The occlusal plane ‘The configuration of the occlusal plane is one of the most beautiful examples of design that can be found in nature. The conformity to that design by the other parts of the mastica tory system is so subtle it is often missed. But the logic of these interrelationships is impor- tant to understand because even slight varia- tions from this intended configuration can lead to unexplained occlusal instability. The irritat- ing reductions in comfort or function that bother the patient and frustrate the dentist are often related to unnoticed occlusal plane prob- ems. Because of the importance of the occlusal plane to the total harmony of the masticatory system, I have elected to divide the discussion into two separated chapters. This chapter de- scribes the design and purpose of the plane so that its relevance can be coordinated with other aspects of masticatory system function. I will then discuss the diagnosis and treatment of occlusal plane variations in a separate chap- ter so that it can relate better to the particular sequencing of occlusal treatment. The plane of occlusion refers to an imagi- nary surface that theoretically touches the in- cisal edges of the incisors and the tips of the occluding surfaces of the posterior teeth, Be- cause the term “plane” refers geometrically to a flat surface, it is not entirely correct to de- scribe the occlusal surface as following a true plane. Instead of a flat surface, the plane of oc- clusion represents the average curvature of the occlusal surface. Despite the problem of se- mantics, it is probably the most practical way of relating the occlusal surfaces of the teeth to fone another and to other structures of the head. Each curvature of the plane is related to specific effects it should produce. Its accept ability should be analyzed on that functional basis rather than on its conformity to a set ideal ‘The curvatures of the anterior tecth are de- termined by establishment of the esthe correct smile line on the upper and the rela- tionship of the lower incisal edges to the ante- rior guidance and the requirements for pho- netics, These factors are covered in Chapter ‘The curvatures of the posterior plane of oc- clusion are divided into (1) an anteroposterior curve called the curve of Spee (Fig. 7-1) and (2) a mediolateral curve, referred to as the curve of Wilson (Fig, 7-2). ‘Together, the composite of the curve of Spee, the curve of Wilson, and the curve of the incisal edges is properly referred to as the curve of occlusion. Popular usage combines both the curve of occlusion and its relation ship to the cranium into the plane of occlu sion (Fig, 7-3). I will discuss cach aspect of it individually. CURVE OF SPEE The curve of Spee refers to the anteroposte- rior curvature of the occlusal surfaces, begin ning at the tip of the lower cuspid and follow: ing the buccal cusp tips of the bicuspids and 8586 Evaluation, diagnosis jsal problems, Fig. 7-1. The curve of Spee begins at the top of the cuspid and touches the tips of the cusp tips of all the posterior teeth, - 7-2. The curve of Wilson is the mediolateral curve that contacts the buccal and lingual cusp tips on each side of the arch, molars and continuing to the anterior border of the ramus. If the curved line continued fur- ther back, it would ideally follow an arc through the condyle (Fig. 7-4). The curvature of the arc would relate, on average, to part of a circle with a 4-inch radius. ‘There is a purpose behind the curve of Spee design as well as its location in relation to the condyle. The curve results from variations in axial alignment of the lower teeth. To align each tooth for maximum resistance to func: tional loading, the long axis of each lower tooth is aligned nearly parallel to its individual arc of closure around the condylar axis (Fig. 7. 5). This requires the last molar to be tilted for: ward at the greatest angle and the forward tooth to be at the least angle. This progression positions the cusp tips on a curve that is di- Fig. 7-3. The curve of ocelusion combines a composite of the curve of Spec, the curve of Wilson, and the curve of the incisal cdges. It is more often called the plane of 0c clusion when it is related to the cranium, rectly related to the condylar axis by a pro- gressive series of tangents. The relationship of the curve of occlusion to the condylar axis also relates to the condy- lar path in protrusion. If the occlusal plane is on an arc that passes through the condyle, the posterior part of the occlusal plane will always, be flat enough and low enough to be discluded by the normal condylar path on its steeper em- inentia (Fig. 7-6). Thus even with a flat zero- degree anterior guidance in protrusion the oc- clusal plane on the lower will be discluded by the forward movement of the condyle that is directed downward at an angle that is steeper than the posterior part of the occlusal plane. It is because of this geometric design that the 4-inch radius of the Monson curve works so effectively if the condyle is used for sur-The occlusal