Criteria for Optimum

Functional Occlusion
"Tlli' clinician tile
needs to understand basic orthopedic
-JPO
1)
or/and's Ii/ustrated Medical defines
occlude as "to close as to the
mandibular teeth into contact with the
teeth in the maxilla "I In dentistry, occlusioll refers
the relationship of the maxil and mandibu­
lar teeth when are in functional contact dur­
activity of the mandible The that
3rises is What is the best functional

.11
:::r occlusion of the teeth? This
... :
stimulated much discussion and debate,
,ears, several concepts of occlusion have been
(it'
and have varying degrees of
It might be interesting to follow the
of these concepts
HISTORY OF THE STUDY OF OCCLUSION
of the occlusal relationships
made by Edward in 1899,'
=:clusion became a topic of interest and much
years of modern
and replacement of teeth
2came more feasible. The first
to describe functional occlu­
"ll was called bellallced OCclHSiof1. This concept
- ,ocated bilateral and balancing tooth contacts
.' ,-,ng all lateral and movements
::: "nced occlusion was primarily for
dentures. with the rationale that this
-
of bilateral contact would aid in the
mandibular movement The
concept was accepted, and with advances in
dental and it carried
over into the field of fixed prosthodontics.))
As total restoration of the dentition became
more feasible controversy arose regarding the
of balanced occlusion in the natural
dentition After much discussion and debate, the
concept of unilateral eccentric contact was subse­
quently the natural dentition 67 This
theory suggeste
contacts) as well as protrusive contacts, should
occur only on the anterior teeth It was during this
time that the term was first used The
study of has come to be known as
the exact science of mandibular movement and
resultant occlusal contacts. The con­
cept was popular not for use in restoring teeth
but also in attempting to
eliminate occlusal It was accepted so
that with any other occlusal
configuration were considered to have a malocclu­
sion and often were treated because their
occlusion did not conform to the criteria
to be ideal.
In the late 1970s the concept of individ­
ualocclusion . This concept centers around
the health and function of the
and not on any
If the structures of the system are
and without pathology, the
is considered physiologic and
of specific tooth contacts.
95
.,.".
96 Functional Allatollllj
Therefore no in the occlusion is indicated
Afte, examiration of m.;merous with a
of occlusal conditions and no apparent
the merit of this con­
cept becomes evidert.
The :aci ng derti stry is apparent
when a with the and symptoms of
occlusal-related comes to the dentai
The dentist must determine
inate th
time) \Vhat is the optir,lum func­
tional occlusion)
the study of occlusion so
have not been sa(sfactorily answered
to determine which conditions
to cause any
examines certain aratomic and
features of the system f\n accu­
mulation of these features wiii represent the
functional occlusion. wh:ch. although it
may not have a h incidence in the
ulation. ShOl.;ld represent to the clin
ment Is when ng to either eliminate
occlusion-related disorders or restore mu:ilated
dentition.
CR.ITERIAFOR1HE .9PTlMUM
FUNCTIONAl··OCClUSION
As discussed, the system IS an
interrelated system of
bones. I and nerves To
si a discussion of th system difficult
necessary oefore the basic concepts that influence
the function and health of al the components can
beJ nderstood.
The mandible bone that is at:ached to the
skull and It' a muscular
sl i rg When the elevator muscles I the masseter.
the medial otemwid, and the temnoral I func­
lion, their contraction raises the
that contact is made and torce the
skull in three areas: the two
IIMls) and the teeth I
these muscles have the pabil
Fig.5-1 When the mandible is elevated, force is applied tc
the cranium in three areas: (I and 2) the temporomandibu­
lar joints and (3j the teeth.
for to
. Thus areas need:
to determine the
IC relationst11p that wilt prevent, mini'T1izc
or eliminate ar.y oreakdown or trauma, The
and teeth wili De exam;ned
OPTIMUM ORTHOPEDICALLY
STABLE JOINT POSITION
The ten" celltric rt'latioll [CRI been used
dentistry for many years ever the year:­
l'ad a of definitions.
considered to designate the
when the
stable
CR as the most retruded
Because this is
the I of the
. It
the const;
tior of dentures l\t the time it
considered the most reliable reference pc
obtainable an edentu:Clus natient for accurat
recoraing the oetween the mand:­
and maxilia and u for contro
usa I contact pattern
'H,mr"'"

(Ptl:H:I',
-
97
The popula of CR grew and carried over
into the field of fixed useful­
ness in fixed
both its ity and
studies associated with muscle function
Conclusions from tne Ic
iE\1G) studies that the muscles of mas­
tication function more harmon and with less
when the in C!;: at the time
:hat the teeth are in maximum i
dental I)'
that CR
.'.as a sound More
of the biomechanics and
-: the TM] however, has questioned the retruded
ly
confusing
::-:rcause the definition
--:r in tneir most
: Some clinicians' that none of
: - -:rse definitions of CR
ton and that the
tioned downward and for'ward on the articular
The ng the most
0' the wil continue
- conclusive evidence exists tha: one
than the others
ertheless. in the midst of this controversy
. sts must needed treatment for thei r
::'lts The use stable,
to treatment. Therefore:t necessary
·c,mine and evaluate all available mfmmation
to draw intel conclusions on \\-hich
treatment.
establishing the criteria for the optimum
stable joint the anatomic
:: J of the TM) must be exarm ned
described. the articular is
dense fibrous connective tssue de\'Oid
and blood vessels" This ailows it wii'l­
forces without damage or the induce­
nful stimuli The purpose disc
--:c;ate. protect and stabilize ,he In
lar during functional movements
-
Criteria for OptimulII FUI1(/iollat Oa/llsiol1
Positional stabll of the jomt however, is not
determined the articular disc
nt stabi is determined
muscles that pull the loint and prevent dis­
location the articular surfaces The directional
'mum
Muscles stabilize joints Therefore each mobile
nthasa stobielMSI
When pursuing most stable
'Hvlls, the muscles that Dull across the nts must
be considered The ma muscles that stabil
the P,Als are the elevators. The direction the
on the
t he tern pora I m usc!es have fi bers that
are oriented nevertheless pre,
dom in a
superior These three rruscle groups
ble for joint and
however, the inferior lateral
a make contribution
In the postural without any influence
from the occlusal condition, the are sta­
bilized muscle tonus of the elevators and the
inferior :ateral Dter\20ids The temperal muscles
Fig. 5-2 The directional force of che primary elevator
muscles (temporaliso masseter, and medial pterygoid) is to
seat the condyles in the fossae in a superoanterior posicion,
98 Functional Anatoll1Y
position the condyles superiorly in the fossae. The
masseters and medial pterygoids the
superoanteriorly. Tonus in the inferior
lateral pterygoids the condyles
against the slopes of the articular
eminences.
By way of summary then, the most orthopedi­
cally stable joint as dictated bv the
muscles is when the are located in their
most superoanterior in the articular fos­
sae, fully seated and resting against the posterior
slopes of the articular eminences. This description
is not however, until the position of the
articular discs is considered. rela­
tionship is achieved only when the articular discs
are interposed between the and
the articular fossae The of the discs in the
joints is influenced by the interart:cular
pressures, the morphology of the discs them­
selves, and the tonus in the lateral ptery­
goid muscles. This last causes the discs to be
rotated on the condyles as far forward as the discal
spaces (determined by interarticular pressure) and
the thickness of the border of the discs
will allow
The complete definition of the most orthopedi­
cally stable position therefore is when the
condyles are in their most superoanterior
in the articular fossae. against the
of the articular with the discs properly inter-
The assume this position when
the elevator muscles are activated with no occlusal
influences. This position is therefore considered to
be the most MS position of the mandible
In this MS position, the articular surfaces and
tissues of the joints are such that forces
applled the musculature do not create any dam­
age When a dried skull is examined, the anterior
and superior roof of the mandibular fossa can be
seen to be quite thick and able to
withstand loading forces.
ing rest and function, this is both anatom­
ically and physiologically sound.
The MS position is now described in the Glossary
of Prostnodontic Terms as CR
2i
earlier defi­
nitions
9ll
of CR emphasized the most retruded
position of the condyles, most clinicians have
come to appreciate that seati ng the condvle in the
superoanterior is far more orthopedically
acceptable
The controversy arises as to whether there an
anteroposterior range in the most superior
tion of the condyle Dawson
l6
that there
not. which that if the condyles move
either anteriorly or posteriorly from the most supe­
rior position, they will also move inferiorly This
may be accurate in the young, healthy but
one must realize that not all joints are the same
Posterior force applied to the mandible is resisted
in the joint the inner horizontal fibers of the
temporomandibular (TM) I
superoposterior of the is there­
fore, by definition. a ligamentous position If this
ligament is tight, little difference may exist among
the most superior retruded position, the most
position (ie Dawsons ), and the
superoanterior (MS) position However, if the Tl\l
ligament is loose or elongated an anteroposterior
range of movement can occur while the
remains in its most position
The more posterior the force placed on the
mandible, the more of the
will occur and the more posterior will be the
condylar . The degree of
Fig.5.3 The most superoanterior position of the condy e
(solid line) is musculoskeletally the most stable positic­
of the joint. However, if the inner horizontal fibers of
temporomandibular ligament allow for some posteric­
movement of the condyle, posterior force will displace tr
mandible from this to a more posterior, less stable positic­
(dotted line).The two positions are at the same superior leve
,
f
(

\
t
,,­
-,1!"
i
5
It

d
5t
e-
is
ig
5t
he
'M
or
\'Ie
he
"nt
the
'jor
dyle
tion
the
lrior
the
ition
eve!.
to the health of the
nt appears to permit
movement from the MS
position the health of the
may be difficult to clinically assess.
Studies of the mandibular
demonstrate that in
portion of
Therefore some
movement to the [CP is
normal during function In most this move­
ment is small (I mm or
occur in the structures of the
However, if
joint
of the TM ligament. joint
posterior range of movement can be increased.
The clinician should note that the most
and posterior (or retruded)
condyle is not a
sound (Fig '5-4). [n this
:)e to the aspect of the
-ior retrodiscal lamina, and retrodiscal tissues.
3ecause th.e retrodiscal tissues are h vascular­
2ed and well sUDDlied with sensory nerve fibers,
are not structured to accept
"rce. Therefore when force is aDDlied to this area,
-ere is a great for eliciting and/or
:'iusing breakdown.
24

28
l=ig.5·4 Posterior force to the mandible can displace the
: : - :yle from the musculoskeletally stable position.
Criteria for Optimum FUl1ctiOflal Occ/usioll 99
When the dried skull is examined from an
anatomic the aspect of the
mandibular fossa is seen to be quite thin and
This fea­ not meant for stress
the fact that the
as discussed in
participate in
does not appear to be
of the joint
t, liga­
function.
exist to act as limiting structures for certain
extended or border nt movements
as
the idea of using this bcnder
an um functional
was discussed Such a
border relationship would not be considered
um for any other nt would this ortho­
princi be any different for the TMI')
Because it is sometimes clinically difficult to
determine the extracapsular and i
condition of the it is advisable not to
force on the mandible when
to locate the 'v1S of the joint The major
should be on guiding or directing the
to their most in
the fossae This can be accomplished either a
bilateral mandibular ng or by the
musculature itself (as discussed in later
For the remainder of this text CR will be defined
as the most superoanterior of the
the articular fossae with the discs
[t can thus be seen that CR
are the same. This definition
of CR is becoming
Another concept of mandibular sug­
gests that a different is optimal for the
are described
of the articular eminences iFig '5-5}l\s the
downward and
the disc
bone are d Examination of
the dried skul; reveals that this area of the
articular eminence is quite thick and able to
withstand force. Therefore tbis
like the most 5uperoanterior appears
be anatomically of forces. in
fact this a normal orotrusive movement of
CLARK COLLEGE UBkARY
100 Functional Anatomy
Fig. 5-5 Forward movement of the mandible brings the
condyles down the articular eminences. Increased muscle
activity is likely.
the mandible. The major differences between this
position and the 1\1S lie in muscle func­
tion and mandibular stability
To position the condyles downward and forward
on the posterior slopes of the articular eminences,
the inferior lateral pterygoid muscles must con­
tract. This is compatible with a protrusive move­
ment. However, as soon as the elevator muscles
are contracted, the force applied to the condyles
by these muscles is in a superior and slightly ante­
rior direction. This directional force will tend to
drive the condyles to the superoanterior position
as already described (i.e., MS position). If the max­
imum ICP were developed in this more forward
position, a discrepancy would exist between the
most stable occlusal position and the most stable
joint position Therefore in order for the patient
to open and close in the ICP (which is, of course,
necessary to function), the inferior lateral ptery­
goid muscles must maintain a contracted state to
keep the condyles from moving up to the most
superoanterior positions Therefore this position
represents a "muscle-stabilized" position. not an
MS position Assuming that this position would
require more muscle to maintain mandibu­
lar stability is logical Because muscle pain is
the most common complaint of patients with
masticatory disorders, it would not seem favorable
to deveiop an occlusal condition that may actually
increase muscle activity. Therefore it does not
appear that this position is compatible with mus­
cular rest,29 and it cannot be considered the most
physiologic or functional position.
Another concept that has been proposed to
help the dentist locate the most optimal condylar
position is through the use of electrical stimula­
tion and subsequent relaxation of elevator mus­
cles. In this concept the elevator muscles are
electrically pulsed or stimulated at regular inter­
vals in an attempt to produce relaxation. This tech­
nique has been used by physical therapists fOl
years with good success in reducing muscle
tension and pain. Therefore there may be good
rationale to use electrical stimulation to reduce
muscle pain, even though data are scarce (see
Chapter II). The followers of this concept believe
that if this pulsation is done in an upright-head
position, the elevator muscles will continue to
relax until their EMC activity reaches the lowest
level possible, which they describe as rest. This
rest represents the point at which the forces of
gravity pul down on the mandible equal the
elasticity of the muscles and ligaments that sup­
port the mandible (viscoelastic tone) In mos[
cases this means that the mandible is positioned
downward and fOf\vard to the seated superoante­
rior position. The fact that this is the position of
lowest EMC does not mean this is a
reasonable position from which the mandible
should function. /\s discussed in this text. the
position (lowest EMC activity) may be found a:
8 to 9 mm of mouth opening. whereas the postura
position is located 2 to 4 mm below the ICP ir
readiness to function
30JI
Assuming that the idea
mandibular position is at the lowest point of EMC
is a naive thought and certainly not sut·
stantiated with data. However. followers of thl:,
believe that it is at this position the::
occlusion should be established.
At least three important considerations
tlon the likelihood that this position is an
mandibular pOSition. The first is related to the fa.:'
that this position is almost always found to
downward and forward to the seated
position. jf the teeth are restored in this
3nd the elevator muscles contract. the condyles
!.dl be seated superiorly. leaving only posterior
:eeth to occlude. The only way the occlusal posi­
.. on can be maintained is to maintain the inferior
pterygoid muscles in a partial state of con­
--action bracing the condyles the posterior
of the articular eminences. This, of course.
'e::lresents a "muscle-braced" position and not an
','5 as previously discussed.
-"nother consideration in a desirable
:;'ldibular position by pulsing the elevator mus­
• e3 is that this position is almost always found to
an increased vertical dimension. The highest
that can be by the elevator mus­
:5 at 4 to 6 mm of tooth separation
32
It is at
=iistance that the elevator muscles are most
c': =2nt in breaking through food substances,
the teeth into maximum intercuspation at
.ertical dimension would cause a great
--:::se of forces to the teeth and periodontal
. _::Jres, increasing the for breakdown.
consideration in using this technique is
: the muscles are relaxed, the mandibular
can be greatly
:·re the patient's head
::::uired maxillary/mandibular
influenced by
= moves his or her head forward or back
tilts it to the right or left, the mandibular
: : :- will change It would not appear
,ype of variation is reliable when restoring
:- er concern with this is that basi­
_::::.- individual. whether healthy or with a
:: disorder, will assume an open and for­
== of the mandible following muscle
Therefore this technique is not helpful
patients from normal healthy
·.'.'hen this occurs, individuals
considered for unnecessary therapy,
_. 8e quite extensive,
'., -'ary, from an anatomic standpoint one
-' ,je that the most superior and anterior
the condyles resting on discs
slopes of the articular em
most orthopedically sound position
3:e standpoint it also appears that this
- of the condyles is mal, An addi­
.-: is that it also has the
Criteria for Optimum Functional Occlusion 101
of reproducible, Because the
condyles are in a superior border position, a repeat­
able terminal movement can be executed
(see Chapter
OPTIMUM FUNCTIONAL TOOTH
CONTACTS
just described has been consid­
ered in relation to the infl factors of
the joint and muscies. As previously discussed. the
occlusal contact pattern influences the
muscular control of mandibular When
closure of the mandible in the MS position creates
an unstable occlusal condition, the neuromuscular
system quickly feeds back muscle
action to locate a mandibular position that will
result in a more stable occlusal condition. Therefore
the MS of the joints can be maintained
when it is in harmony with a stable occlusal
condition. The stable occlusal condition should
allow for effective functioning while minimizing
to any components of the masticatory
system The clinician should remember that the
musculature is capable of much greater
force to the teeth than is necessary for function
Thus it is important to establish an occlusal condi­
tion that can heavy forces with a minimal
likelihood of and at the same time be
effici ent.
The optimum occlusal condition can be deter­
mined by the following situations
I. A patient has only the right maxil and
mandibular first molars present. As the mouth
these two teeth provide the only occlusal
for the mandible (Fig. 5-6) Assuming that
40 Ib of force is applied d function. it can
be seen that all this force will be applied to
these two teeth. Because contact is only on the
right the mandibular position will be
unstable and the forces of occlusion provided
by the musculature will likely cause an over­
closure on the left side and a shift in the
mandibular position to that side This con·
dition does not the mandibular stabil­
ity necessary to function effectively
instability) If forces are applied to
teeth and ioints in this situation breakdown to

102 Functional AnatomlJ
Fig. 5-6 When only right-side occlusal contacts are present,
activity of the elevator muscles tends to pivot the mandible
using the tooth contacts as a fulcrum, The result is an
increase in joint force to the left temporomandibular joint
(TMJ) and a decreased force to the right TMJ.
tre teeth, and supporting structure is a
significant risk
2. Another patient has only the four first molars
present. When the mouth is closed, both right
and left side molars contact lFig. 5-7L This
occlusal condition is more favorable than the
because wr,en force is applied
the musculature, the bilateral molar contacts
a more stable mandibular
only minimal tooth surfaces accept
the 40 lb of force provided during function, the
additlona I teeth lessen force appl ied
to each tooth (20 lb per tooth) Therefore this
type of occlusal condition provides more
mandibular stability wr,i1e decreasing force
to each tooth
3. A third patient has only the four first molars and
four second premolars present When the mouth
is closed In the .r-AS position, all eight teeth
contact evenly and simultaneously (
The additional teeth provide more stabilization
of the mandible. The increase in the number of
teeth also decreases the Forces to each
tooth, thereby potential
(The 40 lb of force during function are now
distributed four of teeth, reSUlting in
10 Ib on each tooth I
Understanding the of these
tions leads to the conclusion that the
occlusal condition during mandibular closure
\vould be provided even and simultaneous
contact of all possible teeth This type of occlusa
furnishes maximum for the
mandible while minimizing the amount of force
"''' If
Fig. 5·8 Bilateral occlusal contacts continue to maim2
Fig. 5-7 With bilateral occlusal contacts, stability of the mandibular stability. As the number of occluding tee:­
mandible is achieved. increases, the force to each tooth decreases.
::aced on each tooth during function Therefore
criteria for optimum functional occlusion
=2\'eloped to this point are described as even and
multaneous contact of all possible teeth when
mandibular are in their most
peroanterior position, resting against the poste­
slopes of the articular eminences, with the
::scs properly interposed In other words, the MS
of the (ie, CR )
jes with the maximum ICP of the teeth. This is
:nsidered orthopedic stabU
Stating that the teeth must contact evenly and
is not descriptive enough to
optimum occlusal conditions The exact
. pattern of each tooth must be more closely
'.amined so that a precise description of the
.: :::;mum relationship can be derived. To evaluate
s better, the actual direction and amount of
.. "::e applied to each tooth needs to be
=,,,mined.
Direction of Force Placed on Hie Teetft
. studying the supportive structures that sur­
': ,,;nd the teeth, it is possible to make certain
servations:
First, osseous tissues do not tolerate pressure
-"::eslG2340 In other words, if force is applied to
:-:e, the tissue will resorb. Because the
:",,,,:h are constantly receiving occlusal a
( is present between the
" -t of the tooth and the alveolar bone to help
:: :,trol these forces The PDL is of col­
connective tissue fibers that suspend the
'th in the socket. Most of these fibers run
: ='c;uely from the cementum, extending occlusally
'ittach in the alveolus ( 5_9)40 When force
: a::Jplied to the tooth, the fibers support it and
sion is created at the alveolar attachment.
- '2::sure is a force that osseous tissue cannot
but tension (pulling) actually stimulates
: c::eous formation. Therefore the PDL is capable of
.: ,erting a destructive force (pressure) into an
force (tension). [n a general sense it
be thought of as a natural shock absorber
.: :rolling the forces of occlusion on the bone.
.:. second observation is how the PDL accepts
::us directions of occlusal force. When a tooth
, ::;ntacted on a cusp tip or a relatively flat surface
Criteria for OptimulI1 Frtnctionai Occ/usion 103
Fig. 5-9 PERIODONTAL LIGAMENT. Most fibers
run obliquely from the cementum to the bone, (The width
of the periodontal ligament has been greatly enlarged for
illustrative purposes.)
Fig. 5-1 0 When cusp tips contact flat suriaces, the result­
ant force is directed vertically through the long axes of the
teeth (arrows), This type of force is accepted well by the
periodontal ligament.
such as the crest of a ridge or the bottom of a
fossa the resultant force is directed vertically
through its long axis. The fibers of the PDL are
aligned such that this type of force can be well
accepted and dissipated (Fig. 5-10 I When a tooth

