line reveals the general arch form and also represents the
demarcation between the inner and outer aspects of the buccal cusps.
9. An imaginary line through the lingual cusps of the ma&illary posterior
teeth, establishes the linguo"occlusal line which represents the
demarcation between the outer and inner aspects of these centric cusps.
@. A third imaginary line through the central developmental grooves of the
9C
ma&illary and mandibular posterior teeth forms the ?entral fossa (?/)
line. In the normal well aligned arch, this line is continuous and reveals
the arch form.
#o visualiDe the buccolingual relationships of the posterior teeth in
occlusion, the appropriate imaginary lines must be matched. #he >O line of the
mandibular teeth occludes with the ?/ line of the ma&illary teeth.
7imultaneously, the HO line of the ma&illary teeth occludes with the ?/ line of
the mandibular teeth.
II. MESIODISTAL OCCLUSAL, CONTACT RELATIONS*IP 4
As mentioned earlier, occlusal contacts occur when the centric cusps
contact the opposing ?/ line. Kiewed from the facial, these cusps typically
contact in one of two areas4 (1) ?entral /ossa areas and (9) marginal ridge and
embrasure areas.
0hen the normal interarch tooth relationship is viewed from the lateral,
it can be seen that each tooth occludes with two opposing teeth. *owever, there
are two e&ceptions to this rule4 (I) the mandibular central incisors and (9) the
ma&illary third molars. #herefore, throughout the arch, any given tooth is found
to occlude with its namesa+e in the opposing arch plus an adacent tooth (i.e.=
two marginal ridges). #his one"tooth"to"two"teeth relationship, helps distribute
occlusal forces to several teeth and ultimately over the entire arch. It also helps
to maintain some arch integrity.
Also, in normal relationship, the mandibular teeth are positioned slightly
lingual and mesial to their counterparts.
9F

STATIC CONTACT RELATIONS*IPS -ET?EEN MAXILLAR+
AND MANDI-ULAR TEET* 4
I. CENTRIC OCCLUSION CONTACTS
 #he holding cusp fossa arrangement, previously described should be the
prevailing pattern. $a&imum contact should be at the tips of the cusps
and the bottom of the fossa, or at least noticeably deviated toward these
areas. #here should be no contact on the inclined planes themselves.
 7ome holding cusps may be opposed by one or two adacent marginal
ridges. If a cusp is in contact with one marginal ridge, it will usually
occlude with the occlusal inclined plane of that ridge in pro&imity to the
adacent triangular fossa. If the holding cusp is occluding with two
9G
adacent marginal ridges, the contact should be even on both of them.
#he cusp tip should be blunt to prevent it from wedging the two
marginal ridges apart.
 Every cusp in a fossa has an adacent groove in that fossa. #he groove
should be wide enough to facilitate the cuspBs escape during lateral
mandibular movements, without its colliding into adacent cuspal
elements. ?usps occluding with a marginal ridge will have the adacent
embrasures to enable their escape during lateral movements.
 #he lower anterior teeth should be positively seated in the concavities of
upper anterior teeth contacting on the lowerBs incisal ridges and part of
their labial surfaces. ?entric contact should be almost even over all
holding cuspal elements, in terms of magnitude andJor surface area.
 Kertical and minimal horiDontal overlap of the wor+ing cuspal inclines of
the buccal cusps in upper teeth should e&ist over the lower teeth. Also,
some overlap of the wor+ing inclines of the lingual cusps of lower teeth
should occur over the upper teeth.
$andibular $a&illary
Loc$&ion o' c#n&%ic s&o6s
II. PROTRUSIVE OCCLUSION -ORDER CONTACT
9<
7uch contact usually occurs when the lower anterior teeth are labial to
the upper teeth. Often, only incisors are involved, however, the cuspids is also
involved. #he contact is usually between the lingual surface of the lower and
the labial surface of the upper incisors. In some instances the most border
contact anteriorly is an edge"to"edge contact. #his situation is most obvious in
a cuspid anterior border contact relationship. #here will be no contact between
posterior teeth at this position of the mandible.
III. ?OR@ING SIDE LATERAL -ORDER CONTACTS
In lateral border location, usually only the cuspids will be in contact
with opposing component(s) through their slopes. 7ometimes, however, part of
the wor+ing inclines of the buccal cusps of the first and second premolars are
included. #here should be no occluding contact with the rest of the teeth on the
wor+ing side.
Also, there should be no tooth contact on the non"wor+ing side
anteriorly or posteriorly.
98
.
?lass I
→ .
No%0$l In&#%$%c" R#l$&ions"i6s o' An&#%io% T##&"
99
Si2 5$%i$&ions o' $n&#%io% &oo&" %#l$&ions"i6s
@;