plane 87 Fig. 7-4. An ideal curve of Spee is ai ‘would extend through the cond erage with a 4-inch radius igned so that a continuation of its are ivles. The curvature of this arc relates on av- Fig. 7-5. The curve of Spee results, in part, from aligning cach lower tooth parallel t0 its are of closure. This re- ‘uires the last molar to be inclinded at the greatest angle88 Evaluation, diagnosis, and treatment of occlusal problems point, as it is in the PMS technique de- scribed in Chapter 14. The anteroposterior curvature of the oc- clusal plane is designed to permit protrusive disclusion of the posterior teeth by the combi- nation of anterior guidance and condylar guid- ance. The separation of posterior teeth during excursive contact of the anterior teeth results in more efficient incisive function as the ante- rior teeth slide past cach other to the over- lapped relationship that makes the shearing ac- tion possible. ‘To separate the posterior teeth for better in- cisive function during protrusive excursions, all forces of the elevator muscles must be loaded entirely onto the condyle and the ante- rior teeth. This results in a strong horizontal component against the upper anterior teeth, since all the contacts are against their lingual surfaces. To protect the anterior teeth from be- ing overloaded, an ingeniously designed sensor system shuts off most of the elevator muscle activity at the precise moment of complete posterior disclusion. This reduction of pres- sure against the anterior teeth depends on a correct occlusal plane because if there is am interfering tooth contact posterior to the ca- nines during excursions the elevator muscles are triggered into hypercontraction. This prevention of increased muscle loading ‘on the teeth and the joints is the dominant rea- son for making certain the occlusal plane is correctly evaluated as a part of every complete examination. If it does not permit the anterior guidance to separate the posterior teeth in ex- cursive movements, there is a real possibility of eventual damage to the teeth, the joints, and, the periodontal structure. CURVE OF WILSON The curve of Wilson is the mediolateral curve that contacts the buccal and lingual cusp tips on each side of the arch. It results from in- ard inclination of the lower posterior teeth, making the lingual cusps lower than the buccal cusps on the mandibular arch; the buccal cusps are higher than the lingual cusps on the maxillary arch because of the outward inclis tion of the upper posterior teeth. There are two reasons for this inclination of posterior teeth. One has to do with resistance to loading, and the second has to do with mas- ticatory function. If the buccolingual inclination of the poste- rior teeth is analyzed in relation to the domi- nant direction of muscle force against them, it will be apparent that the axial alignment of all posterior teeth is nearly parallel with the strong inward pull of the internal pterygoid muscles (Fig, 7-7). The strongest component of lateral function occurs from the outside in, nearly parallel with the direction of the inter- nal pterygoid muscles, which bilaterally pull the condyles medially to the midmost position of centric relation. Aligning both upper and lower posterior teeth with the principle direc- tion of muscle contraction produces the great- est resistance to masticatory forces and creates the inclinations that form the cur (Fig. 7-8) Fig. 7-7. The principal loading force against the posterior teeth occurs during outside inward chewing stroke. The Posterior teeth are thus aligned parallel to the internal pterygoid muscles for optimum resistance to that func- tional stress.There is another reason for the curve of Wilson that relates it definitively to mastica- tory function. Because the tongue and the buc- cinator complex must repetitively place each bite of food onto the occlusal surfaces for mas- tication, there must be easy access for the food to get to the occlusal table, The inward inclina- tion of the lower occlusal table is designed for direct access from the lingual, with no block- age by lower lingual cusps (Fig, 7-9). ‘The outward inclination of the upper oc- clusal table provides access from the buccal for the food to be tossed directly onto the oc- clusal table by the action of the bands of the buccinator muscle (Fig. 7-10). The longer lin- gual cusps of the upper posterior teeth serve as a batlle for food tossed on from the buccal; and the lower buccal cusp serves the same purpose for food tossed on by the tongue. When the curve of Wilson is made too flat, ‘ease of masticatory function may be impaired because of increased activity required to get the food onto the occlusal table. The greater the relative height of the lower lingual cusps, the greater the problem of chewing efficiency may become. Unless the problem is under- stood, it is easily missed because patient com- plaints do not pinpoint the problem. ‘The inclination of the posterior teeth coor- dinates their masticatory function with the necessary function of the tongue