...""""
104 Functional Allatomy
I:J--+- B
'.::::1 ,i/fj B A
Fig. 5-11 When opposing teeth contact on inclines, the
direction of force is not through the long axes of the teeth.
Instead. tipping forces are created (arrows) that tend to
cause compression (A) of certain areas of the periodontal
ligament and elongation (B) of other areas.
contacted on an incline. however. the resultant
force is not directed its axis. Instead.
a horizontal component i incorporated and
tends to cause tipping ( 5-1 II There'ore when
horizontally directed forces are ied to a tooth.
many of the fibers of the POL are not properly
al to control them. As the tooth some
of the POL are \vhile others are
pulled or elongated Overall. the forces are not
dissipated to the bone.:
1
A
The clinician should remember that vertical
forces created tooth contacts are well
the POL. but horizontal forces cannot be ef'ec­
dissipated These forces may create
bone responses or even elicit neuromuscular
reflex activity in an attempt to avoid or guard
against incline contacts.
way of summary. then if a tooth is contacted
such that the resultant forces are directed
. the POL is quite efficient
and breakdown is less
in such a manner that
horizontal forces to the
structures. likelihood of pathologic
effects's greater.
The process of directing occlusal forces through
the axis of the tooth is known as axial ioadifW
Axial loading can be achieved two methods
1 The first method is the
tooth contacts on either cusp
flat surfaces that are lar to the
axis of the tooth These flat surfaces can be thE:
crests of marginal or the bottoms
With this type of contac: the
forces vd] be direcced the long axis
the tooth iFig 5-12. Al
2 The second method (called tripodization) requirf:
o
that each cusp contacti ng an fossa
such :hat it three contac
c
the actual cusp tip. When this c
the resultant force directed throw::'
axis of the tooth ( 12.
Both methods eliminate
the POL to accept
ng forces to the bone and essenti2.
reduce them
B
t ....
J.
Fig. 5-12 Axial loading can be accomplished by (A) cusp tip-to-flat surface contacts or (B)
reciprocal incline contacts (called tripodization).
Amount of Force Placed on the Teeth
The criteria for um occlL:sion have now been
Criteria for OptimullI FUllctiollal Oce/usion 105
it is closer
likelihood of its
the fulcrum to increase the
cracked This demonstrates
that greater forces can be to an oblect as
its nears the fulcrum The same can be
inences
First. even and simultaneous contact of
teeth shoL:ld occur when the mandibu­
::econd, each tooth should contact in such
:or that the forces of closure are directed

aspect that has been left undis­
relates to the of the TMI The
-'.:1 permits lateral and excursions,
-ch allow the teetn to contact during different
of eccentric movements. These lateral excur­
1S allow horizontal forces to be to the
-22-C; As alreadv stated, horizontal forces are not
the su structures and tne
-"_:omuscular system, yet the of the
requires that SOr,le teeth bear the burden of
-:oe forces, Thus several factors
0- be considered wnen identifying which tooth
- -2eth can best accept these horizon:al forces
--e lever system of the mandible can be com­
with a nutcracker When a nut is being
':':- ed it is between the levers of tile nut­
:'.2r and force is aPDlied It it is extremelv hard
said of the 5-1 '31 If a hard
nct is to be cracked between the teeth, the mcst
desirable is not between the anterior
teeth but between the teeth, beca use as
the nut is closer to the fulcrum (the
TMII and the area of the force vectors (tne mas­
seter and medial muscles), greater force
can be ied to the Dosterior than to the anterior
teeth . .)(,-;'
The however, more
fulcrum of the nutcracker is
system is free to move. As a when
forces are to an on the poste­
rior teeth the mandible ;s of
downward and forward obtam the occlusal rela­
that wiil best the desired task
This snifting of the
mandibular Additional r,luscle groups
such as the inferior and
and the temporals are then called on
lateral pterygo
to stabil
the resulti in a more com
than that of a nutcracker.
th concept and realizing that
Whereas the
I
Fig. 5·13 The amount of force that can be generated between the teeth depends on the
distance from the temporomandibular joint and the muscle force vectors. Much more force
can be generated on the posterior teeth (A) than on the anterior teeth (B).
A B

106 Fundional Anatomy
applied to the teeth can create pathologic changes
lead to an obvious conclusion: The damaging hor­
izontal forces of eccentric movement must be
directed to the anterior teeth, which are positioned
farthest from the fulcrum and the force vectors.
Because the amount of force that can be applied to
the anterior teeth is less than that which can be
applied to the posterior teeth, the likelihood of
breakdown is minimized
4850
When all the anterior teeth are examined. it
becomes apparent that the canines are best suited
to accept the horizontal forces that occur during
eccentric movements}' They have the
longest and largest roots and therefore the best
crown/root ratio. They are also surrounded by
dense compact bone. which tolerates the forces
better than does the medullary bone found around
posterior teeth Another advantage of the
canines centers on sensory input and the resultant
effect on the muscles of mastication. Apparently.
fewer muscles are active when canines contact
during eccentric movements than when posterior
teeth contact. 5556 Lower levels of muscular
would decrease forces to the dental and joint
structures, minimizing pathosis, Therefore when
the mandible is moved in a right or left laterotru­
sive excursion. the maxillary and mandibular
canines are appropriate teeth to contact and dissi­
pate the horizontal forces while disoccluding or
disarticulating the posterior teeth. When this con­
dition exists. the patient is said to have canifle 9l1id­
ance or canine rise ( 5-14).
Many patients' canines, however. are not in the
proper position to accept the horizontal forces
other teeth must contact during eccentric move­
ments. The most favorable alternative to canine
guidance is called group fltftction In group function.
several teeth on the working side contact during
the laterotrusive movement. The most desirable
group function consists of the canine, premolars,
and sometimes the mesiobuccal cusp of the first
molar (Fig. 5-15) Any laterotrusive contacts more
posterior than the mesial portion of the first molar
are not desirable because of the increased amount
of force that can be created as the contact gets
closer to the fulcrum (TM])
The clinician should remember that the buccal
cusp-to-buccal cusp contacts are more desirable
A
t
"
l
B
Fig. 5-14 CANINE GUIDANCE. A, Laterotrusiv€
movement, a, Clinical appearance.
:-c; :" 1: •

during laterotrusive movements than are
:.....::::r.i.::
cusp-to-lingual cusp contacts (lingual to
working) ( 5-16, Aj
The laterotrusive contacts Ieither canine gu i I. cc,··",,"
ance or group function] need to provide adequa-c.
:'J
guidance to disocclude the teeth on the
side of the arch lmediotrusive or nonworking sic"
immediately I Fig 5-\6. B) Mediotrusive contac
A
B
Fig. 5-15 GROUP FUNCTION GUIDANCE
A, Laterotrusive movement. B, Clinical appearance.
-
A
B
L
B
L
B
Fig. 5-16 A, Posterior teeth during a laterotrusive move­
-;:'1t. Contacts can occur between opposing buccal (B) and
- gJalIL) cusps. When group function guidance is desirable.
buccal-to-buccal contacts are used. Lingual-to-lingual
:: -:aces are not desirable during eccentric movement.
B. ::>osterior teeth during a mediotrusive movement.
- --tactS occur between the lingual cusps of maxillary teeth
: - :he buccal cusps of mandibular teeth.
to the system because
::::'lount and direction of the forces trat can
.;:; to t'le joint and dental structures. * Some
5 trat mediotrusive contacts
:;ciled by the neuromuscular system differ­
rn other of occlusal contact. EMC
demonstrate trat all to()th contacts are
In other words. the presence
:::ontacts tends to shut down or inhibit
This results from the
in the POL. which when stim'
";cate responses Yet other EMC
5uggest that the presence of mediotru·
teeth increases muscle
the increase in muscle
::Jnstrated. the rationa for its presence
These concepts are discussed in more
13 47.52.57.58
Criteria for Optill1t11ll Functionai Ocdusioll 107
Fig. 5-17 Protrusive movement with anterior gUidance.
detail in 7.1 What however, is that
mediotrusive contacts should be avoided in devel·
ar optimum fUicctional occlusion.
When the mandible moves forward into protru,
sive contact. horizontal forces ca n
ied to the tee,h /\s with !atera movements,
the anterior teeth can best receive and dissipate
these forces.)0 Therefore the
arterio
y
and not the teeth should contact
5-171 The anterior teeth shadid
contact or to disarticulate the
contacts appear
to unfavorable forces to the
system because of the amount and direcion of the
force that *
Our'ne this discussion it has become evident
teeth fJnction
closure of the
accept these forces wei!, I)
because their the arch is such trat
the force can their axes
so axial loading is nearly
The anterior teet h.
well in the arches
anterior teeth receive occlusal
contacts du closure, there is a great Ilkeiihood
that their suooort;ve structures will not be abe
forces and wi II be
common finding in
tooth support I.
I 47 52 57. 58
108 Functional Anatomy
A '''If.....
B
Fig. 5-18 A, Heavy occlusal contacts on the anterior
teeth can occur when posterior tooth support is lost. The
maxillary anterior teeth are not aligned properly to accept
the mandibular closing forces. These contacts often lead to
labial displacement or flaring of the maxillary anterior teeth.
B, Posterior bite collapse. The posterior teeth have been
lost, resulting in flaring of the anterior teeth. The labial flar­
ing has led to increased interdental spacing proximal to the
maxillary lateral incisor.
Anterior unlike posterior teeth. are in
Droper position to accept the forces of eccentric
mandibular movements. Generally. therefore it
may be stated that posterior teeth function most
in stopping the mandible during clo­
sure, whereas anterior teeth function most effec­
ir gu the mandible during eccentric
:llovements. With an appreciation of these roles it
:)ecomes apparent that posterior teeth should
sl more than anterior teeth
.. hen the teeth are occluded in the lCP This condi­
is described as mutlwlly vratected accilJsion.
Postural Considerations and Functional
Tootfl Contacts
,)iscussed in Chapter 4, the postural of
ncandible is that which is maintained during
of inactivitv. It is generally 2 to mIT:
below the lCP and can be influenced to some
head position. The degree to which it is
affected by head position and the resulting
occlusal contacts must be considered when devel­
oping ar. optimum occlusal condition
6261
In the
'lormal upright head position. as well as the alert
position (head forwa rd approxi matel:,
I the posterior teeth should contact
than the anterior teeth (mutuall"
protected occlusion) If an occlusal condition is
established with the patient reclined in a dental
chair. the mandibular postural position and result­
ant occlusal condition may be slightly posteriori"
oriented \Vhen the patient sits up or assumes the
alert feeding , any change in the postural
and its effect on occlusal contacts
be evaluated If in the upright head or the
alert feeding the patient's mandible
assumes a sl anterior postural position
of the elevator muscles will result in heav,
anterior tooth contacts. When this occurs, the
anterior contacts must be reduced until the poste­
rior teeth again contact more heavily durin{;
normal closure. This concept is called the cmteril"
envelope af f,melior! When this slight ir
mandibular not considered, the resu
ing anterior tooth contacts can lead to thE
development of functional wear patterns on the
anterior teeth This is not true for all patients. bu­
it is difficult to predict which patient will show th!:,
response This is especially important to thi::
restorative dentist who wants to minimize force,
to anterior restorations, such as porcelain crowns
Failure to understand and evaluate this positio:­
can lead to crown fractures.
SUMMARY OF OPTIMUM
FUNCTIONAL OCCLUSION
On the basis of the concepts presented in th'
a summary of the most favorable func­
tional occlusal conditions can be derived The fc'­
lowing conditions appear to be the least pathogen:
for the greatest number of patients over tr
time
When the mouth closes, the
their most superoanterior !\' ­
on the
tJ "'"
11'1,
articular eminences with the discs properly
In this position there is even and
;:::multaneous contact of all posterior teeth. The
teeth also contact but more lightly
an the posterior teeth.
. I tooth contacts provide axial loading of
=:clusal forces
'.. :",en the mandible moves into laterotrusive
:: adequate tooth-guided contacts on
::: laterotrusive (working) side are present to
:::3occlude the mediotrusive (nonworking) side
The most desirable guidance is
: -'·.ided by the canines (canine guidance),
en the mandible moves into a protrusive
, sition, adequate tooth-guided contacts on
anterior teeth are present to disocclude all
: teeth immediately
,:-:e upright head position and alert feeding
_ : sc:or., posterior tooth contacts are heavier
-- - anterior tooth contacts,
_____________________
;'t':-tnces
-,;·:.15 illustrated medical dictionary, ed 30, Philadelphia,
Saunders, p 1298.
'_' HI: Classification of malocclusion, Dem Cosmos
_. 1899,
\'1-/: Balanced occlusions, J :1m Dent Assoc 12:
: .. 33, 1925.
IL: Physiologic occlusion, J Am Dent Assoc 13:
:,v)3, 1926.
FS: Cast bridgework in functional occlusion. J Am
20:1015·1019.1933
'.,c:r C: Correction of occlusion: disharmony of the
dentition. N Y Dent J 13:455-463. 1947,
H. Stuart C: Concepts of occlusion, Dent Clin
"iovember:591-601, 1963.
- -- ,'rd SP, Ash MM: Occlusion, ed 3, Philadelphia, 1983.
... :2rs pp 129-136.
_:.'a CO: Current clinical dental terminology, 5t Louis,
: \!osby.
U Studies in the mobility of the human mandible,
. ;.-n[O! Scand lO(Suppl): 19-27, 1952.
::,c CO: Swenson's complete den tH res, St Louis, 1970,
112.
. SP: Dysfunctional temporomandibular joint and
o pain, J Prostltet Dent 11 :353-362, 1961.
-:- S' Bmxism: a clinical and electromyographic
\m Dent AsSN 62:21-28, 19G1.
" Int1uence of occlusal patterns on movement of the
- :.c'c J Prostltet Dem 12:255-261, 1962
Criteria for Optimum FrmclionalOcciusion 109
1.5. Posselt ll: of ('cciusion and re/t,liJiiit,l1ion,
Philadelphia, 1968, FA Davis, p 60.
16. Dawson Pl.: El'aluation, diagnosis and treatment of occlusal
problems, St Louis, 1989. \1osby, pp 28·34.
17. Jankelson B, Swain CW: Physiological aspects of mastica
torv muscle stimulation: the myomonitor, Quime5sence lilt
3:57-62. 1972,
18, Gelb H: Clinical management of IWild, ned? and T\1J paill and
Philadelphia, 1977, Saunders
19. DuBml EL: Sieller's oral anatomy, St Louis, 1980, Mosby,
P 178.
20. Moffet BC: Articular remodeling in the adult human
temporomandibular joint, Am) Anilt 115:119-127,1969,
21. Van B1arcom CW, Campbell SD, Carr AB et al: The glossary
of prostltodontic terms, ed 7. St Louis, 1999, ,\-losb", P 58.
22. Wu CZ. Chou SL. Ash MM: Centric discrepancy associated
with TM disorders in young adults, J Delli Res 69:.'\34-337,
1990.
23. DuBml EL: Sieher'" ora! anatom,o St Louis, 1980, Mosby.
24. lankelson B, Adib F: Effect of variation in manipulation
force on the repetitiveness of centric relations registration:
a computer-based study, I Am Dent Assae 113:59-62, 1987,
25, Isberg A, Isacsson G: Tissue reactions associated with
internal derangement of the temporomandibular joint.
A radiographic, crvomorphologic, and histologic study,
Acta Odontol Scand 44:160-164,1986,
26. Farrar WB, McCarty WL: A clinical outline of temporo­
mandibular joint diagno:;is llnd treatment, Momgomerv, /\Ia,
1983, r-;ormandie Publications,
27, Dolwick MF: Diagnosis and etiology of mtemal demngemenfS
of the temp(lromandibular joint: Presitieni's COIlFerence on tile
Examination, Diagnosis, <lnd ;\janagement of 'Dyj Disorder"
Chicago, 1983. American Dental Association, pp 112-117.
28. Stegenga B, de Bont lG, Boering G: Osteoarthrosis as the
cause of naniomandibular pain and dysfunction: a unif)'­
ing concept, J Oral A,jaxillofilc Surg 47:249-256, 1989.
29. '\1amyama T, r-;ishio K. Kotani :VI, Miyauchi S, Kuroda T:
The effect of changing the maxillomandibular relationship
by a bite plane on the habitual mandibular opening and
closing movement, J Oral Rehabil 11 :455·465, 1984,
30. Rugh ID, Drago C): Vertical dimension: a study of clinical
rest position and jaw muscle activity. I Prosthet Dent
45 :670-675, 1981.
31. Manns A, Zuazola RV, Sirhan mvL Quiroz M, Rocabado .\1:
Relationship between the tonic elevator mandibular activ­
ity and the vertical dimension during the states of vigilance
and hypnosis, Crania 8: 163-1 70, 1990,
32. Manns A, 1'.1iralles R, Santander It Valdivia J: Influence
of the vertical dimension in the treatment of myofascial
pain-dysfunction syndrome, J Proslhet Dent 50: 70()-709.
1983 .
33. Gibbs CH, ,>"1ahan PE, Lundeen He. Brehan K: Occlusal
forces during chewing: influence on biting strength and
food consistency, JProsrl1er Dem 46:561-567, 198:,
3 .. , Bates IF: l\IasticatOlY function-a review of the liter.llure. I L
Speed of movements of the mandible. rate of and
forces developed in chewing. JOral Rehal>i12:24'l-256. 1
II
I
Determinants of Occlusal
Morphology
teet(! that s[<ccessfull[J permit efficient mas­
ticatory function is basic to dentistry and survival.'
-,PO
I
n health the occlusal anatomy of the teeth func­
,ions in harmony with the structures controlling
:he movement patterns of the mandible The
..:ctures that determine these patterns are the
joints I,TM]s) and the anterior
-,,:':", During any given movement the unique
- ::::omic relationships of these structures com­
-:' to dictate a precise and repeatable pathway
- harmony of the occlusal the
- _ teeth must pass close to but must not
: . - :sct their opposing teeth during mandibular
.:':T',ent. Importantly, the clinician should exam­
- - :,sch of these structures carefully and appreci­
, :' .- 2W the anatomic form of each can determine
- -: :::::c1usal morphology necessary to achieve an
_::-:-um occlusal relationship The structures that
mandibular movement are divided into two
_:'3 I; I those that infl uence the movement of the
. portion of the mandible and (2) those
the movement of the anterior por­
- _: the mandible. The TMjs are considered the
.:r controlling factors (PCFs). and the anterior
. ­ are considered the anterior controlling factors
- '; The posterior teeth are positioned between
::0:' :\\'0 controlling factors and thus can be
::,::i bv both to varying degrees
POSTERIOR CONTROLLING FACTORS
(CONDYLAR GUIDANCE)
As the condyle moves out of the centric relation
position, it descends the articular eminence
of the mandibular fossa. The rate at which it moves
inferiorly as the mandible is being protruded
depends on the steepness of the articular emi­
nence. If the surface is quite steep. the condyle will
take a steep. vertically inclined path If it flatter.
the will take a path that is less vertically
inclined The at which the condyle moves
away from a horizontal reference plane is referred
to as the condylar guidance angle.
Generally, the condylar guidance angle gener­
ated bv the orbitin2 condyle when the mandible
than when the mandible
protrudes straightforward This is because the
medial wall of the mandibular fossa is generally
steeper than the articular eminence of the fossa
directly anterior to the condyle
The two TMJs provide the guidance for the pos­
terior of the mandible and are
responsible for determining the character of
mandibular movement posteriorly They have
therefore been referred to as the PCFs of tfte
mandibttiC!r movement. The condylar guidance is con­
sidered to be a fixed factor because it is unaJter­
able in the healthv patient. It can be altered,
III
"111__--­
I 12 FUilctiolwl Ana/omy
however, under certain conditions (trauma.
or a surgical procedure)
ANTERIOR CONTROLLING FACTORS
(ANTERIOR GUIDANCE)
lust the TMls determine or control the manner
in which the posterior portion of the mandible
moves, the anterior teeth determi how the
or laterally the incisal
mandibular teeth occlude with the
of t he maxi I iary anterior The steepness of
these lingual surfaces determines the amount of
vertical movement of the mandible. It the surfaces
are quite steep the anterior aspect of the mandible
will take a steep-incline If the anterior teeth
have little vertical will provide little
vertical guidance during mandibular movement.
The anterior gUidance is considered to be a
variable rather than a fixed factor It can be altered
by denta I proced u res sLlch as restorations, ortho­
dontia. and extractions. It can also be a:te;ed by
pathologic conditions such as caries, habits and
tooth wear,
UNDERSTANDING THE CONTROLLING
FACTORS
To understand the infl of mandibular move­
ment on the occlusal of posterior
teeth, one must consider the factors that influence
mandibular movement. As discussed in Chapter 4.
mandibular movement is determined by the
anatomic characteristics both of the TMJs posteri­
and of the anterior teeth anterioriy Variations
in the anatomv of the TMls and the anterior teeth
in the movement pattern of
If the criteria fOe optimum functional
occlusion to be fulfilled the morphologic char­
acteristics of tooth must be in har­
mony with those of its opposing tooth or teeth
during II tric mandibular movements,
Therefore the exact morphology of the tooth
influenced the it travels
ng tooth or teeth
The relationship of a tooth to the con­
trolling factors influences the D;ecise movement c:
that tooth, This means that the nearer a tooth is L:
the TM!. the more the nt anatomy will
its eccentric movement and the less the anatorr
of the anterior teeth will influence its movemel-:
Likewise. the nearer a tooth is to the
rior teeth. the more the anatomy of the anteri,'
teeth will influence its movement and the less
anatomy of the TMls will influence that mover::er:
The occlusal surfaces of teeth
of a series of cusps with both vertical and horize
tal dimensions. are made up of com
ridges that vary in steepness (vertical dimensic­
and direction (horizontal dimension)
Mandibular movement has both a vertical
horizontal component and it is the relations!­
between these com ponents or the ratio that
in the of mandibular moveme'-­
The vertical component is a function of the
oinferior movement. and the horizontal com::
nent a function of the anteroposterior moveme'-­
If a condyle moves downward two units as it IllC. C'
forvvard two units. it moves away from a horiZOI-­
reference an of 4S degrees I'
moves downward two units and forward one
it from this plane at an ang
64 The angle of devia­
horizontal reference plane is what
ill mandibular movement
the mandible as it me
horizontal plane and zero unite
resulting in a deviation
from horizontal of 0 degrees Fig 6-2 shows
mandible four units in the horizonta;
four units in the vertical plane. The result here
deviation away from horizontal of 4'5
In 6-3 the mandible moves four units ir
horizontal plane, but in the vertical the
moves four units and the l'\CF moves six units
resUlts in a movement of the rCF
movement of the ACE Points bet\,.
the factors will deviate by different amounts
plane depending on the:r
factor The nearer a is to the
the more its movement will appr:
(because of the greater influenCe:
the PCF on its movement) Likewise the
_,'
I!,;'
+1111
.'
Determinants of Occlusal Morphology 113
PCF 4 units forward
ounits downward
Units of -- ~ ___
vertical
HRP
movement
HRP ACF 4 units forward
ounits downward
:--­
Units of J
vertical movement --=:___
iTI'n i I ! I
~ Units of ~
horizontal movement
Fig. 6-1 Horizontal reference plane (HRP) of the mandible at both the posterior (PCF)
and the anterior (ACF) controlling factor. The mandible moves horizontally four units from a
position marked by the dotted line. No vertical movement occurs. The solid line represents
the position of the mandible after the movement has taken place.
::lCF 4 units forward
ounits downward
HRP
HRP
ACF 4 units forward
Fig. 6·2 Movement of the mandible
four units horizontally and four units
vertically at both the posterior (PCF)
and the anterior (ACF) controlling
factor. When the mandible moves
four units down. it moves four units
forward at the same time. The net
result is that it is at a 45-degree angle
from the horizontal reference planes.
Because both the PCFs and the ACFs
are causing the mandible to move at
the same rate. each point on the
mandible is at a 45-degree angle from
the horizontal reference plane at the
end of a mandibular excursion.
ITU
the ACF the more its movement wiil
. ~ 57 (because of the greater :nflu­
.-\CF on its movement I. A
the factors will move a'way from
of
ounits downward
45°
one that 259c closer to the ACF than to the PCF
will move away from horizontal at an of
54 (one fourth of the way between 57 a:'d
45 i
To examine the influence of any anatomic varia­
tion on the movement pattern of the mandible.
114 FUI1cti011lli Al1alolH!J
PCF 4 units forward
ounits downward
HRP
HRP ACF 4 units forward
" _
x y
•••••••••••••••• '\}•••••••••••••••• •••••••••••• -. I I
54' ==' I
Fig.6-3 RESULTANT MOVEMENT OFTHE MANDIBLEWHENTHE CON­
TROLLING FACTORS ARE NOT IDENTICAL. The posterior controlling factor (PCF)
causes the posterior portion of the mandible to move four units forward (horizontally) and four units
downward (vertically). However, the anterior controlling factor (ACF) causes the anterior portion of
the mandible to move four units forward and six units downward. Therefore the posterior portion
of the mandible is moving away from the reference plane at a 45-degree angle, and the anterior por­
tion is moving away at a 57-degree angle. A point (x) that is equidistant from the controlling factors
will move at a 51-degree angle from the reference plane. Another point (y) that is one fourth closer
to the ACF than to the PCF will move at a 54-degree angle. Thus it can be seen that the nearer the
point is to a controlling factor, the more its movement is influenced by the factor.
_ necessary to control all factors except the one distance it extends into the depth of an
ng examined Remember that the fossa are determined three factors
the anterior and guidances lies in how I. The ACF of mandibular movement (ie anter,:'
; nfl uence tooth Because the guidance)
. cclusal surface can be affected in two manners 2. The PCF of mandibular movement (i.e,
and width\. it is to separate the guidance)
influence on mandibular movement into 3. The nearness of the cusp to these control:,­
that influence the vertical components and factors
that influence the horizontal components The centric cusps are de\
anatomy of the occlusal surface is also influ­ to disocclude eccentric mandibu
ced by its relationship with the tooth that movements but to contact in the intercuspal pc<
:asses across it during movement. Therefore the tion. For this to occur, they must be ,
. cation of the tooth to the center of rotation is contact in the i position but not so Ie .
discussed. that thev contact dunng eccentric movements
EFFECT OF CONDYLAR GUIDANCE
VERTICAL DETERMINANTS
(ANGLE OF THE EMINENCE) ON
OF OCCLUSAL MORPHOLOGY
CUSP HEIGHT
=actors that influence the of cusps and the As the mandible is protruded, the desce:'
of fossae are the vertical determinants 0: the articular eminence. Its descent in
:::c;usal morphologv. The len2th of a cusp and the to a horizontal reference plane is determined
,ill,
---,.
""'"
t
-

