Occlusion for the class III jaw relations patient

Wilbur 0. Jensen, D.D.S.*

University of Southern California, School of Dentistry, Los Angeles,Calif.

The class III jaw relations patient possesses challenging changes in occlusal
patterns. The interocclusal distance, evelope of motion, chewing stroke, tooth-
to-tooth relations, and the determinants of occlusion vary from the criteria
established for the class I or class II occlusions. The lack of anterior guidance and
the added width and length of the mandible have a significant effect on occlusal
morphology. Several stable forms of occlusal relationships can be found at one time
in the same dentition. The occlusal morphology is dictated by the condylar move-
ments and mandibular size. The balancing cusps must provide the proprioceptive
guidance for the chewing cycle. One half to 1 mm, rest interocclusal distance is
adequate to allow the teeth to separate in speech and function. (J PROSTHETDENT
1990;64:566-8.)

T he patient exhibiting a mandibular macrognathic
jaw relationship possesseschallenging changes in occlusal
patterns from the criteria established for patients with
class I jaw re1ationship.l The large size of the mandible
creates a unique occlusal design. The interocclusal dis-
tance, envelope of motion, chewing stroke, tooth-to-tooth
relations and the determinants of occlusion vary from the
criteria outlined for class I or class II occlusions. The lack
of anterior guidance has a significant effect on the occlusal
scheme as does condylar function in conjunction with the
articular eminence and the disparity in jaw size relative to
cusp height, tooth placement, and chewing cycle.2
CENTRIC OCCLUSION (MAXIMUM
INTERCUSPAL POSITION)
Centric occlusal contacts do not follow a definite pattern
in the macrognathic patient. Each patient has a different
pattern of centric occlusal contacts depending upon the
relative size of the mandible. In most cases,both the ante-
rior teeth and posterior teeth display simultaneous centric
contacts. The posterior contacts can vary greatly from a
cusp-fossa relationship to a cusp tip-to-cusp tip and, in
some cases, a complete crossbite. All of these tooth rela-
tionships may be present in the same dentition, providing
a unique contact pattern. Tooth-to-tooth closure patterns
vary according to the size of the mandible. The mandibu-
lar first molar may occlude with the maxillary second and
first premolars. Mandibular length can also produce an
anterior crossbite relationship where the maxillary anterior
teeth are overlapped by the mandibular anterior teeth.
WORKING-SIDE MOVEMENT
The incisor teeth in an end-to-end, or beyond, relation-
ship are almost free of working contacts. If any occur, they
*AssociateClinical Professor,Continuing Education.
10/l/20625
are seen at the beginning of the stroke and are of short du-
ration. This anterior relationship provides no discluding
abilities for the canines or anterior teeth. The articular
eminence, jaw size, and the posterior teeth become the
guiding factors.
The major working contacts are found on the posterior
teeth. They occur in variable patterns and are difficult to
describe in terms of the usual occlusal philosophies. With
the lack of anterior guidance, this occlusion is a type of
group function that has no discluding ability from the ca-
nines or incisors. It is, therefore, a component of bilateral
balanced occlusion.
Definite working facets are observed and can be
measured.3 The class III patient has a more limited func-
tional range than the class I or class II patient, but a range
of function does exist and must be allowed for when con-
templating restorative dentistry or equilibration.
BALANCING-SIDE MOVEMENT
The posterior teeth show balancing wear facets, partic-
ularly on the second and third molars. Because of the longer
arch, the balancing contacts increase in duration and
intensity the more posterior the tooth. Each of the poste-
rior quadrants show balancing contacts.
The lack of guidance generally provided by the anterior
teeth leaves the remainder of the determinants of occlusion
to be provided by the temporomandibular joints, relative
jaw size, and tooth-to-tooth relationships. This combina-
tion of joint guidance with no canine or anterior disocclu-
sion, and resulting flatter curve of Spee, does not provide
the ability for group function disocclusion, and dictates a
functional balancing-side contact during lateral move-
ment. The occlusal contacts start at centric closure and re-
main heavy during the entire balancing movement. This
movement differs from the balance of the class II relation-
ship in that it appears to be more intense, broader, and
rides higher on the balancing cusp.
A naturally developed balanced occlusion is observed