and cheeks to put the food where it can be chewed. This co- ordination of functional design creates a need for further design coordination in the articula- tion of the jaw joints. The upper lingual cusps would be in jeopardy of great horizontal stress from the lower buccal cusps if the lower teeth are permitted to move horizontally toward the midline. The articulation of the medial pole of the condyle is designed to prevent that from happening. The same configuration of the fos- sae that brace the condyle-disk assemblies in the midmost position also prevent them from traveling medially without first moving down- ward (Fig. 7-11). In short, the lower posterior teeth must travel down before they can shift medially. This important aspect of design makes it possible to have a curve of Wilson without creating balancing incline interfer- ences. ‘The concept of an immediate side shift, which allows the condyles to translate hori- zontally before any rotation occurs, was a pop- ‘The occlusal plane 89 Fig. 7-8. Alignment of the posterior teeth to parallel the direction of loading from the internal pterygoid muscles results in the curve of Wilson. Fig. 7-9. The lingual inclination of the lower poste teeth positions the lingual cusps lower than the buc ‘cusps. This design permits easy access to the occlusal ta bile. As the tongue lays the food on the occlusal surfaces, it is stopped from going past the chewing position by the taller buceal cus90 Evaluation, diagnosis, and treatment of occlusal problems Fig. 7-10. The outer inctination of the upper teeth positions the buccal cusp higher for easier access from the buceal corridor. The action of the lower band of the buccinator squeezes the bolus up, A, where it can then be pressed on ro the food table by the middle band. B, The longer lingual cusp stops it On the occlusal surface. Fig. 7-11. ‘The design of the funetional curve of Wilson would not work if the lower posterior teeth could travel horizontally toward the midline because the longer lower buceal cusps would clash with the longer upper lingual cusps. The medial pole bony stop prevents any’ side shift until after the condyle thas moved down the cminentia and permits the curve of Wilson design to function without interfer cence. This necessary functional relationship of the joints is also responsible for the solid “midmost” po sition in centric relation. It also explains why the concept of an immediate side shift is wrong,ular notion, but it cannot occur in a healthy joint if the condyles are in centric relation at the start of motion. If it could occur, the curve ‘of Wilson would result in balancing incline in- terferences. The only way this can occur is if there is severe alteration of the shape of the ar- ticulating surfaces. It would be very unlikely to have flattening of the condyle and eminence without similar adaptation of the curve of Wilson. The effect of such changes in the joints is seen in the flat- tening of the curve of Wilson by wearing away of the upper lingual cusps. This type of wear ¢annot occur in a correct occlusal plane with normal, healthy temporomandibular joints. ‘The presence of severe wear on upper lingual cusps should alert the diagnostician to adap- tive changes in the articular surfaces of the joint, The occlusal plane is a marvelous example of the interplay between form and function, Analysis of the occlusal plane should be impor- tant to any dental examination because of its ‘importance to coordinated function of the en- tire masticatory system. Adaptive changes in the occlusal plane are signals of possible dys function somewhere in the system. SUMMARY ‘The form of the occlusal plane is directly re- lated to specific functional requirements. In ad- “dition to alignment of teeth in relationship to the arc of closure for best resistance to load- ing, it should permit ease of access for posi- tioning of the food on the occlusal surfaces. If these two functional requirements are met, an ‘occlusal plane is acceptable if it permits the anterior guidance to do its job. The relationship of the occlusal plane to skeletal points and planes is described in Chap- ter 38. ‘The relationship of the anterior teeth to the ‘occlusal plane is described in Chapter 17. Methods for determining the occlusal plane are discussed in Chapter 20. ‘The methods for mounting casts in relation to a correct occlusal plane are discussed in Chapter 13. All the above references are important to a full understanding of evaluation, diagnosis, and treatment of occlusal plane problems. 1 SUGGESTED READINGS Boucher, D.O.: Current status of prosthodonties, J. Pros: thet, Dent. 10:418, 1960. Mann, AW., and Pankey, LD. Use of the Pankey-Mann in strument in treatment planning and in restoring dhe lower posterior teeth, J. Prosthet. Dent. 10:135, 1980. Monson, GS: Applied mechanics to the theory of mandib: ular movements, Dent. Cosmos 74:1039, 1932, Spee, F.G.: Prosthetic dentistry, ed. 4, Chicago, 1928, Med- ental Publishing Co, Wilson, GL: Dental prosthetics, Philadelphi: Febiger. 1917, Lea &