Deterl11i1wnts of occlusal Morphology I 15
'.""''''1 41311. I,., :"Uiil;;;MMl,1I11l!f"
.."
steepness of the eminence. The steeper the emi­
nence, the more the is forced to move
as it shifts anteriorly This results in
sreater vertical movement of the
:llandible, and mandibular teeth.
In Fig 6-4 the moves away from a hori­
:)ntai reference at a To
c mplify visualization, anterior guidance is i Ilus­
--ated at an equal angle The cusp of
,,'.ill move away from a horizontal reference
a 45-degree To avoid eccentric contact
::2tween premolar A and premolar B in a protrusive
;::vement, cuspal inclination must be less than
in Fig 6-5, and anterior
::e are presented as bei ng 60 degrees to the hor­
_. - ntal reference pia nes With these steeper
"":Ical premolar A will move away
from 8 at a 60-degree
in longer cusps. Therefore a steeper of the
eminence guidance) allows for steeper
cusps.
EFFECT OF ANTERIOR GUIDANCE
ON CUSP HEIGHT
Anterior guidance is a function of the relationship
between the maxillary and mandibular anterior
teeth. As presented in Chapter 3. it consists of the
vertical and horizontal of the anterior
teeth To illustrate its influence on mandlbu!ar
movement and thereFore on the occlusal of
posterior teeth, some combinations of vertical and
horizontal appear in 6-6.
Parts A. B. and C present anterior relationsh
that maintain ecwai amounts of vertical
j')
A
cr
A
/'//
/
/
I
I
,
\
\
\

,
\
,
' ..... _­
8
Fig. 6-4 A, The posterior and
anterior controlling factors are
the same, causing the mandible to
move away from the reference
plane at a 45-degree angle. B. For
premolar A to be disoccluded
from premolar B during a protru­
sive movement. the cuspal inclines
must be less than 45 degrees,
116 Functional Arlalomy
A
(? U,{<\-W
Fig. 6-5 A, Posterior and ante­
rior controlling factors are identi­
cal and cause the mandible to move
away from the reference plane at a
60-degree angle. B, For premolar
A to be disoccluded from premo­
lar B during a protrusive move­
ment, the cuspal inclines must be
B
less than 60 degrees. Thus it can
be seen that steeper posterior
and anterior controlling factors
allow for steeper posterior cusps.

\
\
\
A
the in horizontal
one can see that as the horizontal overlap
increases, the anterior decreases
Parts 0, E, and F present anterior
that maintain equal amounts of horizontal
but varying amounts of vertical overlap By com­
the changes in vertical overlap, one can see
that as the vertical overlap increases, the anterior
guidance angle increases.
Because mandibular movement is determined to
a great extent by anterior changes in the
vertical and horizontal overlaps of the anterior teeth
cause changes in the vertical movement patterns of
the mandible. An increase in horizonta:
leads to a decreased anterior
vertical component to mandibular movement, and
flatter posterior cusps. An increase in vertical over­
produces an increased anterior guidance
a more vertical component to mandibular me.
ment and steeper posterior cusps
EFFECT OF THE PLANE OF
OCCLUSION ON CUSP HEIGHT
The of occlusion is an imaginary line t O L ~
ing the incisal edges of the maxillary anterior te",­
and the cusps of the maxillary posterior teeth
of the plane to the angle of the
nence influences the steepness of the cusps. \\
the movement of a mandibular tooth is vie.­
in relation to the plane of occlusion rather t ~ ,
in relation to a horizontal reference plane -­
i nfl uence of the plane of occl usion can be see:­
In Fig 6-7, condylar guidance and anterior
ance are combined to a 45-degree m.
ment of a mandibular tooth when compared
Determinants of Oalt/sal Morp{lO{ogy I 17
B c
I I
HO
D
HO
, I
Fig. 6-6 The anterior gUidance angle is altered by variations in the horizontal and vertical
overlap. In A to C the horizontal overlap (HO) varies, whereas the vertical overlap (VO)
remains constant. When the HO increases, the anterior guidance angle decreases. In D to F
the VO varies, whereas the HO remains constant. As VO increases, the anterior guidance
angle increases.
reference plane. However. when the with the of occlusion ( it can oe
is compared with one plane hat the movement av/ay from this plane
_- I it can be seen that the tooth is 60 Therefore the posterior tee:h can have
.. 'i\ from plane at only a ;onger cusps and we have determined that the
- results in the need for flatter poste- plane of occlusion oecomes more nearlv Ilel
0::, that tooth contact wil! be to the angle of the eminence. the
the tooth movement is compared must be mace shorter.
i
- -
I 18 Fun(tional AnatolllY
Fig. 6·7 A, The anterior and poste­
rior controlling factors create a
(J
A
45°
from the horizontal reference plane.
B, The tooth moves at a 45-degree
angle from the reference plane (HRP).
However. if one plane of occlusion
(POA! is angled. the tooth will move
away from the reference plane at only
25 degrees. Therefore the cusp must
mandibular movement of 45 degrees
,. POs
be relatively flat to be disoccluded ....
....
during protrusive movement. When
- -
-
....
the angle at which the tooth moves
15°
HRP during a protrusive movement is com­
60°
pared with another plane of occlusion
-,"
..
....
(POs). a much greater discrepancy is
evident (45 + 15 = 60 degrees). This
-
allows for taller and steeper poste­ ;- ­
81
,
V'
- PO;
rior cusps.
25°
of Spee. Given a short radius. the angle at wi­
EFFECT OF THE CURVE OF SPEE
the mandibular teeth move away from the me'
ON CUSP HEIGHT
teeth will be greater than with a
When viewed from the the curve of Sree is an The orientation of the curve of as
curve from the of the mined by the of its radius to a !­
mandibular canine the buccal cusp of will also influence hm\ ­
the mandibular teeth Its curvature can of an individual toot-
be described in terms of the of the radius of 6-10, A the radi us of the
the curve. With a short the curve will be forms a with a constant horizc.
more acute than with a longer radius ( 6-81. reference plane Molars Iwhich are located d 0'
The of curvature of the curve of Spee to the radius I will have shorter cusps. whereas'
influences the height of the cusps that molars (located mesial) will have cusc:
will function in ,;vith mandibular move­ 6- 10. B. the radi us forms a 60-degree d­
ment. In Fig. 6-9 the mandible is moving away from (
a horizontal reference plane at a 45-degree curve Of more the (,
Movement away from the maxi teeth more forward with respect to the horizontal p
will vary depending on the curvature of the curve one can see that all the teeth Iprem'
-
I
----
,
-. •
:---::::- JF
..,': .. '" S....!.. TI(
-E!Ct
..
A
~
-:,'",rence plane
c:, - sced more
:::,:ior teeth
. - ·",r cusps
~ ~ - : : - E C T OF MANDIBULAR LATERAL
--;:'l. 'SLATION MOVEMENT ON
=--_ SP HEIGHT
Determinants of Occlusal Morphology I 19
B
Fig. 6·8 CURVE OF SPEE. A, A longer radius causes a flatter plane of occlusion. B,
A shorter radius causes a more acute plane of occlusion.
B
45°
Fig. 6·9 The mandible is moving away from a horizontal reference plane at a 45-degree
angle. The flatter the plane of occlusion (A), the greater will be the angle at which the
mandibular posterior teeth move away from the maxillary posterior teeth and therefore
the taller the cusp can be.The more acute the plane of occlusion (B), the smaller will be the
angle of the mandibular posterior tooth movement and the flatter the teeth can be.
:S I will have shorter cusps In Fig. 6-10. C. lateral movements ( caII ed Bennett
line from the constant hori- mOVel11/,fltj During a latera excursion the
rotated (curve moves downward and inward in
one can see that the mandibular fossa around axes located in the
(especially the molars) can ( The of inward
movement of the orbiting condyle determined
two factors 1.11 of the medial wall
of the mandibular fossa and (2)
of the
which attaches to the lateral.
condyle If the T!v1 I of the
··:Jular lateral translation movement is a is tight and the medial wall is close to the orbiting
::' shift of the mandible that occurs during a pure arcing movement wili be made
·-li
120 FUllaiollal Allatomy
~

" ""
A
c B
~

Fig. 6-10 ORIENTATION OFTHE CURVE OF SPEE. A, Radius perpendicu­
lar to a horizontal reference plane. Posterior teeth located distal to the radius will need
shorter cusps than those located mesial to the radius. B, If the plane of occlusion is rotated
more posteriorly. it can be seen that more posterior teeth will be positioned distal to the
perpendicular from the reference plane and can have shorter cusps. C, If the plane is rotated
more anteriorly. it can be seen that more posterior teeth will be positioned mesial to the
perpendicular and can have taller cusps.
around the axis of rotation in the rotating
\\hen this condition exists, no late:al translation
the rnandiole occurs therefore no mandibu­
r lateral translation movement} I 6-111 Such
condition occurs, Most often :here some
of tne TM I ment, and the medial \\lall
the rnandibclar fossa lies medial to an arc
round the axis of the ! Fig 6-12)
i1en this occurs, the orbiting is moved
to the medial wall and uces a
Tandibuiar lateral translation moven'ent.
The lateral translation movement has three
c,ltributes: amount, timing, and direction The
;;;,0"111 and are determined in part the
~ : e g r e e to which the medial wall of the mandibular
medially from an arc round the
alsc determined
'ng
../
Fig. 6· I I With proximity of the medial wall and a : ,
temporomandibular (TM) ligament, there is no lateral t-·­
lation movement.

-:.-.
~ "
,
'I'.'.'"
1\'1,,\1:
1111
Ii
./
Fig.6·12 When there is distance between the medial wall
-: 11edial pole of the orbiting condyle and the temporo­
-3ndlbular (TM) ligament allows some movement of the
-: :3.ting condyle, a lateral translation movement occurs.
TM I
. ,:al the wall from the media!
The more
of the orbit-
the greater tne amount of latera!
c movement ( 6-13) and the looser
-\1 ligament attached to the
./
=g_ 6·13 The more medial the medial wall is from the
. : - e. the greater will be the lateral translation movement.
-. '=:ore when the medial walt is in position 3, It witl allow
ateral translation of the mandible than in position I.
fr
\
\,
\
Drlenili;wllts of Occ/usal '2'
./
Fig. 6·14 The direction of the lateral translation move­
ment is determined by the direction taken by the rotating
condyle. When the rotating condyle follows pathway I.
the central fossa of the teeth will need to be wider than
pathway 2 to disengage the opposing teeth.
the greater trle lateral translation movement.
The dirccticn of latera I translation movement
the direction taKen by the
the bodilY move:nent i Fie. 6-14:
Effect of tfle AmoUtlt of Lateral Translation
Movement on Cusp Height
As iust stated the amount Of latera! translation
movement determined the tightness of the
inner horizontal
attached to the rotating
to \,l/hich ;:he medial wall of the :nanciibu1ar
from the :ned:al of the
and the greater
the greater the amoum mandibu­
lar translation movement .As tile lateral transla,
tion movement increases, the shift of the
mandible dictates that the cusps be
shorter;:o perr.lit lateral translation \vithout creat,
between the maxil and :nandibular
teeth ( 6-151
Effect of the Direction of the Lateral Translation
Movement on Cusp Height
The direction of shift of the du
a iateral translation movement is determined
the fl'orDholoev and iJea:ner'tou5 attachments of
122 Functional Analolll/j
,./
Fig. 6-15 The greater the lateral translation movement,
the shorter is rhe posterior cusp. Pathway 3 will require
shorter cusps chan pathway I.
the I'M joint ng rotation The movemen'
occurs within a (or less) cone. the apex
of wh ich is located at the aXIs of rotation ( 6-16)
Therefore in addition lateral movement, the
may also move in (I) a superior
( ) an inferior. (3) an anterior, or (4) a
direction. comb:nations of these can
occur. In other words, shifts
and so on
,./
Fig. 6·16 The rotating condyle is capable of moving larer­
ally within the area of a 60-degree cone during lateral trans­
lation movement.
1
2
3
,./
Fig.6·17 The more superior the lateral translation move­
ment of the rotating condyle (I), the shorter the posterior
cusp. The more inferior the lateral translation movemen:
(3), the taller the cusp.
as a determinant of cusp
is the vertical movement of
a lateral translation mo'. e:
movement of :­
re shorter
lateral movement; likewise
c.
lateroinferior movement will p 0 5 ~
rior cusps than will a straight lateral movement
Effect of the Timing of the Lateral Translation
Movement on Cusp Height
of the lateral translation movement
function of the medial wall to the orb:
and the attachment of the TM I
to the These two condit
determine when this movement occurs durj!'
'ateral excursion. Of the three attributes
ateral translation movement (amount, direc
and timing)' the last has the greatest influenc:­
the occl usaI of the te
c
If the tim:ng occurs late and the maxillar)
n"Landibular cusps are functional range
amount and direction of the lateral transl,,'
movement will have I if any, influenCe:
occiusal morohol02v f-Iowever. if the timing C
-
-'i :- :: 'T
.....r.-- ::,"'- ,.
i
Determinal1ts of Oce/usal Morphology 123
./
Fig. 6·18 TIMING OF THE LATERAL TRANS·
LATION MOVEMENT. /, Immediate lateral transla­
: :on movement (immediate side shift): 2, progressive lateral
movement (progressive side shift). The more
-1iediate the lateral translation, the shorter the posterior
:_sp.
- .ement occurs in the laterotrusive move-
the amount and direction of the lateral
:ation movement will influence
Jsal
.r:e'1 the lateral translation movement occurs
a shift is seen even before the ns
:-;,nslate from the fossa This is ca:ied an imil1e­
':lieral translation movemf'flt or irnmedwte side
6-18). If it occurs in with eccen­
the movement is known as a pro­
_,' latera! tra 115/,1 ti011 mOVP111e11t or side
-'le more immediate the side shift the shorter
i'sterior teeth.
HORIZONTAL DETERMINANTS
OF OCCLUSAL MORPHOLOGY
- - _ital determinants of ocC:usal
relationships that influence the direction of
3'ld grooves on the occlusal surfaces. Because
oetween and over grooves
--c movements. the horizontal determinants
: uence the of cusps.
_. centric cusp generates both lat­
and mediotrusive oathwavs across
yi