CONTACTS AND CONTOURS!
#here are si&ty contacting pro&imal and si&ty"four facial and lingual
surfaces in the full complement of teeth. #he faulty interrelationship between
the contact areas, the marginal ridges, the embrasures, and the gingiva,
predisposes teeth to decay and periodontal diseases. 2ecay is predisposed
facially and lingually, especially in the gingival one"third of the teeth,
primarily by faulty interrelationship between tooth contours. #he +ey to
these :proper1 relationships interpro&imally is the contact area in relation to
its location, e&tent, and siDe, while the proper relationships facially and
lingually are the occluso"gingival and mesio"distal configurations. Although
contacts and contours vary between individuals and teeth, they follow certain
general features that can be used as guidelines in reproducing contacts and
contours in restorations.
According to their general shape, teeth can be divided into three types,
with each having its own physical characteristics in the contact area and related
structures.
A. T$6#%in1 &##&" !
In an inciso"apical direction contacts of tapered ma&illary central and
lateral incisors start incisally near the incisal edges. In a labio"lingual direction
they start slightly labial to the incisal edges.
 #apered cuspids are very angular, with the mesial contact area close to the
incisal edges and the distal contact area near the center of the distal surface.
 #he tapered bicuspid is also angular, possessing crowns,
constricted cervically and with long cusps.
As those crowns taper lingually, the contact areas
occur bucally starting almost at the buccal a&ial
@1
angle of the tooth. 7ince nearly all these contact areas begin appro&imately
1mm gingivally from the crest of the marginal ridges, the bicuspid contacts
of this type of tooth will be found ust gingival from the unction of the
occlusal and middle third of the crown.
 In tapered molars mesial contacts approach the mesio"buccal a&ial angle of
the tooth, in a bucco"lingual direction, and from one"third to one"half the
distance from the occlusal surface to the cemento"enamel unction of the
tooth occluso"gingivally. #he distal contacts of molars shift lingually to the
middle third bucco"lingually, and are midway on the length of the crown
occluso"gingivally. Hingual shifting of the contacts is more noticeable in
mandibular than in ma&illary molars.
 #he pro&imal contour of the tapering type of teeth has one common
feature4 starting at the cemento"enamel unction, the surface presents a
concavity almost to the contact areas, and they are decidedly conve& from
there to the crest of the marginal ridges.
 #his type of tooth presents em'rasures with greater
variations in shape than any of the other types. Incisal
and labial embrasures are almost negligible. #he
gingival embrasures between anterior teeth are very
e&tended incisally and wide at the gingival crest, while
the lingual embrasures are almost the full depth of the
labio"lingual dimensions of the crown and almost as
wide as the distance from the center of one tooth to the center of the
appro&imating one. #he buccal embrasures are very small. #he lingual
embrasures in posterior teeth are very wide bucco"lingually, but diverge
somewhat more than those found between teeth of a sAuare type.
-. SDu$%# &;6#!
#his type of tooth is bul+y and angular, with little rounded contour.
7ince there is little cervical constriction, their pro&imal surfaces are almost
devoid of curves.
@9
 #he incisor contacts are in a line with the incisal edges, labio"lingually
and e&tend almost to the incisal angle incisally. #hese teeth are
freAuently in contact with their neighbor in a plane instead of point,
which varies from ;.F to @ mm.
 ?uspid contacts are relatively close to the incisal edges and in line with
them labiolingually.
#he posterior contacts are broad areas on the sAuare type of teeth in the
occlusal !"# of the crown. #he configuration of the bicuspids and molars places
the buccal e&tent of the contact well into the buccal 1J@. #he lingual e&tent of
the contact of ma&illary molars usually stops in the middle !"#, while the
gingival e&tent is seldom more than I mm from the ?E%.
 $esial contacts are nearer the buccal a&ial
angle .than the distal. $esial contacts of the
mandibular molars may measure from I to C mm
bucco"lingually and vary from a mere line contact
to including half the height of the crown
occlusogingivally. ?ontacts originate in the bucco"occlusal section of
the crown.
 #he distal contacts originate more lingually. If they are small
areas, they will be found at the midline of the crown, bucco"lingually,
and in the occlusal third, occluso"gingivally. If they are large areas,
they will occupy from one"third to two"thirds of the bucco"lingual
dimension and e&tending from the lower border of the marginal ridge
to the ?E% occluso gingivally.
 Incisal, labial, occlusal, and buccal em'rasures are
almost nil. #he gingival embrasures may be
barely noticeable or they may e&tend about one"
third of the height of the crown. 0hen present,
they are very narrow and flat. #he lingual
embrasures may be narrow or wide in their
@@
bucco"lingual e&tension but they are always narrow mesiodistally.
 #he pro&imal contours of sAuare type teeth have a tendency to become a
plane instead of a curved surface. #he distal surfaces are generally either
flat or slightly conve& from the buccal to the lingual surface. #he
conve&ity which creates the marginal ridges disappears at the contact
and the remainder of the surface in the gingival direction is usually flat.
C. O5oi( &;6#!
It is a transitional type between the tapering and sAuare types. Its surfaces are
primarily conve&, but infreAuently they may be concave.
 In an inciso"gingival direction, the mesial contacts of incisors start at about
1JC
th
the height of the crown from the incisal edges. In a labio"lingual
direction they start slightly lingual to their mesial edges. #he distal
contacts but may be found from one"third to one"half the height of the
crown from the incisal edge in an inciso"gingival direction.
 In ovoid posterior teeth the conve&ity of the marginal
ridges carries the contacts almost to the middle of the
crown height. In molars, the buccal e&tent of the
mesial contacts is at the unction of the buccal and
middle thirds of the crowns. >ucco"lingually the
buccal e&tent of the distal contacts is found in line with the central
grooves on the occlusal surface of the crown. 8enerally, there is a
tendency in all three types of teeth for the distal contacts to move in a
lingual direction, progressing further bac+ in the
arch.
#he labial, incisal and buccal em'rasures of ovoid teeth
are larger and more e&tensive than those found in other
types. 8ingival embrasures are relatively short occluso"
gingivally and broad mesio"distally at their bases. Hingual
embrasures are comparatively short labio"lingually and broad mesiodistally.
@C
 'ro&imal contours of ovoid anterior teeth are decidedly conve& from the
incisal angle to the cervi&. >icuspids are freAuently bell"shaped with the
conve& surface running from the crests of the marginal ridges almost to
the cervi&, where they merge via a slightly concave surface to a union
with the root surfaces. #he bicuspids are li+ewise conve& from the buccal
to the lingual a&ial angles. #he mesial surfaces of ovoid molars present
conve& areas which are less e&tensive than those found on the distal
surfaces. #he latter are usually conve& in all directions.
#he relationship between adacent teeth at their contact areas is not
absolutely static, as there is an allowance by the periodontal ligament and bone
elasticity for slight tooth movement in three dimensions. *owever, for practical
purposes, this relationship can be considered fi&ed. #he contact area should
create a positive tight relationship between adacent teeth, unyielding to
physiologically functional forces in order to preserve intact the mesio"distal
dimension of the dental arch and to protect the investing periodontium. #hese
features should also be assimilated in such a way as to discourage the
accumulation of plaAue and cariogenic material at and around the involved
surfaces. 0ith age, the surface dimensions of the contact areas are increased as
a result of pro&imal abrasion and attrition. #his enlargement of the contact area
will subseAuently decrease the dimensions of the adoining embrasures.
MARGINAL RIDGES!
It is imperative to have a marginal
ridge of proper dimensions i.e. compatible
to the dimension of the occlusal cuspal
anatomy, creating a pronounced adacent
triangular fossa and producing an adacent
occlusal embrasure. A marginal ridge
should always be formed in two planes bucco"lingually, meeting at a very
obtuse angle. #his feature is essential when an opposing functional cusp
occludes with the marginal ridge.
@F
A marginal ridge with these specifications is essential for=
1. #he balance of the teeth in the arch.
9. 'revention of food impaction pro&imally.
@. 'rotection of the periodontium.
C. 'revention of recurrent and contact decay.
F. /or helping in efficient mastication.
*A8ARDS OF FAULT+ REPRODUCTION OF P*+SIO,
ANATOMICAL FEATURES OF TEET* IS RESTORATIONS!
A. Con&$c& si3#!
?reating a contact that is too broad, bucco"lingually or occluso"
gingivally in addition to changing the tooth anatomy will change the anatomy
of the inter dental col.
#he normal 3saddle shaped5 area will become broadened.
1. As a result the area for the development of incipient periodontal disease is
mar+edly increased.
9. #he broadened contact produces an inter"dental area that the patient is less
able to clean i.e. increases the area susceptible to future decay.
@. #he microbial plaAue develops more readily and as a result the papillary
area becomes inflamed and edematous.
C. >roadening the contact area will of necessity be at the e&pense of the
dimensions and shapes of the buccal and lingual embrasures.
#his usually leads to improper movement or flow of masticated
material, leads to adhesion of debris and possible interpro&imal impaction of
that debris.
@G
F. >roadening the contact area could also be at the e&pense of the gingival
embrasure, so that the restoration could encroach physio"mechanically on
the interdental periodontium predisposing to its destruction.
?reating a contact that is too narrow bucco"lingually or occluso"
gingivally.
>esides changing the anatomy of the tooth it will allow food to be
impacted vertically and or horiDontally on the delicate non"+eratiniDed
epithelial col area, leads to greater susceptibility for microbial plaAue
accumulation, predisposes to the same periodontal and caries problem.
A contact area placed too occlusally will result in a flattened marginal
ridge at the e&pense of the occlusal embrasure.
A contact area placed too buccally or lingually will result in a flattened
restoration at the e&pense of the buccal and lingual embrasures.
A contact area placed too gingivally will increase the depth of the
occlusal embrasures at the e&pense of the contact areas own siDe on at the
e&pense of broadening or impinging upon the interdental col.
A loose (open) contact creates continuity of the embrasures with each
other and with the interdental col.
Allow for the impaction of food and the accumulation of bacterial
plaAues with accompanying periodontal and caries problems.
#herefore, the proper reproduction of the siDe and location of contact
areas to imitate the natural dentition is essential for the success of the treatment
and restoration of the pro&imal surface.
-. Con&$c& Con'i1u%$&ion!
?reating a contact area that is flat (deficient conve&ity) can ma+e it too
broad buccally, lingually, occlusally and or gingivally, on the other hand, a
contact area with e&cessive conve&ity will diminish the e&tent of the contact
@<
area. >oth will predispose to the problems of decay and periodontal
destruction.
A concave contact area in a restoration usually occurs in restoring
adacent restoration with a conve& pro&imal surface. >esides broadening and
miss locating the contact area, the interloc+ing between the concavity and
adacent conve&ity can immobiliDe the contacting teeth depriving them of
normal stimulating physiologic movements, resulting in periodontitis and or
mechanical brea+down. In restorations with a concave contact area it is
impossible to create the proper siDe of marginal ridge or adacent occlusal
anatomy.
C. Con&ou%!
F$ci$l $n( lin1u$l con5#2i&i#s.
It was previously theoriDed that the vertical conve& curvatures on the
facial and lingual surfaces of teeth hold the gingival under definite tension and
also protect the gingival margin by deflecting food over the gingival margin,
thereby preventing undue frictional irritation while allowing stimulation of the
soft tissues enabling them to +eep their tone.
,ecently e&perimental and clinical data do not fully support this theory.
It has been revealed that there is always more inherent danger in over conve&
rather than under conve& facial and lingual surfaces of teeth. #he over conve&
curvature can create an undisturbed environment for the accumulation and
growth of cariogenic and plaAue ingredients at the gingival margin, apical to
the height of contour. Additionally, this deprives the free and attached gingiva
facially and or lingually from the massaging effect of the apical components of
the food stream.
F$ci$l $n( lin1u$l conc$5i&i#s!
#hose concavities occlusal to the height of contour, whether they occur
on anterior or posterior teeth are involved in the occlusal static and dynamic
@8
relations as they determine the pathways for mandibular teeth into and out of
centric.
2eficient or mislocated concavities will lead to premature contacts
during mandibular movements, which could inhibit the physiologic capabilities
of these movements. On the other hand e&cessive concavities can invite
e&trusion, rotation or tilting of occluding cuspal elements into non"physiologic
relations with opposing teeth.
?oncavities apical to the height of contour therapeutically or
pathologically e&posed are essential for the proper maintenance of the
accompanying new components of the adacent periodontium and must be
imitated in a restoration. 2eficient concavities at these locations can create
restoration overhangs and e&cessive concavities decrease the chance for
successful plaAue control in these e&tremely plaAue retaining areas.
3. A%#$s o' 6%o2i0$l con&ou% $(E$c#n& &o &"# con&$c& $%#$.
In addition to creating a contact area of proper siDe, location and
configuration it is also essential to restore to a proper contour that portion of
the pro&imal surface not involved in the contact. #his would include the areas
occlusal, buccal, lingual and gingival to the contact area.
If not it will lead to restoration overhangs and under hangs, vertical and
horiDontal impaction of debris and impingement upon the adacent periodontal
structures.
D. M$%1in$l Ri(1#!
F. ABs#nc# o' M$%1in$l %i(1#!
@9
In the absence of a marginal ridge force 1 will be directed towards the
pro&imal surface of the adacent tooth. 1 * and 9 *, the horiDontal components
of forces 1 and 9 will tend to drive the 9 teeth away from each other.
$eanwhile the vertical components, 1 K and 9 K, can impact food and other
intra oral materials inter"pro&imally.
2. M$%1in$l %i(1# Ai&" #2$11#%$&#( occlus$l #0B%$su%#s.
E&aggerating the occlusal embrasures will direct forces 1 and 9 towards
the adacent pro&imal surfaces with the horiDontal components, 1 * and 9 *
separating the teeth and the vertical components 1 K and 9 K driving the debris
inter"pro&imally.
3. A(E$c#n& 0$%1in$l %i(1#s no& co06$&iBl# in "#i1"&!
?ontraction of a restoration with a marginal ridge higher than the
adacent. One will allow force A to wor+ on the pro&imal surface of the
restoration.
#he horiDontal component A* will drive the restored tooth away from
the contacting tooth and the vertical component will drive debris inter"
pro&imally. Even in the presence of force >, with its horiDontal component
C;
acting on the marginal ridge, there will be some separation of teeth as the
surface hold for force > is too small to counteract that of force A. >y
constructing a restoration with a marginal ridge lower than the adacent over
the same thing will occur, but the maor movement will be in the non"restored
tooth.
(. A 0$%1in$l %i(1# Ai&" no occlus$l #0B%$su%#!
In this case, the two adacent marginal ridges will act li+e a pair of
tweeDers grasping food substance passing over it. Although debris may not be
forced inter"pro&imally, it will be very difficult to remove once it is trapped.
#. A on#,6l$n#( 0$%1in$l %i(1# in &"# Bucco,lin1u$l (i%#c&ion.
Esually, the facial and lingual inclines of a marginal ridge are part of the
occluding components of the tooth. #herefore, ma+ing them one"planed can
create premature contacts during both functional and static occlusion. A one"
planed marginal ridge=
1. Increases the depth of the adacent triangular fossa magnifying stress in
this area.
9. Increases the height of the marginal ridge in the center ma+ing it amenable
to the adverse effects of the horiDontal components of force.
@. 0ill deflect the food stream away from normal, pro&imal embrasure
movements (spill away).
C1
'. A 0$%1in$l %i(1# Ai&" no &%i$n1ul$% 'oss$.
In this situation there are no occlusal planes in the marginal ridges for
the occlusal forces to act upon, so there are no horiDontal components to drive
the teeth towards each other, closing the contact. /urthermore the vertical
forces will tend to impact food inter pro&imally.
g. A thin marginal ridge in its mesio"distal bul+ will be susceptible to fracture
or deformation leading to the problems of the previously mentioned faulty
marginal ridge.
h. $arginal ridges not compatible in dimension or location with the rest of
the occluding surface components predisposes to similar problems.
C9
MANDI-ULAR MOVEMENTS AND T*EIR RELATION TO
OCCLUSION
T;6#s o' Mo&ion!
C#n&%ic %#l$&ion /CR is the position of the mandible when the
condyles are positioned superiorly in the fossae in healthy #$%s. In this
position the condyles articulate with the thinnest avascular portion of the dis+s.
#his position is independent of tooth contacts. It has also been described as the
most retruded position of the mandible from which lateral movements can be
made, and the condyles are in the most posterior, unstrained position in the
glenoid fossa.
Ro&$&ion, as discussed, is a simple motion of an obect around an a&is.
,otation in ?, is termed terminal hinge (#*) movement and is used in
dentistry as a reference movement for construction of restorations and dentures.
Initial contact between teeth during a #* closure provides a reference point,
termed centric occlusion (?O). $any patients have a small slide from ?O to
$a&imum Intercuspation, typically in a forward and superior direction.
$a&imum rotational opening in #* is limited to appro&imately 9F mm
measured between the incisal edges of the anterior teeth.
T%$nsl$&ion is the third type of motion seen to occur in mandible. In
translation, simultaneous, direct anterior movement of both condyles (or
mandibular forward thrusting), is termed protrusion. 'rotrusion is limited to
appro&imately !$ mm by the ligamentous attachments of the masticatory
muscles and the #$%s
C@
Co06l#2 0o&ion is that which combines rotation and translation in a
single movement. $ost mandibular movements during speech, chewing and
swallowing, consist of both rotation and translation. #he combination of
rotation and translation allows the mandible to open F;mm or more.

