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EQUILIBRATION
PRESENTED BY:
DR. KELLY NORTON
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INTRODUCTION
HOW TO RECOGNIZE A STABLE OCCLUSION REGARDLESS OF WHAT IT LOOKS LIKE
• 1. Stable stops on all teeth when the condyles are in centric
relation
• 2. Anterior guidance in harmony with the border movement
of the envelope of function
• 3. Disclusion of all posterior teeth in protrusive movements 2
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• OCCLUSAL EQUILIBRATION: The modification of the occlusal form of the
teeth with the intent of equalizing occlusal stress, producing
simultaneous occlusal contacts or harmonizing cuspal relations. ( GPT 9)
form. ( GPT- 9)
PRINCIPLES
1. Don’t equilibrate if the outcome is in doubt.
2. A successful outcome can be determined in advance.
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INDICATIONS
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Predicting the Outcome of Selective Grinding
• “RULE OF THIRDS”
• It deals with the buccolingual arch discrepancy when the condyles are in the
musculoskeletally stable position.
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• Anteroposterior discrepancy:
Visualize the centric relation–
to–intercuspal position (CR-
to-ICP) slide.
• The shorter the slide, the
more likely it is that selective
grinding can be accomplished 8
Anteroposterior direction of the slide.
within the confines of the A, when the cusps are relatively tall (sharp), the direction
enamel. of the CR-to-ICP slide is predominantly vertical.
• Generally an anterior slide of B, when the cusps are relatively flat, the CR-to-ICP slide
less than 2 mm can be has a greater horizontal component.
successfully eliminated by a
selective grinding procedure.
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ARMAMENTARIUM FOR OCCLUSAL
EQUILIBRATION
• Small diamond wheel stone and a 12-sided football-shaped finishing bur
work well for precise reduction and reshaping.
• Red and black marking ribbons are held in Miller ribbon holders.
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• EQUILIBRATION PROCEDURES CAN BE DIVIDED INTO FOUR PARTS:
• 1. Reduction of all contacting tooth surfaces that interfere with the completely
seated condylar position (centric relation)
• 2. Selective reduction of tooth structure that interferes with lateral excursions.
This will vary as the influence of the anterior guidance varies to accommodate to
individual chewing cycles. It will also vary, as necessary, to minimize lateral 10
stresses on weak teeth.
• 3. Elimination of all posterior tooth structure that interferes with protrusive
excursions. This must be varied in arch-to-arch relationships in which the
anterior teeth are not in a position to disclude the posterior teeth in protrusion.
• 4. Harmonization of the anterior guidance. It is most often necessary to do this
in conjunction with the correction of lateral and protrusive interferences
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GRINDING RULES
• Rule 4: Eliminate all posterior incline contacts. Preserve cusp tips only.
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Eliminating Interferences to Centric Relation
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Interference to the arc of closure
• As the condyles rotate on their centric
relation axis, each lower tooth follows an
arc of closure.
• Any interference with this closing arc -
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displacing the condyles down and forward
to achieve maximal intercuspation at the
most closed occlusal position.
• Primary interferences that deviate the
condyle forward produce what is
commonly called an anterior slide.
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Anterosuperior And Right Slide
The inclines on the right side that cause a right shift
of the mandible are the inner inclines of the
maxillary lingual cusps against the inner inclines of
the mandibular buccal cusps
(mediotrusive CR interferences)
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The inclines located on the left side that cause a right
shift of the mandible are either
the inner inclines of the maxillary buccal cusps against
the outer inclines of the mandibular buccal cusps or
the outer inclines of the maxillary lingual cusps against
the inner inclines of the mandibular lingual cusps
35 (laterotrusive CR interferences
Anterosuperior And Left Slide
16
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Interference to the line of closure
• Line of closure interferences refer to primary interferences that cause the mandible to
deviate to the left or the right from the first point of contact in centric relation to the most
closed position
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ACHIEVING THE CENTRIC CONTACT POSITION
One or both of the contacts will be on an incline, either the mesial and distal inclines or
the buccal and lingual inclines.
To eliminate the CR slide, these inclines must be reshaped into cusp tips or flat
surfaces.