\
\
)....
CJ?
.., (
;/
Fig. 6·19 The pathway that the cusp of a tooth follows in
passing over the opposing tooth is a factor of its distance
(radius) from the rotating condyle. Mediotrusive pathway
(A) and laterotrusive pathway (B).
ng tooth. Each
tion of the arc formed
the rotating condvle (
be
on the relationship of the
to certain anatomic structures.
EFFECT OF DISTANCE FROM THE
ROTATING CONDYLE ON RIDGE
AND GROOVE DIRECTION
Because the of a tooth varies in relation
to the axis ot rotation of the mandible li.e. rotat­
ing variation \dl occur in the
the laterotrusive and mediotrusive
The greater the distance of the tooth
from the axis of rotation i I. the
wider the formed the laterotrusive and
6-20i. This is consis­
tent regarcJless of whether maxil or mandibular
the are
increased in size as the distance from the rotating
is increased because the ma'1dibular
are
more distally [see Fig 6-20. BI
124 FWlCtionaf Anatomy
...
EFFEC
ROTAT
THE .\1
G
A B
B
Fig. 6-20 The greater the distance of the tooth from the rotating condyle, the wider the
angle formed by the laterotrusive and mediotrusive pathways. This is true for both mandibu­

lar (A) and maxillary (8) teeth. A, Mediotrusive pathway; B, laterotrusive pathway.
EFFECT OF DISTANCE FROM THE
MIDSAGITTAL PLANE ON RIDGE
AND GROOVE DIRECTION
The relationship of a tooth to the midsagittal plane
will also influence the laterotrusive and mediotrusive
Midsagittal
plane
pathways generated on the tooth by an
centric cusp l\s the tooth is positioned farthe'
from the midsagittal plane the angles formed
the laterotrusive and mediotrusive pathways \\
increase \ 6-21 )
Midsagittal
plane

!1B=-=

=-a::
B A
Fig. 6-21 The greater the distance of the tooth from the midsagittal plane, the wider

the angle formed by the laterotrusive and mediotrusive pathways. This is true for both
(A) mandibular and (8) maxillary teeth. A, Mediotrusive pathway; B, laterotrusive pathway .
.1
"'-'­
of the two
determines the
Positioning
the rotating
but nearer the midsagittal plane, would
angle between the
in the dental arch at
and
the smallest
teeth nearer to both
as the distance
increases, its
decreases
than the
anterior region
angles between
been discussed as a vertical determ i-
This movement also
and grooves /\S
pathways gener­
::Hrection that the rotating condyle shifts
lateral translation movement influences
mediotrusive
Dftennil1allts of Occ/usal MorpflO/oqU 125
Midsagittal
plane
t?
!J
B
Fig.6.22 The more anterior the tooth in the dental arch,
the wider the angle formed by the (A) mediotrusive and
(B) laterotrusive pathways.
pathways and resuitant angles (Fig 6-24) If the
shifts in a lateral and anterior
between the laterotrusive and
mediotrusive pathways will decrease on both max­
illary and mandibular teeth If the condyle shifts
laterally and posteriorly, the angles eenerated will
increase,
EFFECT OF INTERCON DYLAR
DISTANCE ON RIDGE AND GROOVE
DIRECTION
In considering the influence of the intercondylar
distance on the of laterotrusive and
mediotrusive it is important to consider
how a distance influences
the relationship of the tooth to the rotating
condyle and midsagittal plane As the inter­
condylar distance increases, the distance between
the and the tooth in a arch
ration increases. This tends to cause wider
between the laterotrus;ve and mediotrusive
However, as the distance
increases, the tooth is placed nearer the midsagit­
relative to the rotating condyle-midsagittal
distance. This tends to decrease the
EFFECT OF DISTANCE FROM THE
ROTATING CONDYLES AND FROM
THE MIDSAGITTAL PLANE ON RIDGE
AND GROOVE DIRECTION
has been demonstrated that a tooths position in
:elation to the rotating condyle and midsagit­
:31 plane influences the laterotrusive and medio­
:-usive pathways The combination
=:)sitional relationships is what
e:\act pathways of the centric cusp
--.e tooth a greater distance from
the latter determinant to negate the influ­
:e of the former. The
:;:erotrusive and mediotrusive pathways would be
by teeth
·'eat distance from both the rotating
'-e midsagittal plane
would be generated
rotating condyle and the midsagittal plane
3ecause of the curvature of the dental arch, the
can be seen: Generally
.. :; tooth from the rotating
_::::1nce from the midsagittal plane
- : ... ever, because the distance from the
- :::::Ie increases faster
:-ease in distance from the midsagittal
the teeth tovvard the
premolars) will have
and mediotrusive pathways than
teeth located more posteriorly
6·22)
::FFECT OF MANDIBULAR LATERAL
TRANSLATION MOVEMENT ON RIDGE
1.." 0 GROOVE DIRECTION
-fjuence of the lateral translation movement
.': _ occlusal
e- ::es the directions of
-' :)unt of it increases, the angle between the
-' -'usive and mediotrusive
- the centric cusp tips increases (Fig 6-23]
=:ection of laterotrusive and
.3
126 Fwutiollal
-j
JJ
Fig. 6-23 As the amount of lateral translation movement increases, the angle between the
(A) mediotrusive and (8) laterotrusive pathways generated by the centric cusp tips increases.
This is true for both mandibular (A) and maxillary (B) teeth.
A B
A, B1A1

B2 A2
B2
B3
A2
A3
'" Ao
E A
B,
B2
B3
_._
rr
/
Fig. 6-24 Effect of anterolateral and posterolateral translation movement of the rotating
condyle. The more anterolateral the movement of the rotating condyle. the smaller the angle
formed by the mediotrusive and laterotrusive pathways (Al and Bl).The more posterolateral the
movement of the rotating condyle. the wider the angle formed by the mediotrusive
and laterotrusive pathways (AI and BI)' This is true for both mandibular (A) and maxillary
(8) teeth.
6-251 The latter factor negates the most often minimai and therefore the leas::
influence of the former to the extent that the net enced of the determinants.
effect of increasing the distance is to A summary of the vertical and horizontal
between the laterotrusive and minants of occlusal morohologv can be fow"
mediotrusive The decrease. however. is Tab'es 6-1 and 6-2.
.:


.l!jJ,J





h,
Determinal1ts of O((IL/SIII MorpFlOlo!JY 127


'
\
\ i 1\\ 1
: \ \ \
I \ I \
\ \ I \
•..
A2
A,
Fig. 6-25 The greater the intercondylar
distances, the smaller the angle formed by the
laterotrusive and mediotrusive pathways. The
greater the intercondylar distances. the smaller
the angle formed by the laterotrusive and
mediotrusive cusp pathways (AI and 8
1
), The
smaller the intercondylar distance. the wider
the angle between the laterotrusive and
mediotrusive cusp pathways (A2 and 8
2
),
TABLE 6-1
Vertical Determinants of Occlusal Morphology (Cusp Height and Fossa Depth)
Factors Conditions Effects
:: :>ndylar guidance Steeper the guidance Taller the posterior cusps
:'.lcerior guidance Greater the vertical overlap Taller the posterior cusps
Greater the horizontal overlap Shorter the posterior cusps
ne of occlusion More parallel the plane to condylar guidance Shorter the posterior cusps
:: J I've of Spee More acute the curve Shorter the most posterior cusps
...::c:eral translation Greater the movement Shorter the posterior cusps
'Tlovement More superior the movement of rotating Shorter the posterior cusps
condyle
Greater t\\e immediate '.>ide '.>\\i1t S\\oner t\\e ?o'.>terior eu'.>?>
TABLE 6-2.
-: rizontal Determinants of Occlusal Morphology (Ridge and Groove Direction)
fM:tors Conditions Effects
- from rotating condyle Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
_ ':::-ce from midsagittal plane Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
translation movement Greater the movement Wider the angle between laterotrusive and
mediotrusive pathways
- = -: ::>ndylar distance Greater the distance Smaller the angle between laterotrusive and
mediotrusive pathways
E'
of
If
-...
.,.
Ie
':;"'5:

128 FUllctiorwl Ana/oll1t}
studies seem to indicate that the
the articular eminence is not related to any
ANTERIOR
occlusal relationshio
'
. In other

FACTORS
bave oeen made to demonstrate
d'ctating mandibular movemeN. This
correlation between the vertica. and horizontal
tant c(wcept because the .ACFs can be influence
of the with tre
dental ures . .Alteration 0: the ,ACFs
lingual concavities of the rraxillary anterior
an important
teeth ivertical and horizc'ntal relationshi of
disturbances in the
anterior lOne suggests that
consistent with
Cons'deration directed 'RtjerCllCeS
ril} toward the PCFs that steepness of the
movement le.g. of the eminence and 1. Moffett BC: The
joint. In Sham
editor Complete demure prosthodolllics, New York, 1·'
lateral translation movement) This phi
,\!cGrdw-llilL pp 2J 3-230.
that moverrent becomes mere
Ricketts R'\I: Variations of the temporornandihular jOiL:
horizontal in articular eminence
rewaled by cephalometric laminagrarhy, :\m J 0,:'
with increase in lateral translationi tr:e 'i :lG:R77-892, 1')50 .
concavities of the maXillary anterior teeth will
•\nglc IL: in temporom':lIldibular form, Alii I
83.223-234, J ')4S.
increase reflect a similar movement characteristic
However, scientific evidence to support a corre­
lation betvveen the .ACFs and rCFs IS
'hlI!!
...".
.rje
mn'l'
l
--
Irhe
is present when lhere i
of tissues without a local
A common location for
Ip who
pain will report that· Itle:r
When ,he is ned. no local
54 FUIICliolllll Anatomy
Arother type of pain sensation that be expe­
rienced wlen afferent inter:,eurons stimulated
is >c Te understand tils condi
tion. tle term must be broken dOWI) nd
raised or increased
condition The in fact mea:-,')
painful
'-';len increased
some I factm. such
splinter in the finger .After a Fe'.'! hours the tissue
round the ;Iter becerres quire sensitive to
toucl This primary because the
cause can found This is a fai situation
in of heac; and neck
different from
at
the sou rce of the
symptoms Instead
may I for some time i 12 to
olockade is administered. This clinical feature
cause some confusion du
Until now Iy the effect a
of svmptoms has consloerecL
is true when afferent Interneuron are
involved. If the ce:ltral effect involves
efferent interneurons. however. motor
One type of efferent effect
the develoome:lt of a localized area hvpersensi­
called are discussed i:l I"'ore
detail in Another com
ttle ng
muscles are activated while the elevator muscles
Clre relaxed In the presence of in however
CNS to resoond differentlv Stohler< has
demonstraleo that when
ta
to
CO-COl1traction
because of simultaneous contraction of antagonis­
m groups BeW' recognized this CNS
response
this conditi,jn is
pain it can
mally
I Thus felt in
a reflex
such in
lead to muscle pain if it
Protective co-contraction Imuscle i
in the genera location
lad to it 1101
ina
muscles of mastication. Tilis condition is not
unusual and unfortu fools mallY de:ltists
muscles of mastication the
of the Hmvever. such treatment
alone cannot resolve the the
co-contraction
pail: must De addressed for
effec've elimination of the masticat,:;rv n'uscle
Understanding rhe effect on
the muse! for
management
Feat detail in later
n however must
use it is vltaily i
usc;e pa i n As has
in input can ind
sou
Tris condition
of Ilal
this condition cal
51',151115 r;;ecel:t stud ies however. feli 1
the that mare aCil
spasms·' ':-hererore this condltic'i
T
io.... __ .. ..
Fundional NeuroanatolHij and Phijsiologij of tile Masticatorij System 55
is more called mLiscle
This condition can become a diagnostic problem
for the clinician because the patient continues to
report suffering after the nal source of
pain has resolved.
Because muscle pain is an important clin­
ical problem to understand. the example
is given to illustrate SOr:le considerations in its
management
A third molar is extracted, and during the ensuing week a
;ocalized osteitis (dry socket) develops. This becomes a
source of constant deep pain that, by way of the central
excitatory effect, produces protective co-contraction
I muscle splinting) of the masseter and medial pterygoid
'T1uscle. The patient returns in 5 days complaining of the
Jainful condition. Examination reveals a limited range of
"'1andibular opening, caused not by the infection but by the
secondary muscle response. If the source of the deep pain
s resolved quickly (Le., the local osteitis is eliminated). the
:;rotective co-contraction is resolved and normal mandibu­
?r opening will return. If the source is not quickly resolved.
:-e protracted co-contraction may itself produce pain •
... .,ich then perpetuates the protective co-contraction and
",:s:ablishes a cyclic muscle pain condition. In such a case .
."inating the original source of pain (the osteitis) will not
."inate the muscle pain. Treatment must now be directed
:::ecificaily toward the masticatory muscle pain disorder.
. , - ch has become wholly independent of the original source
:: :Jain.
central effects involve the autonomic
- _ '2ns. characteristic manifestations will be
Because the autonomic system controls the
:::::n and constriction of blood vessels. variation
'cd flow will appear as reddening or blanching
"" involved tissues. Patients may complain of
or a eye. Sometimes the
the eye will redden Even
:::oms may be reported . a stuffy or runny
SOr:le patients may report a
the same side as the pain CI
.,elling is rarely seen in
yet this is commonly
patients and may represent
to autonomic effects.
The key to determin whether these symp­
toms are a result of the central effect is
their unilaterality Clinicians should remember
that central effects do not cross the r:lid­
line in the trigeminal area. Therefore the ciinical
manifestations will be seen only on the side of the
constant deep pain. In other words. one eye will be
red and the other normal. or one nostril may be
mucus and the other not If the source
of the autonomic were le.g..
allergy). both eyes would be red and both nostrils
discha rging.
Understanding these central
basic to the management of facial pain
The role that such conditions play in the diagnosis
and treatment of temporomandibular disorders is
discussed in detail in later chapters
Suggested 'Readin!ls
Hell \VE: Temporomandibular dis(1l'ders; classiflClltioll, dwgrwsis,
lIIanagemenl. ed 3, Chicago, 1990, Year Book MedicaL
Okeson JP: Bell's oraj/Kial pains, I'd 6, Chicago, 2005,
Quintessence.
'References
1. Okeson JP: Bell's orojaci(// pains, ed 6, Chicago. 2005,
Quintessence .
2. Cuyton AC: Texlboo" of mediwl physiolog)" Philadelphia,
1991. Saunders, p 1013.
3. De Laat ;\: Reflexes elicitable in jaw muscles and their role
during jaw function and dysfunction: a review of the I itcra­
lUre. Part II. Central connections of oro facial afferent tlbers,
Cranio 5:246-253. 1987.
4. Dubner R, Bennett GJ: Spinal and trigeminal mechanisms
of nociception, Artrll1 ReI' Nellrosci 6:381-418, 1983.
5. Sessle Ill: The neurobiology of facial and demal pain:
present knowledge, future directions, J Dent Res 66:962-981.
1987.
6. Hu J\V, Dostrovsky 10, Sessle IlJ: functional properties of
neurons in cat trigeminal subnucleus caudalis (meJulLuy
dorsal horn). I. Responses to oral·facial noxious and
nonnoxious stimuli and projections to thalamus and
subnucleus oralis. I Neurophysiol 45: 1 J92. 1981.
7. Sessle B): Recent insights into brainstem mechanisms
underlying craniof.Kial pain, IDem Educ 66: 108-11 2. 2002.
8. Lund Jr, Donga R. Widmer CC, Stohler CS: The
adaptation model: a discussion of the relationship between
Functional Neuroanatomy
and Physiology of the
Masticatory System
"You wl1not treat [wiess
wldfrsta ml functioll.··
-JPO
T
he function of the system is
, Discr:minatory contraction of
the various head an,d neck muscles is 'lec­
2ssary to move the mandible
,;:ffective :unctioning A h neu
:::ont:ol system coordi nates the
"ctivities of the entire
rill' of nerves
l1eUrGI1Hj5CUfar 5&151011 ,A basic of
anatomy and function of the neuromuscular
stem is essential to the in,fjuence
-:lat tooth contacts as \'1ell as other conditions,
-:'jV on mandibular movement.
This chaoter divided into :hree The
:st section reviews In detail the basic
fU'lction of the neuromusCl;lar system The
describes the basic aclvities of
3stication, swal and The third
- Il reviews important concepts and mechanisms
are necessary to understand orofacia
l
the concepTS in these three sections should
enhance the clinicians abll to understand a
comolaint and orov:de effective
ANATOMY AND FUNCTION OF THE
NEUROMUSCULAR SYSTEM
of discussion, the neuromuscL;lar sys­
divided Into tViO maior comuonents ( I J the
..
neurologic structures and 12) the musc,es. The
anatomy and function of each of components
is reviewed in many instances It
difficult to separate function. With a'l understand­
ing of these components, basic neuromuscula r func­
tion can be revie\ved
MUSCLES
Motor Ullit
The of the neuromuscular system
is the rroto
r
unit. v.,hich consists of a nL;mber of
mUSCle fibers that are innervated ore motor
neuron. Each neuron with the muscle fiber at
a motor When the r.euror is activated
the motor
amounts of which initiates depOlar­
ization of the muscle fibers. causes
the muscle fibers to shortell or contract.
The nJmber of muscle fibers in'lervated by one
motor neuron according the fu'lc­
tlon of the motor unit. The fewer the muscle fibers
per motor 'leu ron, t he more the move­
ment. /\ motor neuron may innervate only
two or three rnuscle fibers, as in the cil muscles
control the lens of the eye).
one motor neuron may innervate
dreds of muscle fibers, in any muscle (e.g.
the rectus femoris in the l.... similar variatio'l
exists in the number of muscle [ibers per motor
neuron v:ithin the muscles of masticaton The
inferior lateral muscle has a
low muscle fj ber/motor neu ron ratio: therefore it is
capable the fine adlustments in length needed
25
'i

:'"
!
Functional NeuroanatolllY mid PflysioloflY of the Masticatory System 31
The limbic structures function to control our
emotional and behavioral activities. Within the
limbic structures are centers or nuclei that are
for speci fic behaviors such as anger.
The limbic structures also control
fear. or
center apparently exists.
on an instinctive level. the individual driven
toward behaviors that stimulate the side
of the center. These drives are not generaly
perceived at a conscious level but more as a basic
nstinct The instinct will certain
behaviors to a conscious level For when
an individual chronic pain behavior
xiiI be oriented toward withdrawal from any stimu­
us that may increase the pain. Often the sufferer
.'.ill withdraw from life itself. and mood alterations
3uch as depression will occur. It is believed that
of the limbic structures interact and
associations with the cortex, thereby coor­
::i;'ating the conscious cerebral behavioral func­
-ons with the subconscious behavioral functions
: the deeper limbic system
from the limbic system leading into
can anyone or all of the
internal bodily functions controlled by the
Impulses from the limbic system
into the midbrain and meduila can control
behavior as wakefulness, excitement
o.-.:J attentiveness. With this basic understanding
.. I imbic function, one can quickly understand the
_. oact it can have on the overall function of the indi­
::Jal. The limbic system certainly a major role
. :Jain problems, as discussed in later chapters
Cortex. The cerebral cortex represents the
. of the cerebrum and is made up
• -"domi of gray matter. The cerebral cortex is
-" portion of the brain most associated
the process, even though it cannot
.ide thinking without simultaneous action of
c'::per structures of the brain The cerebral cortex
- ·-e portion of the brain in which all
_ne's memories are stored, and it is also the
most responsible for one's abil to
-.' muscle skills. Researchers still do not know
basic mechanisms which the
-c'Jral cortex stores either memories or
. _. Jscle skills.
In most areas the cerebral cortex is about 6 mm
th and all it contains an estimated
50 to 80 billion nerve cell bodies Perhaps a biilion
nerve fioers lead away from the cortex. as well as
numbers into it. to
other areas of the cortex. to and from deeper struc­
tures of the brain. and some al the way to the
cord
Different regions of the cerebral cortex have
been identified to have different functions A motor
area is primarily involved with motor
function. A sensory area receives somatosensory
input for evaluation. Areas for I senses. such
as visual and auditory areas. are also found.
If one were to again compare the human brain
with a computer. the cerebral cortex wou:d represent
the hard disc drive that stores all information
of memory and motor function. Once one
should remember that the thalamus keyboard)
is the necessary unit that calls the cortex to function
Sensory Receptors
are neurologlC structures or
organs located in all tissues that proVide
information to the CNS way of the afferent
neurons the status of these tissues. As in
other areas of the body, various types of sensory
receptors are located the tissues that
make up the masticatory system Specialized sen­
sory receptors information to the
afferent neurons and thus back to the CNS. Some
receptors are specific for discomfort and pain These
are called Other receptors provide infor­
mation regarding the position and movement of the
mandible and associated oral structures. These are
called that carry informa­
tion regarding the status of the internal organs are
referred to as Constant input received
from all of these receptors allows the cortex and
brainstem to coordinate action of individual
muscles or muscle groups to create appropriate
response in the individual
Like other s, the masticatory system uses
four malor types of sensory receptors to mon:tor
the status of its structures ( 1 ) the muscle
which are receptor organs found in the
muscle tissues (21 the tendon organs,
located in the tendons: (3) the pacinian corpuscles
11­

96

Functional Allatollllj

Therefore no in the occlusion is indicated Afte, examiration of m.;merous with a of occlusal conditions and no apparent occl~sa;-related the merit of this con ­ cept becomes evidert. The :aci ng derti stry is apparent and symptoms of when a with the occlusal-related comes to the dentai The dentist must determine inate th time) \Vhat is the optir,lum func­ tional occlusion) the study of occlusion so have not been sa(sfactorily answered to determine which conditions to cause any examines certain aratomic and features of the system f\n accu­ mulation of these features wiii represent the functional occlusion. wh:ch. although it may not have a h incidence in the ulation. ShOl.;ld represent to the clin ment Is when ng to either eliminate occlusion-related disorders or restore mu:ilated dentition.