NOVEMBER 1960 VOLUME 04 NUMBER 6

C!LASS III JAW RELATIONS
CLASS I CLASS
Fig. 1. I, Hinge axis; II, terminal hinge opening; III, maximum opening; h, habitual
opening; x, physiologic rest postion; p, maximum protrusion.
often in the macrognathic mandible. Balancing contacts
are physiologic for this jaw relationship and should not be
disturbed during equilibration or restoration of occlusion.
Arbitrary removal of balancing contacts to fit a formula of-
ten causes discomfort, rotational pressures, and increased
stress on the periodontal apparatus.
PROTRUSIVE MOVEMENT
It is generally taught that class III patients do not func-
tion in the protrusive range. Protrusive movement may not
involve the front teeth, and the patient may incise on an
open and close movement. In addition, incising may occur
on a chewing or grinding stroke. Protrusive faceting is ob-
served on the posterior teeth in almost all class III patients.
The wear facets are not long but are present, with the mo-
lar teeth showing the most distinct facets. Mandibular
macrognathic patients have a short protrusive stroke, and
occlusion is improved if incorporated into posterior resto-
rations and appliances.
THE JOURNAL OF PROSTEETIC DENTISTRY
I-Amm
-I
\
20f mm
irh
\
III
ENVELOPE OF MOTION
The envelope of motion, as established by Posselt,4 is
different from the class I jaw or class II jaw relationships
(Fig. 1).The protrusive movement is smaller; the maximum
opening is greater because of the length of the mandible;
the arc of hinge opening is greater because of the jaw size;
the interocclusal rest space is less. A slide from centric re-
lation to maximum intercuspal position is variable. The
envelope of motion includes a smaller protrusive move-
ment, longer maximal opening, and reduced interocclusal
rest dimension.
VERTICAL DIMENSION
When the anterior teeth are in an end-to-end occlusion,
the mandible is not required to move forward for speech or
to incise. The condyles, therefore, have limited movement
down the eminence during function, and little space is
needed to clear occlusal contacts. Vertical clearance of 0.5
to 1 mm is adequate interocclusal rest space in macro-
567

gnathic jaw relations, compared with the 2.5 mm in the
class I, and the 3 to 5 mm in the class II relationships.
OCCLUSALMORPHOLOGYOFTHE
POSTERIOR TEETH
The added width and length of the mandible and the lack
of anterior guidance from the anterior teeth have a signif-
icant effect on occlusal morphology:
1. Centric closure and lateral movements or “orbiting”
movements become dominant movements in establishing
occlusion.
2. Orbiting movements determine balancing cusp height,
fossa width, and escape groove location.
3. The tooth-to-tooth contact in centric closure is for-
ward from the normal pattern and varies with jaw size.
4. Arc of movement is longer and the escape grooves are
located farther mesially on the mandibular teeth.
5. There is no limiting action from the anterior determi-
nants. Jaw movements should be accurately recorded and
reproduced in the restored occlusal scheme.
6. The balanced occlusion is shallower and has longer
balancing contacts on the molars. It is a definite balanced
occlusion. Balance should be used to provide the necessary
guidance in crossbite occlusions.
SUMMARY
A class III mandible exhibits stable forms of occlusal re-
lationships. Cusp-fossa, cusp-marginal ridge, cusp tip-
to-cusp tip, and crossbite tooth relations may all be found
568
JENSEN
at one time in the same dentition. Each can be stable or
corrected to a stable occlusion. The lack of anterior guid-
ance creates major changes. No protection is given by the
anterior teeth to the posterior occlusion. The occlusal
morphology is dictated by the condylar movements and
mandibular size. Accurate interarch recordings are impor-
tant to reproduce the extent of the condylar movement.
Balanced occlusion is dictated by lack of function of ante-
rior determinants. Balancing cusps must provide the pro-
prioceptive guidance for the chewing cycle and crossarch
balance for patient comfort. One half to 1 mm interocclusal
rest distance is adequate to allow the teeth to separate in
speech and chewing. The macrognathic occlusion may be a
stable and comfortable occlusion.
I acknowledgethe valuable assistanceand recommendationsof
Dr. R. Bruce Coye.
REFERENCES
1. Huffman RW, Regonos JW. Principles of occlusion-laboratory and
teaching manual. London, Ohio: H&R Press, 1973.
2. Ingraham R. Physiology of occlusion. Los Angeles: University of South-
ern California, 1972.
3. Waliszewski KJ. A study and classification of centric and eccentric tooth
contacts in patients with Angles’ class II and class III molar relation-
ships. M.S. thesis. Milwaukee, Wis: Marquette University, 1974.
4. Posselt U. Physiology of occlusion. Philadelphia: FA Davis Co, 1962.
Reprint requests to:
DR. WILBUR 0. JENSEN
1441 AVXADO AVE., STE. 508
NEWPORT BEACH, CA 92660
NOVEMBER 1990 VOLUME 84 NUMBER 5