L$&#%$l 0o5#0#n& of the mandible is the result of forward translation of the
condyle of opposite side and rotation of the condyle of same side to which
mandible moves. It is limited to appro&imately 1;mm.
-#nn#& 0o5#0#n&!
As the condyle anatomy is not that of a true spherical ball and soc+et oint,
rotation of the wor+ing side condyle in it1s articular fossa results in a slight
lateral movement of the condyle. #his lateral movement of the condyle
averages :1 mm1 in e&tent and is termed the 3>ennet movement5 or the
:immediate side shift.1 #his movement may be straight lateral, lateral and
anterior= lateral and distal= lateral and superior or lateral and inferior. #he
direction and e&tent of bennet movement varies among individuals.
#hus a lateral mandibular movement consists mostly of rotation around
the vertical a&is of the wor+ing condyle combined with a small element of
lateral translation due to bennet movement.
-#nn#& $n1l#! #he mean angle formed by the sagittal plane and the path of the
non"wor+ing condyle as viewed in the horiDontal plane is termed the 3>ennet
angle5
CC
CAPACIT+ MOTION OF T*E MANDI-LE!
In 19F9, Elf 'osselt described the capacity of motion of the mandible.
#he resultant diagram has been termed 'osseltBs motion (+nown as the
%&nvelope of motion”'. #he path of the mandible (and its occlusal elements)
during its movement in each of the possible three directions (sagittal, horiDontal
! vertical) is described to points beyond which the mandible is not capable of
further movement. #hese points are defined as the border limitation of
mandibular movements, and moving the mandible to these points is therefore
called 3border movements of the mandible5.
CF
?O
'r(c)
O (b)
*
a
?,
'O77EH#17 ELKEHO'E O/
$O#IOL.
  ?, 6 ?entric relation
  ?O 6 centric occlusion
  'r (c) 6 'rotrusion
  * (a) 6 *inge movt. (terminal
arc of opening)
  O (b) 6 ma&. aw opening
#he diagram gives the sagittal view of border movements which is the most
informative. #he teeth define the top of the border diagram which is of
particular interest in restorative dentistry, as is the relationship between $I !
,?'. #he top of the border path is defined by the position and cuspal inclines
of the teeth. #he retruded path is defined by the anatomy of the #$%s (?O to *
and * to O).
#he starting point for this diagram is the first contact of teeth when the
condyles are in ?, and is also described as ,etruded ?ontact 'osition (,?').
/rom here, the mandible on moving forwards, settles in the position of
ma&imum intercuspation, which is +nown as centric occlusion (?O). #he
posterior border of the diagram from ?O to :a1 is formed by rotation of the
mandible around the condyle points. #his border from ?O to :a1 is #*
movement. #he inferior limit to this hinge opening occurs at appro&imately 9F
mm and is indicated by a. #he superior limit of the posterior border occurs at
the first tooth contact and is identified by ,?'. In most healthy adults, a sliding
tooth contact movement positions the mandible slightly anteriorly from ?, into
$a&. Intercuspation"$I (appro&. 1 mm). #he limit of pure rotational opening is
very close to 9F mm in adults. /urther opening can be achieved only by
translation of the condyles anteriorly, producing the line a"b. $a&imum
opening (point b) in adults is appro&imately F; mm.
Appro&imate range of aw movements in adults4
 ,?'"$I ;.F 6 9.; mm
 $I"O C; 6 <; mm
 ,?'"* 1F 6 9; mm
 '"$I 9 6 C mm
 $I"'r F 6 1; mm.
#hese measures are important diagnostically. /or e&ample, mandibular
opening limited to 9F mm suggests bloc+age of condylar translation, usually
the result of dis+ disorders. Himitation of opening in the @F to CF mm range is
suggestive of muscular limitation. #he line ?O" a b represents the ma&imum
CG
retruded opening path. #his is the posterior border, or the posterior limit of
mandibular opening. #he line b"c represents the ma&imum protruded closure.
#his is achieved by a forward thrust of the mandible, while arcing the mandible
closed. ,etrusion, or posterior movement of the mandible, results in the
irregular line c"?O. #he irregularities at the superior border are due to tooth
contacts. #he complete diagram, ?O"a"b"c"?O, represents the ma&imum
possible motion of the incisor point in all directions in the sagittal plane.
Too&" 1ui(#( l$&#%$l 0o5#0#n& o' &"# 0$n(iBl# '%o0 c#n&%ic occlusion
/Ao%:in1 1ui($nc#
In discussing lateral movements of the mandible the following
terminology will be used4
• 0hen the mandible moves toward one side from centric occlusion or
centric relation the side towards which it moves is called the woring
side.
• $ovement of the mandible from centric occlusion or centric relation
towards the wor+ing side is called a woring movement.
• #he opposite side (contralateral) to the wor+ing side when a wor+ing
movement is made is called the non(woring side )balancing side'.
• #he condyle on the wor+ing side is termed the woring condyle.
• #he condyle on the non"wor+ing side is termed the non(woring
condyle.
Hateral movement of the mandible from centric occlusion with the teeth
in contact is guided by the contacting surfaces of the teeth on the wor+ing side.
#his is termed the Bwor+ing guidanceB. #he two most common schemes of
wor+ing guidance found in natural dentitions are Bcanine guidanceB and Bgroup
functionB.
CANINE GUIDANCE 4
As the muscles move the mandible to
C<
the wor+ing side, the tip or the distobuccal incline of the lower wor+ing side
canine glides down the palatal incline of the upper wor+ing side canine. #his
causes the mandible to move laterally, forwards and to open. #his is termed
Bcanine guidanceB.
On a canine guided wor+ing movement the premolars and molars on the
wor+ing side become separated as the mandible moves away from centric
occlusion. All the teeth on the non"
wor+ing side become separated as the
mandible moves away from centric
occlusion. #he canine guidance provides the anterior guiding component and
the condylar guidance constitutes the distal guiding component.
*ncisal guidance )anterior guidance' + 0hen the incisors and canines guide
both protrusive and wor+ing movements
they constitute the anterior guiding
component of mandibular movements.
#heir influence on mandibular movement
is termed the :incisal guidanceB or the anterior guidance.
GROUP FUNCTION 4
Its seen on all the wor+ing side teeth.
#he incisal edges of theB mandibular anterior
teeth glide down the palatal surfaces of the
ma&illary anterior teeth.