Fig.5-1 When the mandible is elevated, force is applied tc the cranium in three areas: (I and 2) the temporomandibu­ lar joints and (3j the teeth.

for to . Thus tl~ese areas need: to determine the IC relationst11p that wilt prevent, mini'T1izc or eliminate ar.y oreakdown or trauma, The and teeth wili De exam;ned

CR.ITERIAFOR1HE .9PTlMUM
FUNCTIONAl··OCClUSION

system IS an interrelated system of bones. I ~eeth and nerves To si a discussion of th system difficult necessary oefore the basic concepts that influence the function and health of al the components can beJ nderstood. bone that is at:ached to the The mandible It' a muscular skull and sl irg When the elevator muscles I the masseter. the medial otemwid, and the temnoral I func­ lion, their contraction raises the that contact is made and torce the skull in three areas: the two IIMls) and the teeth I these muscles have the pabil As discussed, the

OPTIMUM ORTHOPEDICALLY STABLE JOINT POSITION
The ten" celltric rt'latioll [CRI been used dentistry for many years ever the year:­ l'ad a of definitions. considered to designate the ~andibie when the stable CR as the most retruded is Because this the I men~s of the . It the const; tior of CO~ dentures l\t the time it considered the most reliable reference pc obtainable ~n an edentu:Clus natient for accurat oetween the mand:­ recoraing the and maxilia and u for contro usa I contact pattern

'H,mr"'"

Ij~~~~i!Rlm"k'

(Ptl:H:I',

-

Criteria for OptimulII FUI1(/iollat Oa/llsiol1

97

The popula of CR grew and carried over into the field of fixed useful­ ness in fixed both its ity and ~esearch studies associated with muscle function Conclusions from tne Ic iE\1G) studies that the muscles of mas­ tication function more harmon and with less when the in C!;: at the time :hat the teeth are in maximum i dental I)' that CR .'.as a sound More ~ecent ~r~derstandjng of the biomechanics and ~unction -: the TM] however, has questioned the retruded

Positional stabll of the jomt however, is not determined the articular disc nt stabi is determined muscles that pull the loint and prevent dis­ location the articular surfaces The directional 'mum

Muscles stabilize joints Therefore each mobile nthasa stobielMSI When pursuing most stable 'Hvlls, the muscles that Dull across the nts must be considered The ma muscles that stabil the P,Als are the elevators. The direction the on the t he tern pora I m usc!es have fi bers that are oriented nevertheless pre, dom in a superior These three rruscle groups ble for joint and however, the inferior lateral a make contribution In the postural without any influence from the occlusal condition, the are sta­ bilized muscle tonus of the elevators and the inferior :ateral Dter\20ids The temperal muscles

ly
confusing ::-:rcause the definition

--:r in tneir most : ~sae Some clinicians' that none of : - -:rse definitions of CR ton and that the tioned downward and for'ward on the articular ~:ences. The ng the most 0' the wil continue - conclusive evidence exists tha: one than the others ertheless. in the midst of this controversy . sts must needed treatment for thei r ::'lts The use stable, -:~cential to treatment. Therefore:t necessary ·c,mine and evaluate all available mfmmation to draw intel conclusions on \\-hich treatment. establishing the criteria for the optimum stable joint the anatomic :: J of the TM) must be exarm ned described. the articular is dense fibrous connective tssue de\'Oid and blood vessels" This ailows it wii'l­ ~eavy forces without damage or the induce­ nful stimuli The purpose disc --:c;ate. protect and stabilize ,he In lar during functional movements

Fig. 5-2 The directional force of che primary elevator muscles (temporalis o masseter, and medial pterygoid) is to seat the condyles in the fossae in a superoanterior posicion,

-

Tonus in the inferior lateral pterygoids the condyles slopes of the articular against the eminences. until the position of the articular discs is considered.The two positions are at the same superior leve . the most orthopedi­ as dictated bv the cally stable joint muscles is when the are located in their most superoanterior in the articular fos­ sae. the articular surfaces and tissues of the joints are such that forces applled the musculature do not create any dam­ age When a dried skull is examined. This last causes the discs to be rotated on the condyles as far forward as the discal spaces (determined by interarticular pressure) and the thickness of the border of the discs will allow The complete definition of the most orthopedi­ position therefore is when the cally stable condyles are in their most superoanterior in the articular fossae. By way of summary then. against the of the articular with the discs properly interThe assume this position when the elevator muscles are activated with no occlusal influences.. and the superoanterior (MS) position However. the most position (ie Dawsons ). the more of the will occur and the more posterior will be the condylar . if the inner horizontal fibers of [C~ temporomandibular ligament allow for some posteric­ movement of the condyle.1!" .98 Functional Anatoll1Y position the condyles superiorly in the fossae. less stable positic­ (dotted line). this ically and physiologically sound. This position is therefore considered to be the most MS position of the mandible In this MS position. by definition.3 The most superoanterior position of the condy e (solid line) is musculoskeletally the most stable positic ­ of the joint. The masseters and medial pterygoids the superoanteriorly. the morphology of the discs them­ lateral ptery­ selves. This description is not however. most clinicians have come to appreciate that seati ng the condvle in the superoanterior is far more orthopedically acceptable The controversy arises as to whether there an anteroposterior range in the most superior tion of the condyle Dawson l6 that there not.~ t -.5. rela­ tionship is achieved only when the articular discs are interposed between the and the articular fossae The of the discs in the joints is influenced by the interart:cular pressures. the anterior and superior roof of the mandibular fossa can be seen to be quite thick and able to withstand loading forces. is both anatom­ ing rest and function. they will also move inferiorly This but may be accurate in the young. However.­ . and the tonus in the goid muscles.f . healthy one must realize that not all joints are the same Posterior force applied to the mandible is resisted the inner horizontal fibers of the in the joint temporomandibular (TM) I of the is there­ superoposterior fore. fully seated and resting against the posterior slopes of the articular eminences. The degree of anteroposterio~ ( \~ \ Fig. little difference may exist among the most superior retruded position. which that if the condyles move either anteriorly or posteriorly from the most supe­ rior position. if the Tl\l ligament is loose or elongated an anteroposterior range of movement can occur while the position remains in its most The more posterior the force placed on the mandible. posterior force will displace tr mandible from this to a more posterior.'. a ligamentous position If this ligament is tight. The MS position is now described in the Glossary of Prostnodontic Terms as CR 2i earlier defi ­ nitions 9ll of CR emphasized the most retruded position of the condyles.

-ere is a great for eliciting and/or :'iusing breakdown.:yle from the musculoskeletally stable position. are not structured to accept "rce. of the articular eminences iFig '5-5}l\s the downward and the disc bone are d Examination of the dried skul. reveals that this area of the articular eminence is quite thick and able to withstand force. Studies of the mandibular demonstrate that in 5 It ~ d 5t e- is ig 5t he 'M or \'Ie he "nt the 'jor portion of Therefore some movement to the [CP is normal during function In most this move­ ment is small (I mm or However. Therefore when force is aDDlied to this area. and retrodiscal tissues. This definition of CR is becoming Another concept of mandibular stabil.e retrodiscal tissues are h vascular­ 2ed and well sUDDlied with sensory nerve fibers. l=ig. joint posterior range of movement can be increased. The clinician should note that the most and posterior (or retruded) condyle is not a sound (Fig '5-4).5·4 Posterior force to the mandible can displace the : : . Therefore tbis like the most 5uperoanterior appears be anatomically of forces. 3ecause th. 24 • 28 When the dried skull is examined from an anatomic the aspect of the mandibular fossa is seen to be quite thin and This fea­ not meant for stress the fact that the does not appear to be of the joint as discussed in t. if occur in the structures of the joint of the TM ligament. [n this :)e to the aspect of the -ior retrodiscal lamina. exist to act as limiting structures for certain extended or border nt movements the idea of using this bcnder as an um functional was discussed Such a border relationship would not be considered um for any other nt would this ortho­ princi be any different for the TMI') Because it is sometimes clinically difficult to determine the extracapsular and i condition of the it is advisable not to force on the mandible when to locate the 'v1S of the joint The major should be on guiding or directing the to their most in the fossae This can be accomplished either a bilateral mandibular ng or by the musculature itself (as discussed in later For the remainder of this text CR will be defined as the most superoanterior of the the articular fossae with the discs [t can thus be seen that CR are the same.Criteria for Optimum FUl1ctiOflal Occ/usioll 99 to the health of the nt appears to permit movement from the MS position the health of the may be difficult to clinically assess. in fact this a normal orotrusive movement of CLARK COLLEGE UBkARY .tyl~ sug­ gests that a different is optimal for the are described dyle tion the lrior i the ition eve!. liga­ participate in function.

The major differences between this position and the 1\1S lie in muscle func­ tion and mandibular stability To position the condyles downward and forward on the posterior slopes of the articular eminences. If the max­ imum ICP were developed in this more forward position. /\s discussed in this text.:' that this position is almost always found to downward and forward to the seated position. Another concept that has been proposed to help the dentist locate the most optimal condylar position is through the use of electrical stimula­ tion and subsequent relaxation of elevator mus­ cles.. as soon as the elevator muscles are contracted. Therefore it does not appear that this position is compatible with mus­ cular rest. This directional force will tend to drive the condyles to the superoanterior position as already described (i.e. whereas the postura position is located 2 to 4 mm below the ICP ir readiness to function 30JI Assuming that the idea mandibular position is at the lowest point of EMC is a naive thought and certainly not sut· stantiated with data. not an MS position Assuming that this position would to maintain mandibu­ require more muscle lar stability is logical Because muscle pain is the most common complaint of patients with masticatory disorders. MS position). the res~ position (lowest EMC activity) may be found a: 8 to 9 mm of mouth opening. a discrepancy would exist between the most stable occlusal position and the most stable joint position Therefore in order for the patient to open and close in the ICP (which is. the force applied to the condyles by these muscles is in a superior and slightly ante­ rior direction. The fact that this is the position of lowest EMC does not mean this is a reasonable position from which the mandible should function.100 Functional Anatomy Fig. This tech­ nique has been used by physical therapists fOl years with good success in reducing muscle tension and pain. At least three important considerations que~· tlon the likelihood that this position is an ide~ mandibular pOSition. This rest represents the point at which the forces of gravity pul down on the mandible equal the elasticity of the muscles and ligaments that sup­ port the mandible (viscoelastic tone) In mos[ cases this means that the mandible is positioned downward and fOf\vard to the seated superoante­ rior position. In this concept the elevator muscles are electrically pulsed or stimulated at regular inter­ vals in an attempt to produce relaxation. 5-5 Forward movement of the mandible brings the condyles down the articular eminences. However. However. The followers of this concept believe that if this pulsation is done in an upright-head position. This is compatible with a protrusive move­ ment.29 and it cannot be considered the most physiologic or functional position. of course. which they describe as rest. even though data are scarce (see Chapter II). believe that it is at this position the:: occlusion should be established. the mandible. Therefore there may be good rationale to use electrical stimulation to reduce muscle pain. Increased muscle activity is likely. the elevator muscles will continue to relax until their EMC activity reaches the lowest level possible. it would not seem favorable to deveiop an occlusal condition that may actually increase muscle activity. necessary to function). followers of thl:. The first is related to the fa. the inferior lateral pterygoid muscles must con­ tract. the inferior lateral ptery­ goid muscles must maintain a contracted state to keep the condyles from moving up to the most superoanterior positions Therefore this position represents a "muscle-stabilized" position. jf the teeth are restored in this .

As previously discussed. the mandibular : : :.will change It would not appear .' 8e quite extensive. :. _::Jres. The optimum occlusal condition can be deter­ mined by the following situations I. 'e::lresents a "muscle-braced" position and not an '. the occlusal contact pattern influences the When muscular control of mandibular closure of the mandible in the MS position creates an unstable occlusal condition.ype of variation is reliable when restoring of reproducible. the mandibular can be greatly influenced by :·re the patient's head ::::uired maxillary/mandibular =~:ent moves his or her head forward or back ~ ~. As the mouth these two teeth provide the only occlusal for the mandible (Fig.Criteria for Optimum Functional Occlusion 101 3nd the elevator muscles contract. -'ary. a repeat­ able terminal movement can be executed (see Chapter OPTIMUM FUNCTIONAL TOOTH CONTACTS just described has been consid­ factors of ered in relation to the infl the joint and muscies. it can be seen that all this force will be applied to these two teeth. leaving only posterior :eeth to occlude.je that the most superior and anterior the condyles resting on ~he discs slopes of the articular em most orthopedically sound position 3:e standpoint it also appears that this ..'hen this occurs. This. _.'. ~ :~. the neuromuscular system quickly feeds back muscle action to locate a mandibular position that will result in a more stable occlusal condition.ertical dimension would cause a great --:::se of forces to the teeth and periodontal . '.dl be seated superiorly.individual. The stable occlusal condition should allow for effective functioning while minimizing to any components of the masticatory system The clinician should remember that the much greater musculature is capable of force to the teeth than is necessary for function Thus it is important to establish an occlusal condi ­ tion that can heavy forces with a minimal likelihood of and at the same time be effici en t. whether healthy or with a :: ~.'ldibular position by pulsing the elevator mus­ • e3 is that this position is almost always found to an increased vertical dimension. Because the condyles are in a superior border position.-: is that it also has the "~ . Because contact is only on the right the mandibular position will be unstable and the forces of occlusion provided by the musculature will likely cause an over­ closure on the left side and a shift in the mandibular position to that side This con· dition does not the mandibular stabil­ ity necessary to function effectively instability) If forces are applied to ~he teeth and ioints in this situation breakdown to :.ar disorder. of course. from an anatomic standpoint one -' .er concern with this is that basi­ _::::. the teeth into maximum intercuspation at .of the condyles is mal. -"nother consideration in a desirable ~.. The only way the occlusal posi ­ . The highest that can be by the elevator mus­ :5 at 4 to 6 mm of tooth separation 32 It is at =iistance that the elevator muscles are most c': =2nt in breaking through food substances. A patient has only the right maxil and mandibular first molars present. individuals considered for unnecessary therapy. 5-6) Assuming that 40 Ib of force is applied d function..ird consideration in using this technique is ~: : ~~ce the muscles are relaxed. the condyles !..'5 as previously discussed.tilts it to the right or left. Therefore of the joints can be maintained the MS when it is in harmony with a stable occlusal condition. will assume an open and for­ ==~tion of the mandible following muscle Therefore this technique is not helpful patients from normal healthy ·. An addi ­ . increasing the for breakdown. on can be maintained is to maintain the inferior 3~eral pterygoid muscles in a partial state of con ­ --action bracing the condyles the posterior of the articular eminences. ~'.

5-7 With bilateral occlusal contacts.i1e decreasing force to each tooth 3. Another patient has only the four first molars present. The result is an increase in joint force to the left temporomandibular joint (TMJ) and a decreased force to the right TMJ.102 Functional AnatomlJ Fig.!l':~:: "''' If Fig. 5-7L This occlusal condition is more favorable than the because wr.en force is applied the musculature. both right and left side molars contact lFig. When the mouth is closed. and supporting structure is a significant risk 2.r-AS position. ~ mandibular stability. reSUlting in 10 Ib on each tooth I of these illustra~ Understanding the tions leads to the conclusion that the occlusal condition during mandibular closure even and simultaneous \vould be provided contact of all possible teeth This type of occlusa furnishes maximum for the mandible while minimizing the amount of force !lIlr'. stability of the mandible is achieved. The increase in the number of teeth also decreases the Forces to each tooth. 5-6 When only right-side occlusal contacts are present. As the number of occluding tee:­ increases. thereby potential (The 40 lb of force during function are now distributed four of teeth. A third patient has only the four first molars and four second premolars present When the mouth is closed In the . the additlona I teeth lessen force appl ied to each tooth (20 lb per tooth) Therefore this type of occlusal condition provides more mandibular stability wr. the bilateral molar contacts a more stable mandibular only minimal tooth surfaces accept the 40 lb of force provided during function. . tre teeth. activity of the elevator muscles tends to pivot the mandible using the tooth contacts as a fulcrum. 5·8 Bilateral occlusal contacts continue to maim2 Fig. the force to each tooth decreases. all eight teeth 5~8) contact evenly and simultaneously ( The additional teeth provide more stabilization of the mandible.

mum relationship can be derived....:2nous connective tissue fibers that suspend the 'th in the socket..) Direction of Force Placed on Hie Teetft . Most of these fibers run : ='c. osseous tissues do not tolerate pressure -"::eslG2340 In other words. [n a general sense it be thought of as a natural shock absorber . the MS ~sjtjon of the (ie.e mandibular are in their most peroanterior position. it is possible to make certain ~ servations: First.elop optimum occlusal conditions The exact .~:odontalligament ( is present between the " -t of the tooth and the alveolar bone to help :: :.. ~en studying the supportive structures that sur­ ': . ~'~tact pattern of each tooth must be more closely '. Because the :".. such as the crest of a ridge or the bottom of a fossa the resultant force is directed vertically through its long axis. extending occlusally 'ittach in the alveolus ( 5_9)40 When force : a::Jplied to the tooth.e Fig. resting against the poste­ slopes of the articular eminences. but tension (pulling) actually stimulates : c::eous formation. if force is applied to :-:e."""" . .Criteria for OptimulI1 Frtnctionai Occ/usion 103 ::aced on each tooth during function Therefore criteria for optimum functional occlusion =2\'eloped to this point are described as even and multaneous contact of all possible teeth when :~.. (The width of the periodontal ligament has been greatly enlarged for illustrative purposes.uely from the cementum. 5-9 PERIODONTAL LIGAMENT. CR ) coin~ jes with the maximum ICP of the teeth. The fibers of the PDL are aligned such that this type of force can be well accepted and dissipated (Fig.. the fibers support it and sion is created at the alveolar attachment. When a tooth .amined so that a precise description of the . This is ~ :nsidered orthopedic stabU Stating that the teeth must contact evenly and is not descriptive enough to ~2. Most fibers run obliquely from the cementum to the bone.: ~ . second observation is how the PDL accepts ::us directions of occlusal force.'2::sure is a force that osseous tissue cannot ~2Pt.erting a destructive force (pressure) into an ~eptable force (tension). the tissue will resorb.:h are constantly receiving occlusal a :.: ~ :rolling the forces of occlusion on the bone.. "::e applied to each tooth needs to be =. 5-1 0 When cusp tips contact flat suriaces. ::.. . 5-10 I When a tooth ~ .: :::.nd the teeth.ntacted on a cusp tip or a relatively flat surface Fig. the actual direction and amount of . Therefore the PDL is capable of .mined.trol these forces The PDL is of col­ ~...:. This type of force is accepted well by the periodontal ligament. the result­ ant force is directed vertically through the long axes of the teeth (arrows). with the ::scs properly interposed In other words. ~. To evaluate s better.