• When a contact is
found on an incline
close to a centric cusp 18
tip, it is eliminated.
• When a contact area is
located on an incline
near the central fossa
area, the incline is
reshaped into a flat
surface.
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An acceptable CR position has been developed when:
• Equal and simultaneous contacts occur
between cusp tips and flat surfaces on all
posterior teeth.
• When the mandible is guided to CR and
force is applied, no shift or slide occurs. 19
(There are no inclines to create a slide.)
• When the patient closes and taps in
centric, all the posterior teeth are felt
evenly.
• When this is accomplished, orthopedic
stability has been achieved.
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DEVELOPING AN ACCEPTABLE LATERAL AND PROTRUSIVE GUIDANCE
• 1. Acceptable laterotrusive contacts occur
between the buccal cusps and not the lingual
cusps.
• 2. During a straight protrusive movement, the The grinding
mandibular incisors pass down the lingual rule is simple:
surfaces of the maxillary incisors, disoccluding Grind all red
marks on 20
the posterior teeth.
posterior
• During any lateroprotrusive movement, the teeth.
lateral incisors can also be involved in the Do not touch
guidance. any black
• As the movement becomes more lateral, the marks.
canines begin to contribute to the guidance.
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ADJUSTING FOR LATERAL INTEREFERNCES
Ask the patient to close in CR
and visualize the relationship
of the anterior teeth.
It is recommended to clear
balancing interferences first,
then working interferences,
and finally protrusive
interferences
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ADJUSTING FOR LATERAL INTEREFERNCES
Balancing-side or non-working side interferences
on second molars are among the most commonly
missed interferences.
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ADJUSTING FOR LATERAL INTEREFERNCES
• On the working side, the canines should contact during laterotrusive
movements and disocclude all the posterior teeth (canine guidance).
• When the canines are not positioned such that they can immediately provide
laterotrusive guidance, a group function guidance - the mandible is laterally
guided by the premolars and mesiobuccal cusps of the first molars.
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A, During a left lateral
movement, the canine contacts
provide canine guidance.
B, Once the mandibular canine
passes beyond the maxillary
canine, the anterior teeth
should contact. This is called
the crossover.
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ADJUSTING FOR LATERAL INTEREFERNCES
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ADJUSTING FOR PROTRUSIVE INTEREFERNCES
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PROCEDURE FOR CANINE GUIDANCE
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• The desirable contacts are the laterotrusive on the buccal cusps of the premolars and
the mesiobuccal cusp of the first molar.
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EVALUATION IN THE UPRIGHT HEAD-POSITION
(Alert Feeding Position)
• To determine whether a postural change in the
mandibular position has occurred that will
cause anterior tooth contacts to be heavier
than posterior tooth contacts
• If the posterior teeth are contacting 28
predominantly, minimal postural change has
occurred and the selective grinding procedure
is complete.
• If, however, the anterior teeth are contacting
heavily or both anterior and posterior teeth are
contacting evenly, a final adjustment in the
alert feeding position is necessary.
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Influence of Functional Head Postures on the Dynamic
Functional Occlusal Parameters
Haralur SB, Al-Gadhaan SM, Al-Qahtani AS, Mossa A, Al-Shehri WA, Addas MK. Influence of functional head postures on the
dynamic functional occlusal parameters. Annals of medical and health sciences research. 2014;4(4):562-6.
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VERIFICATION OF COMPLETION
Clench Test Anterior Deprogramming Splint
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COMPUTER-ASSISTED DYNAMIC OCCLUSAL
ANALYSIS
T-scanR II system from Tekscan
(Boston, MA) uses a sensor unit
that records occlusal contacts
on a thin Mylar film and relays
the information to a computer. 31
Aim: To assess the reproducibility of the mandibular arc of closure in various types of
articulators using the T-Scan III system.
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Balos MD, Soaita C, Cerghizan D, Popsor S. A study on the mandibular arc of closure reproducibility using the T-Scan III
computerized occlusal analysis system. Procedia Technology. 2015 Jan 1;19:916-20.
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Results:
• The first occlusal contact in mouth is
close to those observed in the non-
arcon articulator.
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SUMMARY