#he buccal inclines of the buccal cusps of the mandibular premolars and molars
glide against the palatal inclines of the buccal cusps of the ma&illary premolars
and molars. #ooth guided wor+ing guidance continues until the guiding teeth
on the wor+ing side meet in an edge to edge relation. /urther movement
towards the wor+ing side is guided by contact of the upper and lower incisors.
C8
#his is termed Bcross overB.
LATERAL,PROTRUSIVE MOVEMENTS
#ooth guided movements
between straight lateral and protrusive
are called Blateral"protrusiveB move"
ments.
#ooth guidance during these movements occurs between opposing
wor+ing side canines, lateral and central incisors. #here should be no tooth
contacts on the non"wor+ing side during these movements. #he combined
effect of the path of the nonwor+ing condyle and the wor+ing guidance main"
tains tooth separation on the non"wor+ing side.
DISCLUSION 4
#his is one of the most important features in the functional dynamics of
mandibular movement. >ecause most functional movements of the mandible
are intraborder type"i.e. lateral and latero"protrusive movements, mandibular
teeth must be disengaged from ma&illary teeth to even allow these movements.
If, in fact, such movements were to occur with teeth still in contact, substantial
lateral loading, with all of its detrimental seAuelae, would result.
2isclusion is more important for posterior than for anterior teeth
primarily because posterior teeth are relatively more incapable of withstanding
lateral loading. #he most effective disengaging tooth is a healthy, well
supported canine (for reasons previously mentioned). #herefore, a sound self"
resistant cuspid should be an integral part of any disclusion mechanism during
protrusive, lateral, or latero"protrusive motion. 7ometimes, the canines may be
assisted by premolars, especially the upper premolars during lateral
disclusions. Also, one or two anterior teeth might assist in forward disclusion
and both premolars and anteriors may assist disclusion in latero"protrusive
directions.
C9
0hen any of these teeth are involved in the disclusion mechanism, the
following should be observed4
A. Only their wor+ing inclines should be included in the act of disclusion.
>. $inimum load should be applied to teeth further away from the canine.
?. #he canine should be the last to disengage, and the tooth furthest from the
canine should be the first to disengage.
24 7upporting (au&iliary) teeth or cuspal elements involved in this group
function disclusion should not e&ceed the mesiobuccal cusps of upper first
molars posteriorly and the central on the same side of the canine anteriorly. .
E. In pure lateral e&cursions only posterior teeth (besides the cuspid) should be
involved as discluding cuspal elements.
/. $ore importantly, in pure anterior e&cursions, only anterior teeth should be
involved. At no time should there by any contact between posterior teeth
during protrusive e&cursions.
8. In no instance should there be any cross"arch cuspal elements involved in
the disclusion mechanism.
*. In some instances, involving lower incisor teeth gliding along the lingual
concavities of upper incisor teeth may be the only functional anterior
discluding mechanism, without the canine being involved. *owever, for lateral
disclusion, there can be no substitute for the canine.
I. /or au&iliary posterior cuspal elements assisting a cuspid in disclusion, the
mesial cuspal inclines for the upper teeth and the distal cuspal inclines for
lower teeth are the most effective in facilitating disclusion with the least
amount of loading and its detrimental effects.
%. If the canineBs self"resistance to lateral loading is doubtful, group function
should be established, loading the most supported tooth ma&imally. #his choice
should be the last resort, however, as failure might be reasonably e&pected.
N. ,egarding the canine itself, the ideal location for the main path of disclusion
should be on the mesial aspect of the lingual surface of the upper cuspid,
paralleling the marginal ridge. At this location Auic+er translation of the
mandible will be achieved. Also, the discluding forces will be distributed in the
F;
most advantageous configuration for the canine to resist them.
OCCLUSAL CONTACTS DURING MANDI-ULAR MOVEMENT
#he masticatory system is e&tremely dynamic. Along with these
movements come potential tooth contacts. It is important to have an
understanding of the type and location of tooth contacts that occur during the
basic mandibular movements. #he term eccentric has been used to describe any
movement of the mandible from the ,?' that results in tooth contact. #hree
basic eccentric movements are discussed4 1) protrusive, 9) laterotrusive, @)
retrusive.
P%o&%usi5# M$n(iBul$% Mo5#0#n&!
A protrusive mandibular movement occurs when the mandible moves
forward from the retruded contact position. Any area of a tooth that
contacts an opposing tooth during protrusive movement is
considered to be protrusive contact.
In a normal occlusal relationship, the predominant
protrusive contacts occur on the anterior teeth, between the incisal
labial edges of the mandibular incisors and against the lingual
fossa areas and incisal edges of the ma&illary incisors.
On the posterior teeth, the protrusive movement causes the mandibular
centric cusps (buccal) to pass anteriorly across the occlusal surfaces of the
ma&illary teeth.
L$&#%o&%usi5# M$n(iBul$% Mo5#0#n&!
2uring a lateral mandibular movement, the right and left mandibular posterior
teeth move across their opposing teeth in different directions. If, for e&ample,
mandible moves laterally to the left, the left mandibular posterior teeth will
move laterally across their opposing teeth. *owever, the right mandibular
posteriors will move medially across their opposing teeth. Hoo+ing more
closely at the posterior teeth on the left side during a left lateral movement
F1
reveals that contacts can occur in to incline areas (,efer diagram). One contact
is between the inner inclines of the
ma&illary buccal cusps and the outer
inclines of the mandibular buccal cusps.
#he other contact is between the outer
inclines of the ma&illary lingual cusps
and the inner inclines of the mandibular
lingual cusps. >oth these contacts are termed laterotrusive. #he term wor+ing
contact is also commonly used for both these laterotrusive contacts. >ecause
most function occurs on the side to which the mandible is shifted, the term
wor+ing contact is very appropriate. (Haterotrusive contacts occur on inner and
outer inclines of opposing cusps.)
M#(io&%usi5# con&$c&s 4
#he potential sites for occlusal contacts are between the inner inclines of
the ma&illary palatal cusps and the inner inclines of the mandibular buccal
cusps. #hese are called mediotrusive contacts. Earlier, the term balancing
contact was used.
(If mediotrusive contacts occur, they occur on the inner inclines of
alternate cusps).
R#&%usi5# M$n(iBul$% Mo5#0#n&!
A retrusive movement occurs when the mandible moves posteriorly
from the $I. ?ompared with the other movements, the retrusive movement is
Auite small (l or 9 mm). 2uring a retrusive movement, the mandibular buccal
cusps move distally across the occlusal surface of their opposing ma&illary
teeth.
SUMMAR+ OF OCCLUSAL CONTACTS!
0hen two opposing posterior teeth occlude in a normal manner, the
clinician should remember that these areas are only potential contact areas,
because all posterior teeth do not contact during all mandibular movements. In
F9
some instances, a few teeth contact during a specific mandibular movement,
which disarticulates the remaining teeth. If, however a tooth contacts an
opposing tooth during a specific mandibular movement, they depict specific
sites of contact.
'otential sites of eccentric contacts ('ro&imal, Hateral ! Occlusal views)
H# I Haterotrusive, $# I mediotrusive, , I retrusive, ' I protrusive.
0hen the anterior teeth occlude in a usual manner, the potential sites of
contact during various mandibular movements are also predictable.
?ommon sites for eccentric contacts on ma&illary anterior teeth. ' I 'rotrusive=
H#I Haterotrusive.
OCCLUSAL CONSIDERATIONS IN RESTORATIVE
TREATMENT
F@
FEATURES TO -E AC*IEVED IN AN OCCLUDING
RESTORATION!,
All features of idealJoptimal occlusion e&plained, should be achieved.
7ummariDing them, they are=
  Lo ,?' at ?entric relation (?,).
  ?O I ?,. Any interfering tooth parts should be eliminated.
  Lo incline contacts of occlusion should be present in restored teeth in
order to avoid ,sids- or eccentric movements of mandible when
closing at I?'. At ma&. Intercuspation, there should not be any further
movement of mandible or teeth.
  #he vertical dimension of occlusion should be maintained (the
supporting cusps should be of sufficient height)
  At ?O, the holding mar+ings on all supporting cusps should be
symmetrical in magnitude and e&tent.
  #he contacts of the cusps should be +ept broad if the holding cusps
occlude with more than one opposing tooth. #his is to prevent
movement of the opposing teeth in a non"a&ial direction by the holding
cusps.
  In ?O, the incisal edges of lower incisors should be located at the
gingival side of the lingual concavity of upper incisors
  Lo non"wor+ing side contacts during lateral e&cursion of mandible.
  In lateral movements, supporting cusps preferably should have slight
freedom in centric (Hong centric) and occlude in a valley li+e space on
opposing teeth (in grooves or embrasures), to facilitate non interfering
passage of cusps.
  2isclusion should occur starting posteriorly and ending by canine
disclusion.
FC
  'osterior disclusion should be achieved in protrusive movements.
  ?anine guidance is preferably achieved, at least in initial stages of
protrusive movement of mandible.
  #he mar+ed contact areas during lateral e&cursions obtained must be
similar when going out of centric and bac+ into centric.
  2uring protrusive movements also the contact mar+ings should be
evenly distributed and symmetrical on all teeth involved.
#hese features in a restoration must in most cases conform to the
pre"operative occlusion.
NEED FOR RESTORING NORMAL OR PRE,EXISTING
OCCLUSION!,
Lew restorations should not introduce any premature contacts and cuspal
interferences.
 Each tooth is to be restored to pre e&isting physiologic occlusion or to an
ideal occlusion so as 3to achieve optimum functions of the
neuromusculature, oints, and the supporting structures of the teeth.5
 ?orrect relationship with adacent teeth, gives the best support against
masticatory stresses, prevents food impaction, and promotes deflection of
food through the embrasures.
 ?orrect relationship with opposing teeth will prevent deflective occlusal
contacts which can lead to pain, pdl damage and O of teeth or restoration.
 ?orrect buccolingual contour will allow deflection of food over the free
gingiva thus protecting the periodontal tissues.
 #he pulp of the tooth is very sensitive and reacts immediately to abnormal
occlusal forces. *ence, occlusion should not be detrimental to pulp.
 Oral hygiene can be maintained properly
 Appearance will be re"established.
()"D*+, "- )(+T*) (.AT*"+ /
FF
Occlusal e&amination is done with condyles in their optimal functional
relationship i.e.= ?entric relation. If patient is simply as+ed to close his J her
teeth together it would put the mandible into a relationship determined by his J
her centric occlusion. #he ability to e&amine and record a patient1s centric
relations is a fundamental s+ill for a dentist whose patient cannot be restored to
the conformative approach. It is difficult, if not impossible, to provide an ideal
occlusion without this first step.
#he essential points of finding centric relation are as follows4
" #he patient should be rela&ed in a supine position.
" #he dentist, whilst holding the patientBs mandible, can feel
that the lower aw is loose and describes a fairly perfect arch, i.e. the head
of the condyle is in the rotational phase of its movement. #his means that
the mandible is in terminal hinge a&is( /ig G).
" >ecause centric relation is Bthe only centric that is
reproducible with or without teeth present., the best confirmation that
centric relation has been found is that the same position is found at
different times and by different operators. A centric relation is a consistent
position, which is one reason why it is so useful in the re"organiDed
approach.
" In order to confirm that it is the same position, the
procedure should be repeated several times and the patient is as+ed
whether the same teeth are touching. #he clinician can be sure that it is the
same aw relationship if the patient feels the same premature contact each
time. It is possible because of the proprioceptive receptors in the
periodontal membrane. #he patientBs proprioception is the most sensitive
! can be used to confirm consistency of centric relation= if it is not a
consistent position, then it is not ?,. Interocclusal in ?, record can be
shifted to the articulator using wa& bite.
FG

F<
( D#n&i&ion 4 Occlus$l E2$0in$&ion!
#he dental structures must be e&amined for all the above mentioned features
such as tooth wear, mobility, various occlusal contactsP
#he occlusal contacts on teeth can be located by mar+ing them with articulating
paper or ribbon held by $iller1s forceps. 7him stoc+ or $ylar strips are also
helpful in identifying the presence of occlusal contacts.
At its simplest, the e&amination of the occlusion is performed in three steps4
 /irst, the teeth need to be dry and one of the easiest ways of doing this is
to as+ the patient to close onto folded tissue paper held by $iller
forceps.
 It is best ne&t to mar+"up the patientBs dynamic occlusion, by as+ing the
patient to slide hisJher teeth from side"to"side whilst holding the
articulating paper (>lue paper) between them. Ideally, the articulating
paper will be no more than C; microns in thic+ness. #hinner articulating
papers such as 8*$ occlusal foil"19Q thic+, is also available, which
mar+s true contact points. #hic+er paper (<;"9;; Q) will give false
mar+s(inaccurate, larger points).
F8

/lue articulating paper held in 0iller forceps to mar the dynamic occlusion
 #he final stage reAuires changing the colour of the paper (,ed) and
as+ing the patient to tap hisJher teethB together into a normal bite. #his
will mar+ the static occlusion. #his Bdry"dynamic"staticB order will
produce a clear representation of the occlusion. It is much more reliable
than the Rstatic dynamicR e&amination order, which tends to rub off the
static occlusion mar+s during e&cursive movements.
If a patientBs occlusion is changed without following these criteria, it is an
31norgani2ed approach.5

F9
Red articulating paper
held in 0iller forceps to
mar the static occlusion
TREATMENT PLANNING 4 CONFORMATIVE OR
RE,ORGANISED APPROAC*

>efore initiating treatment the practitioner must decide whether to
provide restorations within the e&isting occlusal scheme or to change it
deliberately.
)"+-"MAT*V( A00"A)1!
2efined as the provision of restorations :in harmony with the e&isting
aw relationships1, it is the principle of providing a new restoration that does
not alter the patient1s occlusion (contacts of other teeth) is described in
restorative dentistry as the :3onformative approach- and the vast maority of
restorations are provided following this principle.
INDICATIONS!
 0hen patient has an ideal occlusion (or the slide from ,?' to I?' is
small).
 If changing the occlusal surface of the tooth to be restored does not
significantly affect the patient1s centric occlusion or anterior guidance.
 Lumber of teeth to be restored is less (SG).
 'osterior occlusion is stable (7table I?') " with no interferences,
increased toothwear, mobility, rotation, drifting etc.
 7ometimes following loss of posterior teeth in a single Auadrant, the
antagonist teeth may tilt J supra erupt resulting in an uneven occlusal
plane. Enless these teeth are recontoured, any replacement will change the
I?' that will then be determined by the shape of opposing teeth. #o
prevent this, the irregularities have to be eliminated pre operatively, but as
I?' remains unchanged, the approach is considered as conformative.
 #here is no e&isting mandibular dysfunction.
TEC*NIGUE!
G;
When considering the provision of simple restorative dentistry to the
conformative approach, no matter what type of occlusal restoration is being
provided the sequence is always the same - THE ‘EDEC PRINCIPLE’.