A B Fig.. . Instead. 5-11 When opposing teeth contact on inclines.B B '.: 1 The clinician should remember that vertical tooth contacts are well forces created the POL.i/fj A Fig. When this c the resultant force directed throw::' 12. the forces are not dissipated to the bone. effects's greater.::::1 . t . many of the fibers of the POL are not properly al to control them. the resultant its axis. but horizontal forces cannot be ef'ec­ dissipated ~2 These forces may create bone responses or even elicit neuromuscular reflex activity in an attempt to avoid or guard against incline contacts. tipping forces are created (arrows) that tend to cause compression (A) of certain areas of the periodontal ligament and elongation (B) of other areas. way of summary. contacted on an incline. 5-12 Axial loading can be accomplished by (A) cusp tip-to-flat surface contacts or (B) reciprocal incline contacts (called tripodization). Instead. the direction of force is not through the long axes of the teeth.t~. axis of the tooth ( Both methods eliminate the POL to accept ng forces to the bone and essenti2. The process of directing occlusal forces through the axis of the tooth is known as axial ioadifW Axial loading can be achieved two methods 1 The first method is the tooth contacts on either cusp lar to the flat surfaces that are axis of the tooth These flat surfaces can be thE: crests of marginal or the bottoms With this type of contac: the resu]ta. ~ J. however.. reduce them .~forces vd] be direcced the long axis the tooth iFig 5-12.104 Functional Allatomy A---l~-- I:J--+. the POL is quite efficient and breakdown is less in such a manner that horizontal forces to the likelihood of pathologic structures. force is not directed a horizontal component i incorporated and tends to cause tipping ( 5-1 II There'ore when horizontally directed forces are ied to a tooth. then if a tooth is contacted such that the resultant forces are directed .. As the tooth some of the POL are \vhile others are pulled or elongated Overall. Al 2 The second method (called tripodization) requirf: o that each cusp contacti ng an fossa three contac c such :hat it the actual cusp tip.

more Whereas the fulcrum of the nutcracker is system is free to move.-~ requires that SOr. th concept and realizing that A B I Fig. As a when forces are to an on the poste­ rior teeth the mandible .ed it is between the levers of tile nut­ :'.s of downward and forward obtam the occlusal rela­ that wiil best the desired task This snifting of the mandibular Additional r.2r and force is aPDlied It it is extremelv hard ~3sed the fulcrum to increase the it is closer likelihood of its cracked This demonstrates that greater forces can be to an oblect as its nears the fulcrum The same can be 5-1 '31 If a hard said of the nct is to be cracked between the teeth.. greater force can be ied to the Dosterior than to the anterior teeth .:1 permits lateral and excursions.-.luscle groups such as the inferior and lateral pterygo and the temporals are then called on to stabil the fT~andib!e resulti in a more com than that of a nutcracker. even and simultaneous contact of teeth shoL:ld occur when the mandibu­ inences ::econd. Much more force can be generated on the posterior teeth (A) than on the anterior teeth (B). the mcst desirable is not between the anterior teeth but between the teeth. horizontal forces are not the su structures and tne -"_:omuscular system.le teeth bear the burden of -:oe forces.Criteria for OptimullI FUllctiollal Oce/usion 105 Amount of Force Placed on the Teeth The criteria for um occlL:sion have now been First.)(. As alreadv stated. Thus several factors 0. 5·13 The amount of force that can be generated between the teeth depends on the distance from the temporomandibular joint and the muscle force vectors.' The however. beca use as the nut is closer to the fulcrum (the TMII and the area of the force vectors (tne mas­ seter and medial muscles).-2eth can best accept these horizon:al forces --e lever system of the mandible can be com­ with a nutcracker When a nut is being ':':. These lateral excur­ 1S allow horizontal forces to be to the -22-C. ~ . each tooth should contact in such :or that the forces of closure are directed -~e aspect that has been left undis­ relates to the of the TMI The -'. -ch allow the teetn to contact during different of eccentric movements. yet the of the .be considered wnen identifying which tooth .

When this con­ dition exists. and sometimes the mesiobuccal cusp of the first molar (Fig. Because the amount of force that can be applied to the anterior teeth is less than that which can be applied to the posterior teeth. 5-15 GROUP FUNCTION GUIDANCE A.. it becomes apparent that the canines are best suited to accept the horizontal forces that occur during They have the eccentric movements}' longest and largest roots and therefore the best crown/root ratio. 5-15) Any laterotrusive contacts more posterior than the mesial portion of the first molar are not desirable because of the increased amount of force that can be created as the contact gets closer to the fulcrum (TM]) The clinician should remember that the buccal cusp-to-buccal cusp contacts are more desirable A " t l 1: • B ~ Fig. Apparently.rJ A B Fig.::::r. premolars..::. 5-14 CANINE GUIDANCE. 5556 Lower levels of muscular would decrease forces to the dental and joint structures. - . which are positioned farthest from the fulcrum and the force vectors.. :" :~~: during laterotrusive movements than are cusp-to-lingual cusp contacts (lingual to working) ( 5-16. are not in the proper position to accept the horizontal forces other teeth must contact during eccentric move­ ments. fewer muscles are active when canines contact during eccentric movements than when posterior teeth contact. Laterotrusive movement. Many patients' canines. the likelihood of breakdown is minimized 4850 When all the anterior teeth are examined. a. cc.. Therefore when the mandible is moved in a right or left laterotru­ sive excursion.. The most desirable group function consists of the canine. however. which tolerates the forces better than does the medullary bone found around posterior teeth Another advantage of the canines centers on sensory input and the resultant effect on the muscles of mastication.106 Fundional Anatomy applied to the teeth can create pathologic changes lead to an obvious conclusion: The damaging hor­ izontal forces of eccentric movement must be directed to the anterior teeth.." :'J ~:lil~::.··". A. B. B) Mediotrusive contac :. Clinical appearance. the maxillary and mandibular canines are appropriate teeth to contact and dissi­ pate the horizontal forces while disoccluding or disarticulating the posterior teeth. several teeth on the working side contact during the laterotrusive movement. The most favorable alternative to canine guidance is called group fltftction In group function.i. minimizing pathosis. Laterotrusiv€ movement. They are also surrounded by dense compact bone. guidance to disocclude the teeth on the side of the arch lmediotrusive or nonworking sic" immediately I Fig 5-\6. the patient is said to have canifle 9l1id­ ance or canine rise ( 5-14). Aj The laterotrusive contacts Ieither canine gu i ance or group function] need to provide adequa-c.:: ir~ I. Clinical appearance. :-c.

B B L Fig. horizontal forces ca n ied to the tee.--tactS occur between the lingual cusps of maxillary teeth : .:he buccal cusps of mandibular teeth. 5-17 Protrusive movement with anterior gUidance. When the mandible moves forward into protru.1 What however.ve structures will not be abe forces and wi II be common finding in tooth support I.:'1t. Posterior teeth during a laterotrusive move­ Contacts can occur between opposing buccal (B) and . the anterior teeth can best receive and dissipate these forces. which when stim' "..52. the rationa for its presence These concepts are discussed in more closure of the accept these forces wei!. B. buccal-to-buccal contacts are used. well in the arches so axial loading is nearly anterior teeth receive occlusal contacts du closure. * Some 5 trat mediotrusive contacts :. the presence :::ontacts tends to shut down or inhibit This results from the in the POL. 13 47. .cate responses Yet other EMC 5uggest that the presence of mediotru· teeth increases muscle the increase in muscle ::Jnstrated. 58 . there is a great Ilkeiihood that their suooort.)0 Therefore the arterio and not the teeth should contact 5-171 The anterior teeth shadid contact or to disarticulate the contacts appear to unfavorable forces to the system because of the amount and direcion of the force that * Our'ne this discussion it has become evident teeth fJnction y ~~estructive to the system because ::::'lount and direction of the forces trat can .gJalIL) cusps.ciled by the neuromuscular system differ­ rn other of occlusal contact.58 I 47 52 57. 5-16 A. I) because their the arch is such trat the force can their axes The anterior teet h. detail in 7. When group function guidance is desirable. is that mediotrusive contacts should be avoided in devel· ar optimum fUicctional occlusion. ::>osterior teeth during a mediotrusive movement.h /\s with !atera movements. EMC demonstrate trat all to()th contacts are In other words.57. -.Criteria for Optill1t11ll Functionai Ocdusioll 107 A B L Fig.:. Lingual-to-lingual :: -:aces are not desirable during eccentric movement. to t'le joint and dental structures. sive contact.

The labial flar­ ing has led to increased interdental spacing proximal to the maxillary lateral incisor. as well as the alert position (head forwa rd approxi matel:.. These contacts often lead to labial displacement or flaring of the maxillary anterior teeth. Heavy occlusal contacts on the anterior teeth can occur when posterior tooth support is lost. With an appreciation of these roles it :)ecomes apparent that posterior teeth should ~ontact sl more than anterior teeth . resulting in flaring of the anterior teeth..108 Functional Anatomy A '''If. B. normal closure. response This is especially important to thi:: restorative dentist who wants to minimize force. to anterior restorations. bu­ it is difficult to predict which patient will show th!:. . the anterior contacts must be reduced until the poste­ rior teeth again contact more heavily durin{.. below the lCP and can be influenced to some head position. Posterior bite collapse. the mandibular postural position and result­ ant occlusal condition may be slightly posteriori" oriented \Vhen the patient sits up or assumes the alert feeding . The posterior teeth have been lost.. the !\' ­ their most superoanterior on the 11'1.. the postural of ncandible is that which is maintained during of inactivitv. such as porcelain crowns Failure to understand and evaluate this positio:­ can lead to crown fractures. 5-18 A. are in Droper position to accept the forces of eccentric mandibular movements. whereas anterior teeth function most effec­ ir gu the mandible during eccentric :llovements. therefore it may be stated that posterior teeth function most in stopping the mandible during clo­ sure. the resu ing anterior tooth contacts can lead to thE development of functional wear patterns on the anterior teeth This is not true for all patients. This concept is called the cmteril" envelope af f. B Fig. anterior tooth contacts. It is generally 2 to mIT: On the basis of the concepts presented in th' a summary of the most favorable func­ tional occlusal conditions can be derived The fc'­ lowing conditions appear to be the least pathogen: for the greatest number of patients over tr time When the mouth closes. The degree to which it is affected by head position and the resulting occlusal contacts must be considered when devel­ oping ar. optimum occlusal condition 6261 In the 'lormal upright head position. any change in the postural and its effect on occlusal contacts mLiS~ be evaluated If in the upright head or the alert feeding the patient's mandible assumes a sl anterior postural position of the elevator muscles will result in heav. The maxillary anterior teeth are not aligned properly to accept the mandibular closing forces. Anterior unlike posterior teeth.melior! When this slight ir mandibular not considered. SUMMARY OF OPTIMUM FUNCTIONAL OCCLUSION tJ "'" Postural Considerations and Functional Tootfl Contacts ~c . hen the teeth are occluded in the lCP This condi­ ~ion is described as mutlwlly vratected accilJsion. When this occurs. Generally. I the posterior teeth should contact than the anterior teeth (mutuall" protected occlusion) If an occlusal condition is established with the patient reclined in a dental chair.)iscussed in Chapter 4.

p 60.\1: Relationship between the tonic elevator mandibular activ­ ity and the vertical dimension during the states of vigilance and hypnosis. Wu CZ. Am) Anilt 115:119-127.liJiiit. Carr AB et al: The glossary of prostltodontic terms. ~~::'.\janagement of 'Dyj Disorder" Chicago.1iralles R. 3 . 1983 .l1ion. :2rs pp 129-136. Kotani :VI.-. 16.-n[O! Scand lO(Suppl): 19-27. 1899. pp 112-117. ::. Kuroda T: The effect of changing the maxillomandibular relationship by a bite plane on the habitual mandibular opening and closing movement. 1983. 1961. . . ed 30.. I tooth contacts provide axial loading of =:clusal forces '. Rugh ID. 1980. ~terposed _____________________~~_. DuBml EL: Sieller's oral anatomy. Van B1arcom CW. Santander It Valdivia J: Influence of the vertical dimension in the treatment of myofascial pain-dysfunction syndrome. Stuart C: Concepts of occlusion.'t':-tnces -.terior teeth also contact but more lightly ~:' an the posterior teeth. 1926. ned? and T\1J paill and Philadelphia. : \!osby. 1983. 1990.. '_' ~ ~ HI: Classification of malocclusion. Farrar WB. 26.'~. Dem Cosmos _.:-:e upright head position and alert feeding _ : sc:or. Isacsson G: Tissue reactions associated with internal derangement of the temporomandibular joint. <lnd . 1987.15 illustrated medical dictionary. St Louis.1933 '. J Delli Res 69:. Mosby. 22. 1. 1952. I Am Dent Assae 113:59-62. DuBml EL: Sieher'" ora! anatom. 19G1. 1977.M .en the mandible moves into laterotrusive :: ~sitions. lankelson B. 29. 18. Diagnosis.c:r C: Correction of occlusion: disharmony of the .'rd SP. Rocabado . Brehan K: Occlusal forces during chewing: influence on biting strength and food consistency. Momgomerv. St Louis. McCarty WL: A clinical outline of temporo­ mandibular joint diagno:.c'c J Prostltet Dem 12:255-261. J Oral Rehal>i12:24'l-256. J Prosrl1er Dem 46:561-567. \1osby. P 58.: IL: Physiologic occlusion. de Bont lG. P 178.. 1984. Dawson Pl.~".-264.anterior tooth contacts. 23. . _~. 1963. rate of and forces developed in chewing.·:.c CO: Swenson's complete den tH res.. Bates IF: l\IasticatOlY function-a review of the liter. 1962 ~_'. 112. St Louis..o St Louis. 1981. Sirhan mvL Quiroz M. 1983. Boering G: Osteoarthrosis as the cause of naniomandibular pain and dysfunction: a unif)'­ ing concept. Mosby. Moffet BC: Articular remodeling in the adult human temporomandibular joint. 198:. Ash MM: Centric discrepancy associated with TM disorders in young adults.v)3. ~d SP: Dysfunctional temporomandibular joint and o pain. diagnosis and treatment of occlusal problems.>"1ahan PE. :-. adequate tooth-guided contacts on ::: laterotrusive (working) side are present to :::3occlude the mediotrusive (nonworking) side The most desirable guidance is : -'·. Quime5sence lilt 3:57-62. 1'. . Adib F: Effect of variation in manipulation force on the repetitiveness of centric relations registration: a computer-based study. dentition. p 1298. J Prostltet Dent 11 :353-362. J Am 20:1015·1019.5.: El'aluation.llure. 33. 32. N Y Dent J 13:455-463. Stegenga B.Criteria for Optimum FrmclionalOcciusion ~~:e 109 articular eminences with the discs properly In this position there is even and . Gelb H: Clinical management of IWild. 28. Gibbs CH. . 24.'\34-337. " Int1uence of occlusal patterns on movement of the . Lundeen He. Isberg A. 1980. 1999. A radiographic. Ash MM: Occlusion. Saunders 19..'a CO: Current clinical dental terminology. posterior tooth contacts are heavier -.is llnd treatment. Miyauchi S. 1972.:::multaneous contact of all posterior teeth. Drago C): Vertical dimension: a study of clinical rest position and jaw muscle activity.:".1969. J Proslhet Dent 50: 70()-709. St Louis. 20. Philadelphia. 1 FS: Cast bridgework in functional occlusion. 21.~d S' Bmxism: a clinical and electromyographic \m Dent AsSN 62:21-28. FA Davis. and histologic study. . J Oral Rehabil 11 :455·465. Posselt ll: of ('cciusion and re/t. pp 28·34. -:. American Dental Association. \'1-/: Balanced occlusions. . Campbell SD. 27. . Jankelson B. 33.1986. Dolwick MF: Diagnosis and etiology of mtemal demngemenfS of the temp(lromandibular joint: Presitieni's COIlFerence on tile Examination. 1947. 1989. 1970. Crania 8: 163-1 70.ishio K. J Oral A.jaxillofilc Surg 47:249-256. _:.. . "~...'lY ~~ II .ormandie Publications. J :1m Dent Assoc 12: : . 1990. ~ Saunders. I Prosthet Dent 45 :670-675. adequate tooth-guided contacts on anterior teeth are present to disocclude all : ~~erior teeth immediately . crvomorphologic. 1989. 17. 30. '\1amyama T. Manns A.:. Chou SL. J Am Dent Assoc 13: :. r-. 25. /\Ia. H. Philadelphia. Dent Clin ~'n "iovember:591-601. Acta Odontol Scand 44:160-164. 5t Louis.\-losb". 1968.. ~ sition.: U Studies in the mobility of the human mandible. Philadelphia. ed 3.ided by the canines (canine guidance).. Zuazola RV. en the mandible moves into a protrusive .. Swain CW: Physiological aspects of mastica torv muscle stimulation: the myomonitor. 31. ed 7. 1925. r-. IL Speed of movements of the mandible. Manns A. The ~.

:':T'.:':"..' -. The posterior teeth are positioned between ::0:' :\\'0 controlling factors and thus can be ::.:r controlling factors (PCFs).~:.PO POSTERIOR CONTROLLING FACTORS (CONDYLAR GUIDANCE) As the condyle moves out of the centric relation the articular eminence position._: the mandible. Generally. the will take a path that is less vertically at which the condyle moves inclined The away from a horizontal reference plane is referred to as the condylar guidance angle. :' .-: :::::c1usal morphology necessary to achieve an _::-:-um occlusal relationship The structures that mandibular movement are divided into two _:'3 I. vertically inclined path If it flatter..TM]s) and the anterior -.ent. I n health the occlusal anatomy of the teeth func­ ..:sct their opposing teeth during mandibular . ~::.:. the condylar guidance angle gener­ ated bv the orbitin2 condyle when the mandible than when the mandible protrudes straightforward This is because the medial wall of the mandibular fossa is generally steeper than the articular eminence of the fossa directly anterior to the condyle The two TMJs provide the guidance for the pos­ terior of the mandible and are responsible for determining the character of mandibular movement posteriorly They have therefore been referred to as the PCFs of tfte mandibttiC!r movement. the condyle will take a steep.sch of these structures carefully and appreci­ .2W the anatomic form of each can determine . the clinician should exam­ .'..a!ntain harmony of the occlusal .~-:Joromandibular joints I.Determinants of Occlusal Morphology teet(! that s[<ccessfull[J permit efficient mas­ ticatory function is basic to dentistry and survival. If the surface is quite steep. The condylar guidance is con­ sidered to be a fixed factor because it is unaJter­ able in the healthv patient.ions in harmony with the structures controlling :he movement patterns of the mandible The .~._~:erior teeth must pass close to but must not : . Importantly. and the anterior . The TMjs are considered the . ­ are considered the anterior controlling factors . I those that infl uence the movement of the .~ior portion of the mandible and (2) those ~-:-"fluence the movement of the anterior por­ . During any given movement the unique . . It can be altered.::i bv both to varying degrees III I "111_ _ - - ­ .. The rate at which it moves inferiorly as the mandible is being protruded depends on the steepness of the articular emi­ nence.:ctures that determine these patterns are the -. it descends of the mandibular fossa.::::omic relationships of these structures com­ ~ -:' to dictate a precise and repeatable pathway the .