T*E EDEC PRINCIPLE FOR DIRECT RESTORATIONS 4
2. (&amine!
E&amine the static and dynamic occlusions before pic+ing up a
handpiece. $ar+ them pre operatively on teeth, as e&plained earlier.
$alpositioned opposing supporting cusps, ridges or fossae may be recontoured
in order to achieve optimal occlusal contacts in the restored tooth. 'lunger
cusps and over erupted teeth are to be reduced. In anterior restorations, the
scheme of incisal guidance must be e&amined and understood prior to tooth
preparation. Also, an assessment of periodontal condition must be made.
3. Design!
Always visualiDe the design of the cavity preparation. #his is better done
after a simple occlusal e&amination .#he e&isting occlusal mar+s will either be
preserved by being avoided in the preparation, or they will be involved in the
design, but never end preparation margins at these points.
#he contacts do not have to be e&actly duplicated but may be improved
(from being :incline contacts1 to :cusp tip to fossaJmarginal ridge1 relationships
or it may be possible to add an occlusal contact if the restoration being replaced
was in infra occlusion). Often it will be found that the previous restoration was
in infra occlusion, as every dentist is an&ious to avoid the :high restoration1.
#his should be avoided and altered. ?ontact point placement and space for
G1
#he E2E? 'rinciple is useful in relation to4
" 2irect restorations
" Indirect restorations.
interpro&imal soft tissues must be given adeAuate consideration. At the same
time, care for periodontal tissues if reAuired must be decided on.
4. (&ecution!
#he e&ecution of the restoration must be to the design (form) of the
preparation that the dentist will have decided before starting to cut. ?areful
placement of rubber dam clamps, matri& bands and wedges is important.
?ontrolled interpro&imal cutting and care in restoring a&ial tooth contour to
avoid overcontouring is essential. ?arving of restorations must be harmonious
to occlusion and should not introduce premature contacts.
5. )hec6!
/inally, chec+ the occlusion of the restoration, that it does not prevent all
the other teeth from touching in e&actly the same way as they did before. #his
is either done by=
" referring to some diagrammatic record made
" by reversing the colour of the paper or foils used pre"operatively and
using the preoperative mar+s as a reference
" /rom memory.
Interarch contacts must be e&amined in the following seAuence=
(a) E&amination of ,' contacts 6 #he teeth are to be guided gently to ,?' and
the initial contacts should be obtained as and mar+ed with plastic foil supported
by $iller holders. If in supraocclusion, restoration must be adusted until there
are appropriate bilateral contacts on posterior teeth.
(b) E&amination of I' contacts 6 'atient is as+ed to gently tap teeth together in
intercuspal position but without biting with pressure .Hight contact may
identify a supracontact on the restoration, which is mar+ed with foil as before.
A premature or heavy contact on the restoration is recontoured, so that at I?'
there is simultaneous bilateral contact on posterior teeth. 2uring this
G9
adustment of restoration contact, the anatomy of the tooth may be more clearly
defined.
(c) E&amination of Hateral and 'rotrusive contacts 6 Hateral guidance from ,'
is chec+ed with plastic foil and $iller1s holders to ensure that the restoration
does not cause interference in lateral e&cursions. 8uidance should be on
anterior teeth and any group function interferences that may result in
interferences should be relieved.
'rotrusive guidance from ,' is chec+ed by as+ing patient to slide incisor
teeth to an edge"to"edge position and then slide bac+ to I'. ,eturn aw to ,' by
operator guidance. *eavy contacts mar+ed, as before, should be relieved.

're " e&isting (pre"op.) Initial chec+ of after adustment"
mar+s. finished restoration simulates pre"op. mar+ings
T*E EDEC PRINCIPLE FOR INDIRECT RESTORATIONS 4
#he essential difference between a direct and an indirect restoration is
that a second operator is involved, namely the laboratory technician. #he
dentist not only has to e&amine the occlusion but the results of that e&amination
have to be accurately recorded and that record has to be transferred to the
technician.
G@
#he E2E? principle is still followed for indirect restorations.

/inally, because of the interval in treatment to allow the restoration to be
made, the clinician has the responsibility to maintain the patient in the same
occlusion during that interval between the prepared tooth and the adacent and
opposing teeth.
2. (&amine!
#he e&amination of the patient1s pre"e&isting occlusion is carried out
in e&actly the same way as described for the direct restoration. #here is a need
for this information to be transferred accurately to the laboratory technician=
hence a record must be made. #he occlusal relationship of teeth is the
important record, because the technician cannot carry out his or her
responsibilities without +nowing how the upper and lower models relate to one
another.
#his information can be transferred by interocclusal records. #he methods
of recording interocclusal records include4
  #wo dimensional bite records 6 Intra oral photographs, written
records, andJor Occlusal 7+etching
  #hree dimensional bite records 6 >ite registration materials such as
hard wa&, acrylic resin, elastomers etc and functionally generated
path techniAue, dynamic occlusion bite registrations.
  A combination of both.
3. Design!
?linically the cavity preparation is designed in e&actly the same way as
for a direct restoration. #he fundamental differences from direct restorations
GC
are that firstly the technician is going to ma+e the restoration and secondly that,
dependent on the material to be used, there will be certain reAuirements
especially with regard to sufficient clearance between the top of the preparation
and the opposing teeth. If because of clinical considerations (e.g.= nearness of
pulp in a vital tooth) the technician may not have sufficient room, for material
(say an adeAuate thic+ness of porcelain in a metal ceramic crown), then it is
much better to give the technician permission to reduce the height of the
opposing tooth than to ris+ a high crown. #he opposing tooth may be
accordingly adusted at the ne&t sitting.
Another process in designing of indirect restoration is Model grooming.
It is the title given to the process of adusting the models so that they more
accurately reflect the occlusal contacts that the patient has in hisJher real
dentition. #hese are small and not gross adustments to the occlusal surfaces of
the plaster models. #he obections to this process include that firstly they
should not be necessary and once scratches are made on those models, they
are no longer a completely accurate representation of patient-s teeth (*f models
are ,groomed-, then they are not accurate'. #his is also true, but though models
are not accurate, the process of grooming is designed to reduce the inaccuracy.
#he models would no longer be an accurate three dimensional representation of
the patient1s teeth but you could still ma+e an accurate restoration on them as
only the occlusal surfaces matter. $odel grooming adusts the occlusal surfaces
of the models so that they ma+e the same contacts as the patient1s teeth do. It is
part of the :relevant anatomy replication1 process. *ence it is acceptable.

S&$1#s B#'o%# s&$%&in1 l$Bo%$&o%; '$B%ic$&ion o' %#s&o%$&ion
GF
4. (&ecute!
In tooth preparation, adeAuate space for the material must be provided.
In case of 6os&#%io% &##&", a minimum of 1"1.Fmm occlusal reduction is
necessary to overlay a supporting cusp. Lon supporting cusps do not have to be
reduced to the same e&tent as they do not receive direct a&ial contact from
opposing teeth in centric occlusion (e&cept in cases of lateral cross bite). In
case of inlays, margins should not be +ept at occlusobuccal line angles of
mandibular teeth or occlusopalatal line angles of ma&illary teeth. #hese are the
sites of contact of the supporting cusps in centric occlusion and placement of
margins in these areas will render the cusps wea+ and liable to fracture. In case
of $n&#%io% &##&", the palatal and incisal aspects have to be reduced sufficiently
to prevent overcontouring of restoration. A porcelain ac+et crown reAuires a
minimum of 1"1.Fmm clearance for adeAuate thic+ness of porcelain while a
ceramometal crown reAuires 1.F" 9mm clearance. Enderpreparation of a tooth
results in overcontouring of the crown, which then incorporates a cuspal
interference or prematurity. #he dentist will then be faced with the options of
mutilating or perforating the crown, grinding the opposing tooth, ignoring the
problem or re"doing the preparation. Occlusal reduction should therefore be
carefully chec+ed in centric occlusion, ! in wor+ing, non"wor+ing and
protrusive relations.
'articular care must be ta+en in restoring individual c$nin#s, as they are
involved in both types of wor+ing guidance and the original wor+ing guidance
must be duplicated as closely as possible. In tooth preparation, sufficient
amount of reduction is essential and the original contour of palatal surface must
be maintained. An overcontoured canine will cause a steep canine rise. #his
may act as a wor+ing interference. 0hen restoring a canine, the canine
guidance should aim to ust clear contact of the premolars and molars on the
wor+ing side during a wor+ing movement. 0hen a canine is being replaced by
a pontic on a fi&ed bridge, canine guidance can be developed. If a cantilever
GG
bridge is made using the premolars, group function should be developed
instead and the pontic must be free of any lateral contacts.
/rom an occlusal point of view one of the most significant
considerations in e&ecution is the provision of a temporary restoration which
duplicates the patient1s occlusion and is going to maintain it for the duration of
the laboratory phase. /or this= the temporary restoration should be a good fit
and provide the correct occlusion, so that the prepared tooth maintains its
relationships with adacent and opposing teeth. >y far the easiest way of
achieving these aims is to ma+e a custom temporary crown thus preserving the
patient1s pre"e&isting occlusion.

Prepared tooth with occlusal marks on Temporary crown in place with same
adjacent teeth occlusal marks on adjacent teeth
5. )hec6!
#he occlusion of the restoration should be as ideal as possible
(preferably not on an incline) and should not prevent all the other teeth from
touching in e&actly the same way as they did before. #his needs to be chec+ed
before and after cementation. ?ementation is the last place to get it wrongT As+
the patient to slide their teeth using one colour of articulating paper or foil, and
then tap their teeth using a different colour and chec+ occlusion as done for
direct restorations.
#he important limitation of the conformative approach is that none of the
teeth to be prepared or adusted can be deflecting contacts (an occlusal contact
that guides the mandible into the aw relationship is +nown as a deflecting
G<
contact) because then on changing them, the aw relationship will probably be
changed and it becomes a reorganiDed approach no matter how few teeth are
being restored, which is a much more comple& procedure.
#he conformative approach is favored not because it is the easiest but
because it is the safest. It is least li+ely to introduce problems for the tooth, the
periodontium, the muscles, the temporomandibular oints, the patient and the
dentist. *ence, this approach must be used whenever possible.
(",A+*7(D A00"A)1!
7ometimes the treatment of a patient1s dental needs is impossible in the
same occlusion and so the aw relationship which that occlusion dictates.
0hen these are changed then the approach is +nown as :the reorganiDed
approach1. #he deciding factor determining the difference between the
approaches is :4aw relationship- -changes reAuired in aw relationships ma+e it
,reorgani2ed approach-.. 3#he provision of new restorations to a different
occlusion which is defined before the wor+ is started4 i.e. :to visualiDe the end
before starting1 is defined as the re(organi2ed approach.”
In such a scenario, as the patient is going to have a different aw
relationship after treatment, the safest way of managing this change is to ensure
that the new occlusion is more, rather than less, ideal in relation to the rest of
the articulatory system.
*deal occlusion
G8
Essentially the only difference between the conformative and the re"
organiDed approach is that the re"organiDed approach is the conformative
approach with the e&tra stages of designing and e&ecuting a new occlusion
before providing the definitive or :final1 restorations to conform with this new
occlusion.
INDICATIONS!
  0henever conformative approach is not possible (unstable I?', slide
from ,?' to I?' is large).
  0hen restoration involves teeth with deflecting contacts. If a
modification to these deflecting contact teeth is envisaged, this then
becomes a reorganiDed approach.
  $ultiple restorations (UG teeth) -esp. cases where all posterior teeth are
to be restored in one arch or most teeth in opposing Auadrants are to be
replaced ! abutment teeth form interferences..
  /ull mouth rehabilitation cases.
  In cases of reduced vertical dimension (assoc. with short clinical crown
height).
  A significant change in appearance is wanted.
  #here is a history of fracture of e&isting restorations or of teeth.
  A tooth or teeth isJare significantly out of position (i.e. overerupted,
tilted or rotated)
  'resence of mandibular dysfunction (#emporomandibular disorder).
TEC*NIGUE!
#he re"organiDed approach is a seAuential process with a clearly
defined starting and end point. It is a much more complicated process and the
conseAuences of failure are much more than in the conformative approach.
Even in large cases it is Auite often possible that by using very careful records
G9
or by splitting the restorations into stages, one can conform to the pre e&isting
occlusion. *ence, where possible try to avoid the ,e"organiDed approach. #he
+ey for success in this approach is the 7eAuential treatment plan with the
completion of each defined step.
#he treatment can be approached following the E2E? 'rinciple.
2. The (&amination 0hase!
#he first essential part of the e&amination in reorganiDing an occlusion is
to determine the 3&5TR*3 R&67T*O5. ?entric relation can be determined by
careful bimanual manipulation, as e&plained earlier.
In some patients with tense musculature or who have been functioning
with their less than ideal (habitual) occlusion for long periods of time, it is
necessary to :de(programme- the musculature for some period of time before
recording centric relation. In such cases=
 ,epeat several times to educate a patient to rela&.
 A cotton roll or leaf gauge can be placed between the patient1s front
teeth for a few minutes to brea+ the proprioceptive feedbac+ mechanism
of habitual closure.
 At the chairside, an anterior bite plane (:Hucia ig1) may also be
constructed in acrylic resin. #his may be worn by the patient for some
time in the chair to :de"programme1 the musculature prior to
<;
( 8 (&amine the e&isting occlusion. $The e&amination phase%
D 8 Design the new occlusion. $The planning phase%
( 8 e&ecuting the planned new occlusion9 :aw relationship ; restorations. $The
pre-definitive restoration treatment phase%
) 8)hec6ing that the definitive restorations conforms to the occlusion that has
'een designed and e&ecuted in the previous phases. $The definitive treatment
phase%
manipulation. #his can also be incorporated into an interocclusal record.
#he ig covers the upper central incisors ! is shaped to have contact
with the lower central incisors in ,?' and create a posterior separation
of 9mm.
 If even this is ineffective, a stabiliDation splint may have to be
employed. #his is a hard acrylic splint made to cover whichever
dentition has the most missing teeth .*ere, the use of splints comprises
part of the e&amination phase, than being reserved solely for treatment
of a #$2.
The static occlusion is also e&amined on a tooth level to discover the e&istence
of any incline contacts between the cusps of opposing teeth.
The dynamic occlusion needs to be e&amined with a view to discovering any
posterior interference.
An estimate of the condylar angles is to be made. #his can be done by simply
adusting the condylar angles of the articulator until the space (or lac+ of it)
between the molars on the L07 is the same as it is in the patient .
7tudy casts are also poured which are essential to indicate the static relations
of teeth ! for careful treatment planning. #he centric relation record may be
transferred to an articulator (use of interocclusal records and occlusal s+etch).
$a&illary cast is related to the *inge a&is of articulator using a facebow.
#he e&amination phase of the process is completed when the clinician has
a set of articulated models that are an accurate representation of the patient1s
occlusion and aw relationship.
<1
3. The 0lanning 0hase!
'rior to initiating the designing of new occlusion, accurately duplicate the
stone models at the correct centric relation and occlusion on the articulator. #he
steps in this phase include4
a) $oc+ eAuilibration on study models.
b) A 2iagnostic wa& up (with creation of occlusal planes).
a' 0oc e8uilibration on study models:
$oc+ eAuilibration is a process involving many small occlusal
adustments carried out on the stone models until multiple and ideal contacts
between opposing teeth occur in centric relation. It is carried out on one
set(duplicate), whilst not sacrificing the hard earned accurate record which
represents the patient1s e&isting occlusion on the other set (i.e. the starting point
of the treatment).
Obectives 6
 #he coincidence of centric occlusion in centric relation or centric relation
occlusion (?,O).
 Establishment of a dynamic occlusion that is free from posterior
interferences.
 ?usp to fossa contacts between opposing teeth.
Advantages 6
" It is undoubtedly the best way of learning how to eAuilibrate (valuable
rehearsal) as changes made in the mouth are irreversible.
" It can answer the Auestion whether provisional restorations are going to be
necessary in order to provide a patient with ?,O.
" It will enable the patient to see the clinical obectives more clearly.
" #his facilitates obtaining the patient1s informed consent and gives them
confidence in your approach to treatment planning.
<9
Inclin#s &o B# $(Eus&#( $n( (i%#c&ion o' o66osin1
&oo&" sli(#
M$n(iBul$% 0o5#0#n& M$2ill$%; &##&" M$n(iBul$% &##&"
a) 'rotrusive
2istal inclines, mesial
direction
$esial inclines, distal
direction
b) Hateral wor+ing side
Hingual inclines,
transverse direction
>uccal inclines,
transverse direction
c) Lonwor+ing side
$esiolingual (grooves),
obliAue direction
2istobuccal (grooves),
obliAue direction
d) ?entric
$esial inclines,
anteroposterior direction
2istal inclines,
anteroposterior direction
S#Du#nc# o' occlus$l co%%#c&ions 4
#he seAuence of these adustments on the models is recorded as an aid
for subseAuent clinical eAuilibration carried out in the mouth. If the adustments
of the stone teeth e&ceed that prudent for the real teeth, it indicates that it will
not be possible to achieve an ideal occlusion without maor alteration to those
teeth such as provisional restorations of some type, orthodontic adustment etc.
b' 9iagnostic :ax up:
2iagnostic wa&ing is a method of determining the optimal occlusion that
can be obtained in unusual J comple& cases on casts mounted on adustable
articulator. In this process the correctly mounted and now eAuilibrated casts are
modified by the application of wa& as a moc+"up of the final restorations or
prostheses.
A diagnostic wa& up is essential=
" #o determine the type of restorations, design ! placement of pontics,
provide ideal occlusal contacts.
<@
" #o determine the need for palliative orthodontics (minor tooth
movements), need for crown lengthening ! as a guide to optimum
crown preparation.
" 7o that the new vertical dimension can be maintained or increased by
developing the cusp height and fossa depth ! to provide ideal anterior
guidance and enhanced tooth morphology.
" #o provide a template for the temporary restorations and result in better
aesthetics.
7eAuence 6
#his reAuires careful designing and carving using wa& of different
colors.
  After casts are mounted, teeth to be restored are reduced
appro&imately 9mm in all positions (including a&ial surfaces) of the
casts.
  Le&t add wa& to these teeth and any gaps to be restored to a level
above the proposed occlusal planes. If an edentulous area is to be
restored, pontic may be formed from Auic+ cure acrylic ! set into
position using wa&.
  Initially the ideal occlusal planes are established by use of :>roadric+
flag techniAue1 6 fi&ing of a flag on the articulator ! determining the
plane (as the radius of a sphere of Cinches) by geometric dividers.
  #rim wa& down to this plane, which will be the position of the cusp
tips of teeth to be restored.
  ?arve morphology of teeth as reAuired, into the wa&, to full contour
bringing them to occlusal contact with the opposing arch.
  Epper casts are now re"fit to the articulator and minor occlusal
adustments, if reAuired, are made to the opposing teeth.
A wa& up of a proposed restoration is an ideal opportunity to see the end
<C
point of an occlusal change, before pic+ing up a handpiece. #his will help the
patient, dentist and technician to visualiDe the final result. >y designing, the
final restoration will loo+ and function better.
#he planning and design phase of the process is completed when the
clinician has a set of articulated models and is confident that they are an
accurate representation of the ,end point- of the treatment plan.
4. The pre-definitive restoration treatment phase!
Once the end point of treatment is visualiDed, the clinician can set around
to bringing about these changes in the patient in this phase. #his phase involves
e&ecution of the planned new occlusion and aw relationship.
7teps involved include=
a) EAuilibration of natural teeth and minor orthodontic ,
&
if reAuired.
b) 'reparation of teeth.
c) 'rovisional restorations.
a' &8uilibration of natural teeth:
Occlusal eAuilibration involves carrying out the changes performed on
the models during moc+ eAuilibration in the design phase. #he aim of
eAuilibration is to effect changes in the centric occlusion to give it as far as
possible the features of an ideal occlusion to reduce the ris+ of precipitating
adverse reactions.
#he eAuilibration of the teeth is done by careful and seAuential removal
of the premature contracts in centric relation until all of the posterior teeth
touch simultaneously in that aw position. It is done over at least two visits and
without local anaesthetic. EAuilibration is not an easy procedure. It is, however,
a necessary s+ill for the dentist who wishes to restore a case to the re"organiDed
approach. If desired occlusion can1t be met by eAuilibration alone, the teeth
may be moved in three planes to a position that is compatible with the aim of
<F
the treatment plan. 0hether this is needed is determined at the study model
stage itself.
b' ;reparation of teeth:
In this stage, one of the obectives of the clinician is to prepare the teeth
in such a way +eeping the anatomy to allow the technician to construct the
crowns to the agreed occlusal design. In particular, the preparations should
have appropriate occlusal reduction. AdeAuate functional cusp bevel must be
provided where reAuired to provide for bul+ of material ! prevent occlusal
prematurity. #ooth preparation characteristics are similar to indirect
restorations in conformative approach. It is important that the clinician +eeps
the final occlusal prescription in mind during the preparing of the teeth=
otherwise the technician may not be able to create the desired result.
A transparent acetate template that has been made on a model of the
diagnostic wa&"up during the preparation of the teeth is very useful, and almost
ustifies the diagnostic wa&"up stage by itself. It is not only used to form the
temporary crowns, but will help to gauge the amount of tooth removal
necessary.
c' ;rovisional restorations:
#he function of the provisional restorations is not only to protect the
prepared teeth and maintain gingival health, but also to maintain the occlusion
whilst the permanent crowns are being made. All the information regarding the
occlusal scheme of the final restorations should be programmed into the
provisional restorations. 7ubtle changes may be reAuired but the final
restorations should conform to the provisionals. #hey may provide the ideal
means of testing the change in occlusion against the tolerances of the patient.
#heir fitting also affords the clinician an opportunity to refine the functional
and aesthetic aspects of the treatment.
/inal refinements to the new occlusion can only be made in the patientBs
mouth and this is best done on the provisional restorations, not the definite
<G
restorations. #hus, the provisionals are used to :develop1 the re"organiDed
occlusion.
'rovisional restorations can be either chairside or laboratory made. >oth
are adustable and allow changes to be made until appropriate occlusal contacts
and aesthetics are developed. 'rovisional restorations are usually made in heat"
cured acrylic or composite and are cemented with a temporary cement to
facilitate easy removal. Over a number of review appointments, the occluding
surfaces of the, restorations are adusted by eAuilibration or addition. #he
obective is to fulfill the criteria of an ideal occlusion. #he final act of this
phase of treatment is to articulate study casts made from impressions of mouth
with the provisional crowns in place. #hese models will guide the technician
during the construction of the definitive restorations.
#he pre"definitive restoration phase of the process is completed when the
patient has an ideal (i.e. tolerated) occlusion with provisional restorations.
5. The definitive treatment phase!
Once the provisional restorations are at the stage when the clinician and
the patient are satisfied, they can be replaced by the definitive restorations now
using the conformative approach (i.e. to conform to this newly established
occlusion). ?rown fabrication (wa&ing) is commenced in this stage and cast.
#he challenge for the laboratory technician is to :copy1 the occlusal features
that have been :developed1 in, and shown to be comfortable by, the
provisionals.
/or restoration of upper anterior teeth, this can be achieved by a
customiDed incisal guidance table, in order to conform to the same anterior
guidance. #he anterior guidance table of a semi"adustable articulator is loaded
with an accurate autopolymerising acrylic, such as pattern resin. #he movement
of the incisal pin through the material creates a template of the movements of
the articulator during lateral and protrusive movement= thus the custom incisal
<<
guidance table is created. It is particularly valuable in setting the ideal crown
length and palatal contour of the canine restoration.
#he restoration is then chec+ed clinically for marginal fit and occlusal
contacts as in the conformative approach and then cemented.
#hus, the :,eorganiDed approach1 involves firstly the establishment of a
:more ideal1 occlusion in the patient1s pretreatment dentition or provisional
restorations= and then adhering to that design using the techniAues of the
:conformative approach1
T*E RE,ORGANI8ED APPROAC*! A SUMMAR+
A comple& case involving multiple crowns provided to a different aw
relationship, and maybe to an increased vertical height, may seem impossible
and daunting.
7uccess will be the result, as long as these phases are predetermined and
the discipline is maintained of not starting a phase until the aims of the
previous one have been achieved.
#he number of stages of the re"organiDed approach will vary from case to
case, depending on the comple&ity and operator e&perience, but the essential
steps can be summariDed as follows4
  Attend to the needs of individual teeth first (e.g. Endodontics, core
placement) but without changing the bite=
  2iagnose and treat any temporomandibular disorder=
  2etermine Bcentric relationB
  2esign and develop an ideal occlusion with the aid of interocclusal
records, study casts on articulators, diagnostic wa& ups, eAuilibration of
teeth, provisional restorations etc.
  2evelop the needed restorations to this developed occlusion
<8