The result here deviation away from horizontal of 4'5 In 6-3 the mandible moves four units ir horizontal plane. mandibular movement is determined by the anatomic characteristics both of the TMJs posteri ­ and of the anterior teeth anterioriy Variations in the anatomv of the TMls and the anterior teeth in the movement pattern of If the criteria fOe optimum functional occlusion to be fulfilled the morphologic char­ acteristics of tooth must be in har­ mony with those of its opposing tooth or teeth during II tric mandibular movements. ortho­ dontia.' teeth will influence its movement and the less t.. but in the vertical the moves four units and the l'\CF moves six units resUlts in a movement of the rCF movement of the ACE Points bet\. It the surfaces are quite steep the anterior aspect of the mandible will take a steep-incline If the anterior teeth have little vertical will provide little vertical guidance during mandibular movement.' I!.~ horizontal component and it is the relations!­ between these com ponents or the ratio that in the of mandibular moveme'. C' forvvard two units.I 12 FUilctiolwl Ana/omy however. under certain conditions (trauma. habits and tooth wear. the anterior teeth determi how the or laterally the incisal mandibular teeth occlude with the of t he maxi I iary anterior The steepness of these lingual surfaces determines the amount of vertical movement of the mandible. the nearer a rior teeth.' .:-. It can also be a:te. UNDERSTANDING THE CONTROLLING FACTORS To understand the infl of mandibular move­ ment on the occlusal of posterior teeth. or a surgical procedure) ANTERIOR CONTROLLING FACTORS (ANTERIOR GUIDANCE) lust the TMls determine or control the manner in which the posterior portion of the mandible moves. and extractions.::~ _.' +1111 . one must consider the factors that influence mandibular movement. Therefore the exact morphology of the tooth influenced the it travels ng tooth or teeth tooth to the con­ The relationship of a trolling factors influences the D. the factors will deviate by different amounts plane depending on the:r factor The nearer a is to the the more its movement will appr: (because of the greater influenCe: the PCF on its movement) Likewise the "~i""'. The anterior gUidance is considered to be a variable rather than a fixed factor It can be altered by denta I proced u res sLlch as restorations.ecise movement c: that tooth.ed by pathologic conditions such as caries. As discussed in Chapter 4. and the horizontal com:: nent a function of the anteroposterior moveme'-­ If a condyle moves downward two units as it IllC."~ anatomy of the TMls will influence that mover::er: The occlusal surfaces of teeth consj~of a series of cusps with both vertical and horize tal dimensions. are made up of com ridges that vary in steepness (vertical dimensic ­ and direction (horizontal dimension) Mandibular movement has both a vertical an. the more the nt anatomy will influenc~ its eccentric movement and the less the anatorr of the anterior teeth will influence its movemel-: tooth is to the ante~ Likewise.­ The vertical component is a function of the sur=~ oinferior movement. four units in the vertical plane. the more the anatomy of the anteri.. it moves away from a horiZOI-­ of 4S degrees I' reference an moves downward two units and forward one it from this plane at an ang 64 The angle of devia­ horizontal reference plane is what ill mandibular movement the mandible as it me horizontal plane and zero unite resulting in a deviation from horizontal of 0 degrees Fig 6-2 shows mandible four units in the horizonta. This means that the nearer a tooth is L: the TM!.

Because both the PCFs and the ACFs are causing the mandible to move at the same rate. . A the factors will move a'way from of one that 259c closer to the ACF than to the PCF will move away from horizontal at an of 54 (one fourth of the way between 57 a:'d 45 i To examine the influence of any anatomic varia­ tion on the movement pattern of the mandible.-\CF on its movement I. 6·2 Movement of the mandible four units horizontally and four units vertically at both the posterior (PCF) and the anterior (ACF) controlling factor. No vertical movement occurs.vertical movement ~ ___ 113 HRP HRP ACF 4 units forward :--­ iTI'n ~ o units downward Units of vertical movement --=:___ i J I ! I Units of ~ horizontal movement Fig. The mandible moves horizontally four units from a position marked by the dotted line. When the mandible moves four units down. 6-1 Horizontal reference plane (HRP) of the mandible at both the posterior (PCF) and the anterior (ACF) controlling factor. . The net result is that it is at a 45-degree angle from the horizontal reference planes.Determinants of Occlusal Morphology PCF 4 units forward o units downward Units of .~ the ACF the more its movement wiil 57 (because of the greater :nflu­ . The solid line represents the position of the mandible after the movement has taken place. each point on the mandible is at a 45-degree angle from the horizontal reference plane at the end of a mandibular excursion. it moves four units forward at the same time. ::lCF 4 units forward o units downward HRP HRP ACF 4 units forward o units downward 45° ITU Fig.

that thev contact dunng eccentric movements . A point (x) that is equidistant from the controlling factors will move at a 51-degree angle from the reference plane. cation of the tooth to the center of rotation is discussed. cclusal surface can be affected in two manners and width\.114 FUI1cti011lli Al1alolH!J PCF 4 units forward o units downward HRP HRP x y 54' " _R. the desce:' the articular eminence. ---. For this to occur. the more its movement is influenced by the factor.usal morphologv. ""'" VERTICAL DETERMINANTS OF OCCLUSAL MORPHOLOGY =actors that influence the of cusps and the of fossae are the vertical determinants :::c. Thus it can be seen that the nearer the point is to a controlling factor. The nearness of the cusp to these control:.:' guidance) 2. However. The PCF of mandibular movement (i.6-3 RESULTANT MOVEMENT OFTHE MANDIBLE WHEN THE CON­ TROLLING FACTORS ARE NOT IDENTICAL. The len2th of a cusp and the EFFECT OF CONDYLAR GUIDANCE (ANGLE OF THE EMINENCE) ON CUSP HEIGHT t 0: As the mandible is protruded.­ factors The centric cusps are de\ to disocclude eccentric mandibu movements but to contact in the intercuspal pc< tion. _ necessary to control all factors except the one ng examined Remember that the the anterior and guidances lies in how . Therefore the posterior portion of the mandible is moving away from the reference plane at a 45-degree angle. distance it extends into the depth of an fossa are determined three factors I.. contact in the i position but not so Ie .ill. Therefore the .e. The ACF of mandibular movement (ie anter. _~r' ==' I I Fig. guidance) 3. Its descent in rela~ to a horizontal reference plane is determined - .. it is to separate the ~~ructural influence on mandibular movement into that influence the vertical components and that influence the horizontal components anatomy of the occlusal surface is also influ­ ced by its relationship with the tooth that :asses across it during movement. The posterior controlling factor (PCF) causes the posterior portion of the mandible to move four units forward (horizontally) and four units downward (vertically).~"do""wacd ~ I ACF 4 units forward •••••••••••••••• ' \ } •••••••••••••••• ~ •••••••••••• . and the anterior por­ tion is moving away at a 57-degree angle.nfl uence tooth Because the . the anterior controlling factor (ACF) causes the anterior portion of the mandible to move four units forward and six units downward. they must be enoug~ . Another point (y) that is one fourth closer to the ACF than to the PCF will move at a 54-degree angle.

MMl.a 45-degree To avoid eccentric contact ::2tween premolar A and premolar B in a protrusive ~. cuspal inclination must be less than in Fig 6-5. and anterior I 15 from 8 at a 60-degree of the in longer cusps.. B. The posterior and anterior controlling factors are the same... As presented in Chapter 3. /'// I .""''''1 41311.'. Therefore a steeper eminence guidance) allows for steeper cusps. _­ 8 A . EFFECT OF ANTERIOR GUIDANCE ON CUSP HEIGHT Anterior guidance is a function of the relationship between the maxillary and mandibular anterior teeth.. Parts A. it consists of the vertical and horizontal of the anterior teeth To illustrate its influence on mandlbu!ar movement and thereFore on the occlusal of posterior teeth..1I11l!f" '·::"!ii\ft~:. 6-4 A.ill move away from a horizontal reference ~.'.ntal reference pia nes With these steeper "":Ical premolar A will move away A cr j') Fig.. The steeper the emi ­ nence. some combinations of vertical and horizontal appear in 6-6. I / / \ \ \ ~ . causing the mandible to move away from the reference plane at a 45-degree angle." ~--- Deterl11i1wnts of occlusal Morphology steepness of the eminence. . \ ' .. the cuspal inclines must be less than 45 degrees.~. and mandibular teeth.. and C present anterior relationsh that maintain ecwai amounts of vertical ~ ::e are presented as bei ng 60 degrees to the hor ­ _. anterior guidance is i Ilus­ --ated at an equal angle The cusp of . For premolar A to be disoccluded from premolar B during a protru­ sive movement.. B.. the more the is forced to move as it shifts anteriorly This results in sreater vertical movement of the :llandible. ... I. :"Uiil.::vement. In Fig 6-4 the moves away from a hori ­ :)ntai reference at a To c mplify visualization.

the cuspal inclines must be less than 60 degrees.­ and the cusps of the maxillary posterior teeth of the plane to the angle of the nence influences the steepness of the cusps. in relation to a horizontal reference plane -­ i nfl uence of the plane of occl usion can be see:­ In Fig 6-7. Posterior and ante­ rior controlling factors are identi­ cal and cause the mandible to move away from the reference plane at a 60-degree angle. ment of a mandibular tooth when compared . An increase in horizonta: leads to a decreased anterior vertical component to mandibular movement.­ in relation to the plane of occlusion rather t~.{<\-W • \ \ \ A the in horizontal one can see that as the horizontal overlap increases. one can see that as the vertical overlap increases. (? B U. B. and F present anterior that maintain equal amounts of horizontal but varying amounts of vertical overlap By com­ the changes in vertical overlap. E. \\ the movement of a mandibular tooth is vie. For premolar A to be disoccluded from premo­ lar B during a protrusive move­ ment. and flatter posterior cusps. ment and steeper posterior cusps EFFECT OF THE PLANE OF OCCLUSION ON CUSP HEIGHT The of occlusion is an imaginary line tOL~ ing the incisal edges of the maxillary anterior te". Thus it can be seen that steeper posterior and anterior controlling factors allow for steeper posterior cusps.116 Functional Arlalomy A Fig. condylar guidance and anterior ance are combined to a 45-degree m. 6-5 A. Because mandibular movement is determined to a great extent by anterior changes in the vertical and horizontal overlaps of the anterior teeth cause changes in the vertical movement patterns of the mandible. the anterior guidance angle increases. An increase in vertical over­ produces an increased anterior guidance a more vertical component to mandibular me. the anterior decreases Parts 0.

In A to C the horizontal overlap (HO) varies. - reference plane. whereas the vertical overlap (VO) remains constant. As VO increases. However. that tooth contact wil! be ~en the tooth movement is compared ~'ovement with the of occlusion ( it can oe hat the movement av/ay from this plane i 60 Therefore the posterior tee:h can have the . the anterior guidance angle increases.onger cusps and we have determined that Ilel plane of occlusion oecomes more nearlv to the angle of the eminence. In D to F the VO varies. the anterior guidance angle decreases.Determinants of Oalt/sal Morp{lO{ogy B I 17 c I I HO D . When the HO increases..I it can be seen that the tooth is . results in the need for flatter poste0::. . 'i\ from plane at only a =~. whereas the HO remains constant. when the is compared with one plane _. I HO Fig. the must be mace shorter. 6-6 The anterior gUidance angle is altered by variations in the horizontal and vertical overlap.

. EFFECT OF THE CURVE OF SPEE ON CUSP HEIGHT When viewed from the the curve of Sree is an curve from the of the of mandibular canine the buccal cusp the mandibular teeth Its curvature can of the radius of be described in terms of the the curve... whereas' molars (located mesial) will have cusc: 6.. . the angle at wi­ the mandibular teeth move away from the me' teeth will be greater than with a radi~. -. POs . '" S .vith mandibular move­ ment..... V' . • ----. The anterior and poste­ rior controlling factors create a mandibular movement of 45 degrees from the horizontal reference plane. .:: ( .. .. -. a much greater discrepancy is evident (45 + 15 = 60 degrees). The tooth moves at a 45-degree angle from the reference plane (HRP). When the angle at which the tooth moves during a protrusive movement is com­ pared with another plane of occlusion (POs).. !. the radi us forms a 60-degree d­ 0' :---::::..PO. Given a short radius.10. T I( curve Of more the (.. With a short the curve will be 6-81..JF ':.. A the radi us of the forms a with a constant horizc. more acute than with a longer radius ( The of curvature of the curve of Spee cusps that influences the height of the will function in . The orientation of the curve of as dE~~' of its radius to a !­ mined by the will also influence hm\ ­ of an individual toot6-10. 6-9 the mandible is moving away from a horizontal reference plane at a 45-degree Movement away from the maxi teeth will vary depending on the curvature of the curve of Spee.I 18 Fun(tional AnatolllY Fig.. Therefore the cusp must be relatively flat to be disoccluded during protrusive movement. .­ . B. the tooth will move away from the reference plane at only 25 degrees. more forward with respect to the horizontal p one can see that all the teeth Iprem' -E!Ct .. However. In Fig.~.25° I . 15° . 6·7 A.. if one plane of occlusion (POA! is angled. A (J ----HRP 45° . reference plane Molars Iwhich are located d to the radius I will have shorter cusps. B.': ~ ." 81 60° . This allows for taller and steeper poste­ rior cusps...

the greater will be the angle at which the mandibular posterior teeth move away from the maxillary posterior teeth and therefore the taller the cusp can be. :S I will have shorter cusps In Fig. 6·9 The mandible is moving away from a horizontal reference plane at a 45-degree angle.fltj .·". ~ B 45° Fig. line from the constant hori-:.11 of the medial wall of the mandibular fossa and (2) of the which attaches to the lateral.r cusps ~~-::-ECT --.Determinants of Occlusal Morphology I 19 A B Fig. B. . A shorter radius causes a more acute plane of occlusion.'". The flatter the plane of occlusion (A). the smaller will be the angle of the mandibular posterior tooth movement and the flatter the teeth can be. . 6·8 CURVE OF SPEE. 'SLATION OF MANDIBULAR LATERAL MOVEMENT ON =--_ SP HEIGHT ··:Jular lateral translation movement is a ::' shift of the mandible that occurs during ca II ed Bennett lateral movements ( During a latera excursion the moves downward and inward in the mandibular fossa around axes located in the ( The of inward movement of the orbiting condyle determined two factors 1. 6-10. condyle If the T!v1 I of the is tight and the medial wall is close to the orbiting a pure arcing movement wili be made mOVel11/. C.The more acute the plane of occlusion (B).:ior teeth (especially the molars) can . A longer radius causes a flatter plane of occlusion.rence plane rotated (curve c:. A.sced more one can see that :::. ·-li .:'l.

and direction The .120 FUllaiollal Allatomy A ~ " "" • B ~ Fig. C. no late:al translation the rnandiole occurs therefore no mandibu­ r lateral translation movement} I 6-111 Such condition occurs.ltributes: amount./ Fig. temporomandibular (TM) ligament. there is no lateral t-· ­ lation movement.. . B. the orbiting is moved to the medial wall and uces a Tandibuiar lateral translation moven'ent. c :­ around the axis of rotation in the rotating \\hen this condition exists. it can be seen that more posterior teeth will be positioned mesial to the perpendicular and can have taller cusps..-. Radius perpendicu­ lar to a horizontal reference plane. If the plane of occlusion is rotated more posteriorly. A. timing. If the plane is rotated more anteriorly. 6-10 ORIENTATION OFTHE CURVE OF SPEE. and the medial \\lall the rnandibclar fossa lies medial to an arc ! Fig 6-12) round the axis of the i1en this occurs.0"111 and are determined in part the ~:egree to which the medial wall of the mandibular medially from an arc round the alsc determined 'ng • -:. ~" . 6· I I With proximity of the medial wall and a : ... it can be seen that more posterior teeth will be positioned distal to the perpendicular from the reference plane and can have shorter cusps. Most often :here some of tne TM I ment. The lateral translation movement has three c. Posterior teeth located distal to the radius will need shorter cusps than those located mesial to the radius.

Drlenili. the greater will be the lateral translation movement. the central fossa of the teeth will need to be wider than pathway 2 to disengage the opposing teeth. . The dirccticn of latera I translation movement the direction taKen by the the bodilY move:nent i Fie. .'. 6·14 The direction of the lateral translation move­ ment is determined by the direction taken by the rotating condyle. : . a lateral translation movement occurs. con~act between the maxil and :nandibular teeth ( 6-151 Effect of the Direction of the Lateral Translation Movement on Cusp Height The direction of shift of the du a iateral translation movement is determined the fl'orDholoev and iJea:ner'tou5 attachments of .ting condyle.:o perr. '=:ore when the medial walt is in position 3.'" \ 1\'1. -.:he medial wall of the :nanciibu1ar from the :ned:al of the and the greater the greater the amoum mandibu­ lar translation movement .wllts of Occ/usal Mor~hology '2' fr \\.:al the wall from the media! of the orbitthe greater tne amount of latera! c ~'ation movement ( 6-13) and the looser ~ -\1 ligament attached to the the greater trle lateral translation movement. the shift of the mandible dictates that the cusps be shorter. 6-14: Effect of tfle AmoUtlt of Lateral Translation Movement on Cusp Height As iust stated the amount Of latera! translation movement determined the tightness of the inner horizontal attached to the rotating to \.6·12 When there is distance between the medial wall -: 11edial pole of the orbiting condyle and the temporo­ -3ndlbular (TM) ligament allows some movement of the -: :3.e./ =g_ 6·13 The more medial the medial wall is from the .'~ ateral translation of the mandible than in position I./ Fig.l/hich . . 'I'.\1: 1111 Ii .As tile lateral transla.lit lateral translation \vithout creat.. tion movement increases. When the rotating condyle follows pathway I. . ~he TM I The more ./ Fig. It witl allow .

e: movement of :­ c.122 Functional Analolll/j 1 2 3 - . (3) an anterior. the shorter is rhe posterior cusp. re shorter lateral movement. In other words. -'i :. ./ Fig. the Therefore in addition may also move in (I) a superior ( ) an inferior./ Fig.. the shorter the posterior cusp. the I'M joint ng rotation The movemen' occurs within a (or less) cone....::.' movement will have I if any. Of the three attributes ateral translation movement (amount."'. direc and timing)' the last has the greatest influenc:­ of the te c the occl usa I If the tim:ng occurs late and the maxillar) n"Landibular cusps are functional range amount and direction of the lateral transl. comb:nations of these can occur.r.. likewise p05~ lateroinferior movement will rior cusps than will a straight lateral movement Effect of the Timing of the Lateral Translation Movement on Cusp Height of the lateral translation movement to the orb: function of the medial wall and the attachment of the TM I to the These two condit determine when this movement occurs durj!' 'ateral excursion.6·17 The more superior the lateral translation move­ ment of the rotating condyle (I).:: 'T . if the timing C .. The more inferior the lateral translation movemen: (3). 6·16 The rotating condyle is capable of moving larer­ ally within the area of a 60-degree cone during lateral trans­ lation movement.. shifts and so on ./ Fig. influenCe: occiusal morohol02v f-Iowever..-. as a determinant of cusp is the vertical movement of a lateral translation mo'. or (4) a direction. the taller the cusp.. 6-15 The greater the lateral translation movement. Pathway 3 will require shorter cusps chan pathway I. the apex of wh ich is located at the aXIs of rotation ( 6-16) lateral movement..

/. BI .e.r:e'1 the lateral translation movement occurs ns a shift is seen even before the :-.1 ti011 mOVP111e11t or side -'le more immediate the side shift the shorter i'sterior teeth. This is consis­ tent regarcJless of whether maxil or mandibular the are increased in size as the distance from the rotating is increased because the ma'1dibular are more distally [see Fig 6-20. Mediotrusive pathway (A) and laterotrusive pathway (B).. If it occurs in with eccen­ ~:ovement. the wider the formed the laterotrusive and 6-20i.nslate from the fossa This is ca:ied an imil1e­ ':lieral translation movemf'flt or irnmedwte side 6-18).Determinal1ts of Oce/usal Morphology 123 yi ~\ '~Al . the movement is known as a pro­ _.. ) . 6·19 The pathway that the cusp of a tooth follows in passing over the opposing tooth is a factor of its distance (radius) from the rotating condyle. EFFECT OF DISTANCE FROM THE ROTATING CONDYLE ON RIDGE AND GROOVE DIRECTION Because the ing of a tooth varies in relation to the axis ot rotation of the mandible li. ng tooth./ Fig. Immediate lateral transla­ : :on movement (immediate side shift): 2. _. The more -1iediate the lateral translation. Each tion of the arc formed the rotating condvle ( be on the relationship of the to certain anatomic structures..' latera! tra 115/. 6·18 TIMING OF THE LATERAL TRANS· LATION MOVEMENT. Fig. progressive lateral :-~nslation movement (progressive side shift).. the shorter the posterior :_sp. centric cusp generates both lat­ ~·.._ital determinants of ocC:usal relationships that influence the direction of 3'ld grooves on the occlusal surfaces. the horizontal determinants : uence the of cusps./ \ CJ? . Because oetween and over grooves --c movements. rotat ­ HORIZONTAL DETERMINANTS OF OCCLUSAL MORPHOLOGY .ement occurs in the laterotrusive movethe amount and direction of the lateral :ation movement will influence Jsal . i . ( .e and mediotrusive oathwavs across variation \dl occur in the the laterotrusive and mediotrusive The greater the distance of the tooth from the axis of rotation i I.