-" D*()T (ST"AT*"+S
Amalgam restorations are the most commonly used direct restorations for
restoring carious or bro+en posterior teeth. $odern amalgams, when well
<9
"cclusal assessment /
/$ ?i&" &"# %#s&o%$&ion ou& s#l#c& $ 6$i% o' in(#2 &##&"H A"ic" "ol(
s"i0 s&oc:.
/B M$%: Ai&" Bl$c: $%&icul$&in1 'oil $n( $(Eus& ICP.
/c M$%: Ai&" %#( $n( $(Eus& #2cu%si5# in&#%'#%#nc#s $n( (#'l#c&ions
/( A(Eus&0#n& co06l#&#
condensed, finished and restored in sufficient bul+, may provide very adeAuate
posterior restorations and adeAuately support the posterior forces of occlusion.
'rior to cutting a tooth, its opposing occlusal surfaces should be e&amined.
$alpositioned opposing supporting cusps, ridges or fossae must be recontoured
in order to achieve optimal occlusal contacts in the restored tooth. 'lunger
cusps and over"erupted teeth may be reduced and any premature contacts or
cuspal interferences may be eliminated in order to avoid their duplication in the
restoration.
/ormulation of ideal contacts and contours 6
/or the proper reproduction with a restorative material of the previously
described ideal contacts and contours of teeth, two operative acts must precede
or accompany the restorative procedure, tooth movement and matricing.
Tooth movement may be achieved by appropriate use of wedges
or separators such as Elliot separator, /errier double"bow separator etc. #hey
aid in placement of matri& and compensate for thic+ness of the band to ensure
re"establishment of contact on removal of band. <edges also help in restoring
pro&imal contour and maintain gingival embrasure. 0edges are triangular in
shape, in conformity with the gingival embrasure. Occlusally, the wedges must
not be too thic+ as this may influence the pro&imal contour. Also, if the wedge
is not high enough only point contact between the wedge and the band is
achieved. #his may lead to poor contour or displacement of the wedge during
condensation. Hoss of contact point may occur if the cross"sectional height of
the wedge is too large. A uniform tapering of the wedge is needed in order to
render sufficient and even contact throughout the pro&imal embrasure. In case
of high embrasures or wide pro&imal bo&es, ,piggy bac- wedging or ,double
wedging- may be resorted to.
Matricing creates a temporary wall opposite to the a&ial walls,
surrounding areas of tooth structure that were lost during preparation. #hey are
used when restorative material is introduced in plastic state to provide shape for
the restoration during setting of the restorative material and maintain its shape
8;
during hardening of the material. #he bands have to be burnished at contact
area to ensure that there is no :open contact1 at the end of restorative procedure.
A variety of matri& retainers and bands are available for use. #he commonly
used ones for compound and comple& amalgam cavities are #offlemire
(Eniversal retainer), siAveland, Ivory no. 1, Ivory no. 8 retainers etc.

C$%5in1 o' A0$l1$0 &o $c"i#5# occlus$l "$%0on; 4
?ondensing and carving bac+ an amalgam restoration to correct
occlusion is different from carving an indirect wa& pattern. #hough, the aim of
both is to establish stable occlusal contact, it must be remembered that once
carved away, amalgam occlusal contacts cannot be replaced as conveniently as
wa& can be added to a pattern. In amalgam, establishment of a single point
contact at the fossa is recommended as a practical alternative to tripodisation as
inadvertent removal of any one of the three tripod contacts will result in
occlusal instability.
#he contour of the amalgam must follow that
of the enamel inclines (Enamel planes are ta+en as
a guide by placing the carving instrument such that
it lies partly on enamel and a partly on amalgam).
#he height of the marginal ridge should be the
same as that of the adacent tooth. $esial and distal
triangular fossae may be carved as small triangular depressions between the
marginal ridges and the central groove.

0hen the entire tooth is to be built up in amalgam, there are no enamel
planes to guide carving. #he restoration may be contoured by referring to outer
81
?A,KIL8
$A,8ILAH
,I28E
?A,KIL8
A$AH8A$
buccal and lingual contours of the teeth on either side of the restoration. >uccal
and lingual cusp tips should be placed in a line oining those cusp tips of
adacent teeth. It should be noted that the buccolingual width of :the occlusal
table is slightly narrower than the ma&imum buccolingual width of the tooth.
7imilarly, the line of the central fossae may be contoured by following the
central fossae line of the adacent teeth. #he level of the central fossae and
ridges may be carved to that of the adacent teeth prior to testing of the
occlusion by closure.
8EI2E /O, ?A,KIL8 HA,8E A$AH8A$ ,E7#O,A#IOL7
On completion of condensation and gross carving, a small point contact of
the opposing cusp into a fossa or on marginal ridges must be obtained and the
occlusion carefully mar+ed while the amalgam can still be carved. A maor
problem is the possibility of fresh amalgam fracturing during adustment of
centric occlusion and eccentric contacts. /or this reason, the patient must be
as+ed to close lightly and also the amalgam should be allowed to undergo an
initial set after the gross contouring has been completed. #his reduces the
chances of fracture while prematurities and interferences are being eliminated.
're"mature contacts on the new restoration must be Auic+ly removed with a
discoid carver. #his procedure is repeated until the adacent teeth contact while
the restoration still can mar+, thus insuring the restoration has not been carved
out of occlusion. Once adacent teeth are in contact, the articulating ribbon
mar+s on restoration are refined to achieve a small point contact when the
mandible is closed in ma&imum Intercuspation.
#he occlusal contacts should be small and centered over the long a&is of
89
root support. #he mar+ should be narrowed in the bucco"lingual dimension to
prevent interferences during lateral e&cursions.

#he restoration is tested in centric and e&cursive movements with
articulating papers, as discussed and adusted, if reAuired. #he marginal ridges,
central fossae, developmental and supplemental grooves may be refined after
occlusion has been adusted.
In case of tooth colored restorations, the appro&imate anatomy is built up
with the material and then reduced and occlusion adusted using burs.
In restoring anterior teeth, they are builtJcontoured ta+ing adacentJsimilar
contralateral tooth as a guide and e&isting incisal guidance (protrusive sliding
contact upto the edge"to"edge position) must be restored. ?ontact occurs on
palatal surfaces of upper central, lateral incisors and canines and the bucco"
incisal angle of the lower central ! lateral incisors and canines.
',O#,E7IKE IL?I7AH 8EI2AL?E

8@
 #ooth morphology for carving
amalgam restorations4
1 6 marginal ridge
9 6 triangular fossa
@ 6 developmental groove
C 6 supporting cusp tip
F 6 non supporting cusp tip
G 6 obliAue ridge
< 6 central fossa
8 6 cusp ridge
9 6 supplemental groove.