\1 G A B B Fig. Mediotrusive pathway. the wider the angle formed by the laterotrusive and mediotrusive pathways. ::111!11. 6-21 The greater the distance of the tooth from the midsagittal plane. laterotrusive pathway.r:1. the wider the angle formed by the laterotrusive and mediotrusive pathways.124 FWlCtionaf Anatomy EFFEC ~'D ROTAT THE . A. Mediotrusive pathway. 6-20 The greater the distance of the tooth from the rotating condyle. This is true for both mandibu­ lar (A) and maxillary (8) teeth. . B.9~" <~ .. laterotrusive pathway. A. ~.. EFFECT OF DISTANCE FROM THE MIDSAGITTAL PLANE ON RIDGE AND GROOVE DIRECTION The relationship of a tooth to the midsagittal plane will also influence the laterotrusive and mediotrusive pathways generated on the tooth by an centric cusp l\s the tooth is positioned farthe' from the midsagittal plane the angles formed the laterotrusive and mediotrusive pathways \\ increase \ 6-21 ) Midsagittal plane Midsagittal plane y~ !1B=-= ~ A B 'I~ =-a:: Fig. This is true for both (A) mandibular and (8) maxillary teeth.1 "'-'­ . B.

the can be seen: Generally as the distance .22 The more anterior the tooth in the dental arch.e tooth a greater distance from the rotating but nearer the midsagittal plane. its _ ::::1nce from the midsagittal plane decreases ." 0 GROOVE DIRECTION -fjuence of the lateral translation movement ~eady been discussed as a vertical determ iThis movement also . the distance between the and the tooth in a arch ration increases.. would :~lJse the latter determinant to negate the influ­ angle between the :e of the former. as the distance increases. tooth from the rotating increases. the wider the angle formed by the (A) mediotrusive and (B) laterotrusive pathways.:erotrusive and mediotrusive pathways would be in the dental arch at by teeth and ·'eat distance from both the rotating the smallest '-e midsagittal plane teeth nearer to both would be generated rotating condyle and the midsagittal plane 3ecause of the curvature of the dental arch. the angles eenerated will increase. pathways and resuitant angles (Fig 6-24) If the shifts in a lateral and anterior between the laterotrusive and mediotrusive pathways will decrease on both max­ illary and mandibular teeth If the condyle shifts laterally and posteriorly. :. the angle between the -' -'usive and mediotrusive pathways gener­ ... This tends to decrease the ::FFECT OF MANDIBULAR LATERAL TRANSLATION MOVEMENT ON RIDGE 1. because the distance from the .:::::Ie increases faster than the ~ :-ease in distance from the midsagittal the teeth tovvard the anterior region angles between premolars) will have ~terotrusive and mediotrusive pathways than teeth located more posteriorly Midsagittal plane !J B t? Fig.: . the tooth is placed nearer the midsagit ­ relative to the rotating condyle-midsagittal distance. ever. The :.6. This tends to cause wider between the laterotrus.::es the directions of -' :)unt of it increases.ve and mediotrusive However.': _ occlusal and grooves /\S e.the centric cusp tips increases (Fig 6-23] ::Hrection that the rotating condyle shifts . 6·22) EFFECT OF INTERCON DYLAR DISTANCE ON RIDGE AND GROOVE DIRECTION In considering the influence of the intercondylar distance on the of laterotrusive and mediotrusive it is important to consider how a distance influences the relationship of the tooth to the rotating condyle and midsagittal plane As the inter­ condylar distance increases.Dftennil1allts of Occ/usal MorpflO/oqU 125 EFFECT OF DISTANCE FROM THE ROTATING CONDYLES AND FROM THE MIDSAGITTAL PLANE ON RIDGE AND GROOVE DIRECTION has been demonstrated that a tooths position in :elation to the rotating condyle and ~he midsagit ­ :31 plane influences the laterotrusive and medio ­ :-usive pathways The combination of the two =:)sitional relationships is what determines the e:\act pathways of the centric cusp Positioning --.3 lateral translation movement influences = :ection of laterotrusive and mediotrusive ..

: . the wider the angle formed by the mediotrusive and laterotrusive pathways (AI and BI)' This is true for both mandibular (A) and maxillary (8) teeth._ B1A1 B2 A2 B2 B3 '" Ao .J A B.!~I. 6-24 Effect of anterolateral and posterolateral translation movement of the rotating condyle. . This is true for both mandibular (A) and maxillary (B) teeth.::&o """"':~2 '~-. is most often minimai and therefore the leas:: enced of the determinants. the smaller the angle formed by the mediotrusive and laterotrusive pathways (Al and Bl).The more posterolateral the movement of the rotating condyle. B2 B3 E ~~ Fig. A summary of the vertical and horizontal minants of occlusal morohologv can be fow" Tab'es 6-1 and 6-2.. h. A2 A3 / rr _. however.126 Fwutiollal Al1atoll1~ -j A A~ JJ B· B Fig.l!jJ. 6-23 As the amount of lateral translation movement increases. The more anterolateral the movement of the rotating condyle. IHji~.'II!Qj:r' .'Ir' ~":illll!JnI~~~. 6-251 The latter factor negates the influence of the former to the extent that the net effect of increasing the distance is to between the laterotrusive and mediotrusive The decrease. the angle between the (A) mediotrusive and (8) laterotrusive pathways generated by the centric cusp tips increases. -:-~I I'_~IZ::' ~ A.

\ \ ~ \ ~ \ A2 A. the smaller the angle formed by the laterotrusive and mediotrusive cusp pathways (AI and 8 1 ).lcerior guidance ~ ~ ne :: J of occlusion I've of Spee .=-: ::>ndylar distance Wider the angle between laterotrusive and mediotrusive pathways Wider the angle between laterotrusive and mediotrusive pathways Wider the angle between laterotrusive and mediotrusive pathways Smaller the angle between laterotrusive and mediotrusive pathways . ' \ i\ \ :I \ \ \~i\..Determinal1ts of O((IL/SIII MorpFlOlo!JY 127 ~Al\(-. Fig.-Y \ I 1\\ 1 I •. -: rizontal Determinants of Occlusal Morphology (Ridge and Groove Direction) fM:tors ::::~ce Conditions Effects from rotating condyle Greater the distance Greater the distance Greater the movement Greater the distance _ ':::-ce from midsagittal plane _::~-:" translation movement .:-l\. The smaller the intercondylar distance. The greater the intercondylar distances.>\\i1t Taller the posterior cusps Taller the posterior cusps Shorter the posterior cusps Shorter the posterior cusps Shorter the most posterior cusps Shorter the posterior cusps Shorter the posterior cusps S\\oner t\\e ?o'..>?> TABLE 6-2.~.::c:eral translation 'Tlovement Steeper the guidance Greater the vertical overlap Greater the horizontal overlap More parallel the plane to condylar guidance More acute the curve Greater the movement More superior the movement of rotating condyle Greater t\\e immediate '.-~:'~ . 6-25 The greater the intercondylar distances. the smaller the angle formed by the laterotrusive and mediotrusive pathways..>terior eu'. TABLE 6-1 Vertical Determinants of Occlusal Morphology (Cusp Height and Fossa Depth) Factors Conditions Effects :: :>ndylar guidance :'. the wider the angle between the laterotrusive and mediotrusive cusp pathways (A2 and 8 2).>ide '.\-.-V·_A2)..

. Alii I ~: 83. New York. and horizontal with tre of the lingual concavities of the rraxillary anterior teeth ivertical and horizc'ntal relationshi of anterior lOne suggests that consistent with Cons'deration directed steepness of the ril} toward the PCFs that of the eminence and movement le.ACFs can be influence the . scientific evidence to support a corre­ lation betvveen the .." 'hlI!! .\!cGrdw-llilL pp 2J 3-230.g. lateral translation movement) This phi moverrent becomes mere that horizontal in articular eminence with increase in lateral translationi tr:e 'i concavities of the maXillary anterior teeth will increase reflect a similar movement characteristic However. l . •\nglc IL: ~dctorS in temporom':lIldibular form. This tant c(wcept because the ..223-234.. studies seem to indicate that the the articular eminence is not related to any occlusal relationshio ' . of If .~ .. Ricketts R'\I: Variations of the temporornandihular jOiL: rewaled by cephalometric laminagrarhy. Moffett BC: The editor Complete demure prosthodolllics. 1·' E' . In Sham 1. . .. .. In other AN[)P(C)STE~IOR. 1')50 .:' :lG:R77-892.ACFs dental ures . J ')4S.128 FUllctiorwl Ana/oll1t} lns~ead.CONTR<pLlING ~~~1](C)NSH1PBETWEEN ANTERIOR FACTORS bave oeen made to demonstrate correlation between the vertica."'5: ..Alteration an important disturbances in the 0: 'RtjerCllCeS joint.ACFs and rCFs IS d'ctating mandibular movemeN. :\m J 0.rje mn'l' Ie ':.

however.~t demonstraleo that when ta to p:otE~ct CO-COl1traction because of simultaneous contraction of antagonis­ m groups BeW' recognized this CNS response this conditi. This clinical feature cause some confusion du Until now Iy the effect a of svmptoms has consloerecL is true when afferent Interneuron are involved.e pa i n As has in input can ind on for T io. feli 1 the that m a r e aCil spasms·' ':-hererore this condltic'i ttle ng muscles are activated while the elevator muscles Clre relaxed In the presence of in however ~. no local cause can found This is a fai situation of heac. motor One type of efferent effect hvpersensi­ the develoome:lt of a localized area called detail in are discussed i:l I"'ore Another com effere.ecel:t stud ies however. such splinter in the finger ... If the ce:ltral effect involves efferent interneurons.. tle term must be broken dOWI) nd raised or increased condition The in fact mea:-.After a Fe'.. such treatment alone cannot resolve the the co-contraction pail: must De addressed for effec've elimination of the masticat. ~ .Iter becerres quire sensitive to toucl This primary because the Irhe is present when lhere i of tissues without a local A common location for Ip Patien~s who pain will c~)mmon report that· Itle:r When .151115 r. -- sou Tris condition of Ilal cal this condition 51'. Tilis condition is not unusual and unfortu fools mallY de:ltists muscles of mastication the of the Hmvever.he is ned. and neck in different from at the sou rce of the symptoms Instead may I for some time i 12 to olockade is administered.le CNS to resoond differentlv Stohler< has .54 FUIICliolllll Anatomy be expe­ Arother type of pain sensation that rienced wlen afferent inter:.rv n'uscle Understanding rhe effect the muse! management Feat detail in later n however must use it is vltaily i usc.'! hours the tissue round the .len increased some I factm.jn is pain it can lead to muscle pain if it Protective co-contraction Imuscle i in the genera location mally lad to it 1101 I Thus felt in a reflex musclE~ ina such in muscles of mastication..') painful s~imul '-'.eurons stimulated is >c Te understand tils condi tion.. __ ~.:.

caused not by the infection but by the secondary muscle response. Chicago. variation 'cd flow will appear as reddening or blanching "" involved tissues. Responses to oral·facial noxious and nonnoxious stimuli and projections to thalamus and subnucleus oralis. the example is given to illustrate SOr:le considerations in its management A third molar is extracted. Chicago. This becomes a source of constant deep pain that. Examination reveals a limited range of "'1andibular opening. 1990. lIIanagemenl. . future directions. 4. Saunders. . Sessle B): Recent insights into brainstem mechanisms underlying craniof. Sometimes the the eye will redden Even . 2002. by way of the central excitatory effect. Dostrovsky 10. Okeson central effects involve the autonomic . Because muscle pain is an important clin­ ical problem to understand.rotective co-contraction is resolved and normal mandibu­ ?r opening will return. Lund Jr."inating the original source of pain (the osteitis) will not ~ . :-e protracted co-contraction may itself produce pain • . allergy).g . . Patients may complain of or a eye.\: Reflexes elicitable in jaw muscles and their role during jaw function and dysfunction: a review of the Iitcra­ lUre. . 3. ed 6.... a stuffy or runny :::oms may be reported -~ SOr:le patients may report a the same side as the pain CI . Hu J\V. both eyes would be red and both nostrils discha rging. Widmer CC.ich then perpetuates the protective co-contraction and ".ch has become wholly independent of the original source :: :Jain. 8. Quintessence.Fundional NeuroanatolHij and Phijsiologij of tile Masticatorij System 55 is more called mLiscle This condition can become a diagnostic problem for the clinician because the patient continues to report suffering after the nal source of pain has resolved. If the source is not quickly resolved.. 1987. Part II. Sessle IlJ: functional properties of neurons in cat trigeminal subnucleus caudalis (meJulLuy dorsal horn). . dwgrwsis. In such a case . 1991. The patient returns in 5 days complaining of the Jainful condition. the local osteitis is eliminated). 6. Central connections of oro facial afferent tlbers.Kial pain. and during the ensuing week a . produces protective co-contraction I muscle splinting) of the masseter and medial pterygoid 'T1uscle. Therefore the ciinical manifestations will be seen only on the side of the constant deep pain. De Laat .. I Neurophysiol 45: 1 73~ J 92. Artrll1 ReI' Nellrosci 6:381-418. 2005. Understanding these central basic to the management of facial pain The role that such conditions play in the diagnosis and treatment of temporomandibular disorders is discussed in detail in later chapters Suggested 'Readin!ls Hell \VE: Temporomandibular dis(1l'ders. I'd 6. 'References JP: Bell's orojaci(// pains. Stohler CS: The pajn~ adaptation model: a discussion of the relationship between 1.ocalized osteitis (dry socket) develops. 2005. Year Book MedicaL Okeson JP: Bell's oraj/Kial pains. Sessle Ill: The neurobiology of facial and demal pain: present knowledge. Donga R. characteristic manifestations will be -~~ Because the autonomic system controls the :::::n and constriction of blood vessels. Dubner R._ '2ns. Cranio 5:246-253. classiflClltioll. 1987. yet this is commonly patients and may represent to autonomic effects.elling is rarely seen in ::~rs. The key to determin whether these symp­ toms are a result of the central effect is their unilaterality Clinicians should remember that central effects do not cross the r:lid­ line in the trigeminal area. IDem Educ 66: 108-11 2. 7. 5. Bennett GJ: Spinal and trigeminal mechanisms of nociception. I. Cuyton AC: Texlboo" of mediwl physiolog)" Philadelphia. Quintessence. 2. or one nostril may be mucus and the other not If the source of the autonomic were le. ed 3. If the source of the deep pain s resolved quickly (Le. p 1013. the :. Treatment must now be directed :::ecificaily toward the masticatory muscle pain disorder. 1981. 1983. one eye will be red and the other normal."inate the muscle pain.. Chicago.. J Dent Res 66:962-981.:s:ablishes a cyclic muscle pain condition. In other words.

hich consists of a nL. v. in any muscle (e... as in the cil muscles control the lens of the eye)..d neck muscles is 'lec­ 2ssary to move the mandible .ders~anding of ~he anatomy and function of the neuromuscular the in. -:'jV on mandibular movement.:ffective :unctioning A h neu :::ont:ol system coordi nates the "ctivities of the entire rill' of nerves ~2rm l1eUrGI1Hj5CUfar 5&151011 .euror is activated a motor the motor amounts of which initiates depOlar­ causes ization of the muscle fibers. the muscle fibers to shortell or contract.g. the neuromuscL. The nJmber of muscle fibers in'lervated by one motor neuron according the fu'lc­ tlon of the motor unit.lar sys­ divided Into tViO maior comuonents ( I J the . similar variatio'l exists in the number of muscle [ibers per motor neuron v:ithin the muscles of masticaton The inferior lateral muscle has a low muscle fj ber/motor neu ron ratio: therefore it is capable the fine adlustments in length needed ANATOMY AND FUNCTION OF THE NEUROMUSCULAR SYSTEM :~'urposes of discussion.Il reviews important concepts and mechanisms are necessary to understand orofacia l the concepTS in these three sections should enhance the clinicians abll to understand a ~~en. t he more the move­ motor neuron may innervate only ment. Each neuron with the muscle fiber at When the r.es.mber of mUSCle fibers that are innervated ore motor neuron.lar system The ~::::ond describes the basic aclvities of 3stication. With a'l understand­ ing of these components.. 25 ~!ili 'i :'" .fjuence stem is essential to -:lat tooth contacts as \'1ell as other conditions. The anatomy and function of each of components is reviewed in many instances It difficult to separate function.·· treat [wiess ~IOU -JPO system is Discr:minatory contraction of the various head an. swal and The third . This chaoter divided into :hree The :st section reviews In detail the basic ~'-d fU'lction of the neuromusCl. /\ two or three rnuscle fibers.. basic neuromuscula r func­ tion can be revie\ved MUSCLES Motor Ullit The of the neuromuscular system is the rroto r unit. T he function of the neurologic structures and 12) the musc. one motor neuron may innervate ~Ull­ dreds of muscle fibers.. the rectus femoris in the l.A basic un.t's comolaint and orov:de effective . The fewer the muscle fibers per motor 'leu ron.Functional Neuroanatomy and Physiology of the Masticatory System "You wl1not wldfrsta ml functioll.

thereby coor­ ::i. and it is also the -~~ most responsible for one's abil to ~ -. These drives are not generaly perceived at a conscious level but more as a basic nstinct The instinct will certain behaviors to a conscious level For when an individual chronic pain behavior xiiI be oriented toward withdrawal from any stimu­ us that may increase the pain.~er • -"domi of gray matter.Functional NeuroanatolllY mid PflysioloflY of the Masticatory System 31 The limbic structures function to control our emotional and behavioral activities.'ating the conscious cerebral behavioral func­ -ons with the subconscious behavioral functions : the deeper limbic system from the limbic system leading into can anyone or all of the ~-any internal bodily functions controlled by the Impulses from the limbic system into the midbrain and meduila can control ~ch behavior as wakefulness. If one were to again compare the human brain with a computer. the individual driven side toward behaviors that stimulate the of the center. As in other areas of the body. excitement o.ide thinking without simultaneous action of c'::per structures of the brain The cerebral cortex . such as visual and auditory areas. and some al the way to the cord Different regions of the cerebral cortex have been identified to have different functions A motor area is primarily involved with motor function. are also found. Some receptors are specific for discomfort and pain These are called Other receptors provide infor­ mation regarding the position and movement of the mandible and associated oral structures. one can quickly understand the _. In most areas the cerebral cortex is about 6 mm th and all it contains an estimated 50 to 80 billion nerve cell bodies Perhaps a biilion nerve fioers lead away from the cortex. Researchers still do not know basic mechanisms which the -c'Jral cortex stores either memories or . on an instinctive level. Once one should remember that the thalamus keyboard) is the necessary unit that calls the cortex to function Sensory Receptors are neurologlC structures or organs located in all tissues that proVide information to the CNS way of the afferent neurons the status of these tissues. Iimbic function. These are called that carry informa­ tion regarding the status of the internal organs are referred to as Constant input received from all of these receptors allows the cortex and brainstem to coordinate action of individual muscles or muscle groups to create appropriate response in the individual s. With this basic understanding . :Jain problems. _. or center apparently exists. muscle tissues (21 the located in the tendons: (3) the pacinian corpuscles 11­ . _. The cerebral cortex represents the of the cerebrum and is made up . Areas for I senses. as well as numbers into it.·-e portion of the brain in which all _ne's memories are stored.-. The limbic structures also control fear. various types of sensory receptors are located the tissues that make up the masticatory system Specialized sen­ sory receptors information to the afferent neurons and thus back to the CNS. oact it can have on the overall function of the indi­ a major role ::Jal. to other areas of the cortex.:J attentiveness. to and from deeper struc­ tures of the brain. The cerebral cortex is -" portion of the brain most associated the process.ill withdraw from life itself.'. Often the sufferer . as discussed in later chapters Cortex. and mood alterations 3uch as depression will occur. Jscle skills.. It is believed that of the limbic structures interact and associations with the cortex. the masticatory system uses Like other four malor types of sensory receptors to mon:tor the status of its structures ( 1) the muscle which are receptor organs found in the tendon organs. the cerebral cortex wou:d represent the hard disc drive that stores all information of memory and motor function. The limbic system certainly .' muscle skills. even though it cannot . A sensory area receives somatosensory input for evaluation. Within the limbic structures are centers or nuclei that are for speci fic behaviors such as anger.

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