OCCLUSION AND RESTORATIVE MATERIALS
#he relationship between occlusion and restorative materials is mainly
dictated by the wear of teeth or restorative materials. #he other factors to be
considered include= :Occlusal forces, the type of 8uidance, presence of
parafunctional movements, available ?rown length etc1.
In the mouth, wear of teeth, restorative materials, and prostheses can
disrupt occlusal relationships, leading to destabiliDation of occlusion. #he
attritional characteristics of occlusal restorations should appro&imate as closely
as possible the potential for wear of the teeth.
A0$l1$0 4
#he wear rate of amalgam is only slightly more than enamel and has no
appreciable effect on the function of occlusion. *ence, these are preferred in
areas of heavier occlusal forces (stress bearing areas), in patients with
parafunction. It was noted in a clinical comparison of amalgam and composite
restorations at three years that only FM" 1;M of amalgam restorations lost their
anatomic form compared to composite restorations (G;M " <;M).
Co06osi&# %#sin 4
?omposite resins showed a wear rate 9.F 6 @ times the adacent areas.
?omposite resins were found to have very low abrasive resistance compared to
enamel. In some cases it was found that opposing tooth had supraerupted to
maintain function with worn composites. Also, in time, contact areas of class II
composites were found to be substantially flattened due to wear, resulting in
shifting of adacent teeth thus altering occlusion.
7ome currently available systems e&hibit wear rates nearly the same as
amalgam. E&tent of wear depends on V siDe and hardness of the filler
particles. #he microfill is least abrasive followed by barium silicate glasses and
8C
finally AuartD filled posterior composite resins. Harger the particle siDe greater
is the degree of wear.
WuartD containing posterior composite resins have shown superior wear
resistance. #his can be attributed to=
1) 7tability of AuartD as filler
9) #heir chemical structure offers one of the best potentials for optimiDing the
silane coupling agent.
@) Abrasive nature of AuartD.
Also, it was found that on :*eat treatment1 of resin inlays and onlays
reduced wear. 2ecreased appro&imal wear was noted when resin was dry
heated at 19FX? for F minutes after first curing by light than those that were
light cured only.
Po%c#l$in 4
#hey have great potential for abrading the antagonist material or tooth.
*igh potential for abrasion related to e&posure of hard AuartD particles in the
feldspathic matri&. Improper occlusion with porcelain coincidentally generated
a clic+ing type of sound whenever the opposing teeth contacted prematurely.
#hey cause uneven wear of teeth resulting in loss of occlusal stability and
causing occlusal trauma. #he development of occlusal interferences associated
with posterior porcelain restorations can also trigger bru&ism.
#he use of porcelain for ma&illary anterior teeth is generally contraindicated
in cases of limited canine guidance, decreased overet and increased overbite,
when teeth are thin in labiolingual direction and when there is evidence of
bru&ism. /ull porcelain occlusal coverage may be given in patients with canine
guided occlusion as there will be no functional contact on porcelain in lateral
and e&cursive movements. It is then less susceptible to shearing forces.
E&cessive wear effects of porcelain may result in tooth instability, sensitivity of
natural teeth, wear of opposing restorative material, or even holes in opposing
cast restorations. 'atients with porcelain occlusals reAuire careful regular
8F
monitoring for occlusal imbalances and e&cessive wear.
$inimiDation of wear of enamel by dental ceramics 6
1) 8enerating e&tremely small particles of AuartD to minimiDe this problem.
9) 'roducts that contain no AuartD particles at all.
@) ?astable ceramic (2icor) has been mar+eted that is a highly polishable
material. 2icor is considerably less abrasive to enamel than conventional
porcelains.
C) Ese of metal in functional bru&ing areas.
F) If occlusion in ceramic, use ultra"low fusing ceramics
G) 'olish and glaDe the ceramic surfaces
<) ,e"polish and readust occlusion periodically if needed.
Pol;0#%ic R#sin 4
'olymeric teeth are considerably less wear resistant. 7mall occlusal
interferences are eventually neutraliDed or eradicated through normal function.
-$s# 0#&$l $llo;s 4
#he difficulty of developing functional harmony and their e&treme
hardness ma+e the base metal alloys often the cause of trauma from occlusion.
It is difficult to adust the occlusion on stainless steel crowns and their removal
may be necessary when interferences are more than minimal.
In cases where considerable amount of effort is reAuired for establishing
and maintaining occlusion (such as in cases of bru&ism), gold or palladium
based cast alloys are materials of choice because they e&hibit similar
mechanical properties.
It is found that relative wear rate of :li+e1 restorative materials opposing
each other is less than the total wear of different combinations and hence li+e
materials should oppose each other where possible.
8G
PAT*OLOGIC OCCLUSION
Any disharmony e&isting between the teeth ! the #$% that result in
symptoms and signs that reAuire intervention is +nown as 'athologic occlusion.
#hese maor dysfunctions include=
" >ru&ism
" #raumatic Occlusion
" #$% and muscle pain dysfunction syndrome ($'27)
=>?*SM!
>ru&ism is defined as grinding andJor clenching the teeth, and is not
related to the functions of mastication and swallowing. ?linical signs of this
parafunctional activity are uneven occlusal wear and broad faceting of the
teeth. >ru&ism generates forces of greater than normal magnitude and intensity
sustained over a prolonged time.
E&iolo1; o' B%u2in1 ,
#he etiology of bru&ing is un+nown. It is suspected by many authorities to be
neurological= resulting from nervous tension coupled with the presence of
occlusal interferences. #he emotional stress may be the result of longstanding
psychological conflicts, temporary wor+ stress and fatigue, or the sudden onset
of personal psychological problems. >ru&ism has also been referred to as the
3freeway disease5. *ighly competitive people often show signs of bru&ism.
Emotional stress relates to bru&ing, and that occlusal interferences act only to
aggravate the occlusal situation after bru&ing has begun.
,esearch shows that most people who bru&, and who present themselves
for clinical e&amination, are under stress, and that most of them e&hibit some
type of occlusal disharmony.
8<
Clinic$l si1ni'ic$nc# o' B%u2in1 ,
→ 8ross wear of the teeth. #he wear may involve all of the dentition, one
side only, or ust the anterior teeth, depending on whether the individual is
a bilateral or unilateral bru&er, or bru&es on the anterior teeth only. $any
people who bru& grind only the opposing canines, destroying the canine
disclusion effect and setting up gross occlusal interference, patterns on the
posterior teeth.
→ If the wear progresses at an accelerated rate, the pulps of the teeth can
become e&posed, causing tooth pain and necessitating endodontic as well
as restorative treatment.
→ 7ome bru&ers do not produce large facets of wear. #he teeth may e&hibit
minimum faceting, yet be mobile due to occlusal traumatism.
→ Individuals who bru& often e&hibit enlarged masseter muscles. #his is
always a strong indication of bru&ing. #hey also present with alveolar
tenderness.
→ *ypertrophy of the masseter may occur bilaterally or unilaterally
depending on whether the individual is a bilateral or a unilateral bru&er.
#he proprioceptive mechanism may become overloaded or consciously
ignored by the individual. #his can result in diminished response by the
proprioceptive protective mechanism that would normally act by refle&.
→ 'ain and aw stiffness primarily in the morning is characteristic.
→ Individual may end up with an orofacial dys+inesia i.e.= lac+ of
proprioception, grossly worn teeth, loss of vertical dimension, and a
totally confused neuromuscular pattern that is erratic and irregular. #here
are no holding stamp cusps to effect a positive centric occlusion position.
T%#$&0#n& ,
88
Often psychotherapy, physiotherapy and biofeedbac+ procedures must
precede or accompany occlusal treatment in these patients. It is essentially a
relearning process for the muscles and proprioceptors, followed by or
accompanied by a reorganiDation of the occlusal surfaces of the teeth with
restorative methods.
Occlusal therapy includes occlusal adustment or ?oronoplasty, bite raising
gold crowns on molars, and splints (vulcanite splints covering occlusal surfaces
of all teeth were first to be recommended).#hey act by reducing muscle
hypertonicity as has been observed in E$8 studies. 7plints are also used to
minimiDe tooth surface loss.
,estorative mode of therapy is indicated in the treatment of bru&ism
when a stable, well"balanced occlusion cannot be established by occlusal
adustment alone. #hey may be indicated in order to substitute for or to prevent
e&cessive loss of tooth substance by bru&ism. 0hen vertical dimension has to
be raised, it has to be +ept to a minimum and restorations should be of same
degree of hardness to prevent uneven wear. #he occlusal pattern in such
restorations should be as close to ideal as possible to minimiDe the tendency for
bru&ism and to prevent future occlusal wear.
TA>MAT*) ")).>S*"+ A+D TA>MA -"M ")).>S*"+!
#he term traumatic occlusion was introduced by :7tillman1 in 191< and
was defined by 7tillman and $c ?all as follows=
%Traumatic occlusion is an abnormal occlusal stress which is capable of
producing or has produced an in<ury to the periodontium”
#he resulting tissue inury is termed as 3#rauma from Occlusion.5
Si1ns $n( S;06&o0s!
?linical manifestations of trauma from occlusion are usually
inconspicuous unless the condition is severe.
#he signs are,
89
" Increased tooth mobility
" 7oreness to pressure
" Atypical pattern of occlusal and incisal wear J >ru&ism
" 'artial or total coronal fractures of teeth
" ?hanges in percussion sounds (dull percussive sound)
" $igration of teeth
" *ypertonicity of masticatory muscles
" 'eriodontal abscesses (if in conunction with deep periodontal
poc+ets)
" 8ingival clefts
S;06&o0s inclu(#H
" 'ulpal pain
" 'eriodontal pain
" /ood impaction
" $uscle pain J spasm
" 7ensitivity of teeth
" Hoose teeth
" *eadache andJor facial pain.
T%#$&0#n&!
#reatment should constitute occlusal adustment along with other
procedures such as splinting of teeth, orthodontic therapy, restorative
treatment as and when needed. #reatment may also involve e&traction of teeth
with advanced periodontal disease.
9;
S;06&o0s o' o5#%lo$( o'
0$s&ic$&o%; s;s&#0
TM@ A+D M>S).( DAS->+)T*"+ SA+D"M(!
It is a musculos+eletal dysfunction of the stomatognathic system giving rise
to symptoms in the masticatory muscles, temporomandibular oints, teeth and
the periodontium.

")).>SA. AD@>STM(+T $=y Selective ,rinding#)oronoplasty%
Occlusal adustment is 3the establishment of functional relationships
favorable to the periodontium by one of the following procedures4 reshaping of
the teeth by grinding, dental restoration, tooth movement, tooth removal or
orthognathic surgery5
?oronoplasty is 3the selective reduction of occlusal areas with the
primary purpose of influencing the primary contact conditions and the neural
pattern of sensory input.5 It is a direct and irreversible change of the occlusal
scheme.
#his cannot however be eAuated to :7pot 8rinding1 that is common
practice. 7pot grinding employs the principle of grinding away all articulating
paper mar+ings until the patient feels that the restoration is no longer :high1. As
a result the restored tooth may become non functional and completely out of
contact. #his often results in compounded occlusal problems due to shifting of
the position of teeth causing unstable terminal relations, loss of vertical
dimension, supra eruption of opposing teeth etc.
In(ic$&ions!
1. 'rimary #rauma from Occlusion due to
" 'eriodontal
91
" 2ental
" 'ulpal
" #.$.%. ($'27)
" Leuromuscular
" Oral soft tissues
9. 7econdary #rauma from Occlusion
" #ooth mobility associated with loss of support
@. 'rior to e&tensive restorative dental treatment, planned occlusal
reconstruction.
C. In restricted functional movements " for improvement of functional
relations and inducement of physiological stimulation of the entire
masticatory system.
F. Instability of occlusion following orthodontic or other dental
treatment.
S&#6s!
It is a planned procedure and should be done in a step wise manner,
preserving and restoring the anatomy of the teeth at a particular age. #he steps
are as follows=
A. 8rooving
>. 7pheroiding
?. 'ointing

A. 8rooving 6
It consists of restoring the depth of developmental grooves, which have
been made shallow by occlusal wear. It is carried out using a tapered cutting
tool until a desired depth is achieved.
>. 7pheroiding 6
99
It consists of reducing the prematurities while restoring the original
tooth contour. #his is done with a light paint brush stro+e, gradually blending
the area of prematurity with the adacent tooth surface. A special effort is made
to preserve the height of the cusps.
0hen the teeth are flattened by wear, the buccolingual diameter of the
occlusal surface is increased. #he obective is to restore the buccolingual width
of occlusal surface to normal dimensions.
?. 'ointing 6
#his step consists of restoring cusp point contours and is done by
reshaping the tooth with rotating cutting tools.
#hen, at each recall the occlusion should be analyDed since occlusion is
dynamic and may need minor adustments every time.
9@