J Ind Orthod Soc 2005 ; 38:80-90

CLINICAL Functional Occlusion in Orthodontics

Dr Puneet Batra
MDS , M orth RCS (Edinburgh), DNB , PGDHM , PGDMLS , FPFA
Seni or Res id ent,
Di v ision of Orthodontics, Department of Dental Surge ry
A ll Indi a In stitute of M edi ca l Sc iences, New Delhi .

Dr Ritu Duggal
MDS , FIMSA, FPFA
Assoc iate Professo r,
Division of O rth odo nti cs, Departm ent of Dental Surge ry
A ll Indi a Inst itute of M edi ca l Sciences, New Delhi .

Dr Hari Parkash
MDS, FIMFT, FI CO, MNAMS,FACD
Professo r and Head
Departm ent of D ental Surge ry
All Indi a In stitute of M edi ca l Sc iences, New Delhi .

Abstract Orthodonti c treatment has the capacity to change static and functional occlusal relationship
fundamentally. The aim of this article is to discuss the goa ls of an ideal functional occlusion
as well as how teeth react after the orthodontic appliances are removed. We wish to discuss
th e evidence in literature about RCP and ICP co inciding and the various occlusal schemes
that we could consider after orthodontic treatment. Th e role of interference in occlusion after
orthodontic treatment leading to relapse as well as occlusal equilibration is discussed. We
also present a case in which the steps for debonding as advocated by Roth are illustrated .

Keywords Functional occlusion, Retruded cuspal position, Intercuspal position.

The features that constitute an ideal functional
occlusion have not been co nclusively established.
Orthodontic treatment has the capac ity to change static
and functional occlusal relationship fundamentalil.
It is generally assumed that an ideal static occlusal
relationship is compatible with an ideal functional
occlusion, but this is not necessarily so. The post
treatment maintenance of a healthy stomatognathic
system and attainment of the stability of the post-
orthodonti c treatment resu Its are no small tasks to be
taken lightly.
Criteria for an ideal Functional Occlusion
(as advocated by Roth) 2-6:
1) Teeth should reach maximum intercuspation with
the mandible centered to the cranium so that the
condyles are seated in the superior most relationship
that is c linically attainable.
2) Upon closure into occlusion the stress upon the
posterior teeth should be directed as nearly as
possible down the long axis of the posterior teeth
so that the resultant stresses are transmitted as
tension to the periodontal ligament and th e lamina
dura.
3) Th e posterior teeth should co ntact equally and
even ly upon closure into the occlusion with no actual
co ntact of the anterior teeth (clearance .005 inch)
to avoid lateral stresses on the anterior teeth and
supporting structures, while the mandibl e is in the
ideal condyle fossa relationship.
4) There should be minimum overjet and overbite, but
effective overbite so that upon movements in any
direction out of full occlusion, 'the anterior teeth
act as a group with the cuspids as the main guiding
inclines to gently but immediately disengage or
disocclude the posterior teeth. The lift or guidance
of the anterior teeth should be in harmony with the
movement pattern that is dictated by the
temporomandibular joint so that minimal lateral
stresses can be applied to the anterior teeth during
mandibular movement.
5) The pattern of occlusion or occlusal scheme with
rega rds cusp height, fossa depth, ridge and groove
direction and cusp placement should be as nearly
as possible in total harmony with the characteristics

80
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of th e fu ll exte nt of mandibular movements in all
directio ns. This will provide the minim al amount
of interference of the teeth w ith the possible
movement patterns of the mandible as dictated by
the temporomandibul ar jo ints.
Occlusal harmony and post treatment tooth
movement
Overcorrecting of certa in aspects is required because
of th e physiological rebound phenomenon 2,),6 . What
needs to be co nsidered are a variety of possible causes
of re lapse due to inadequate detailing of the tooth
pos itions resulting fro m the untoward occ lu sa l forces
that tend to move teeth from their treated positions.
Specific areas requiring overcorrecting
are 7 - 12
1) Comp lete leve ling to the flat curve of Spee
2) Slight upri ghting of the mandibul ar teeth in the
buccal segments with a hi nt of dista l rotation of the
mandibular first premolars
3) Overcorrected torque of the max ill ary anteri ors
4) Sli ght overcorrecting of lingual crow n torque of the
max ill ary molars
5) Overco rrecting of the antero-posterior relationship
of the upp er to lower teeth towards C l ass III
relationship of the buccal segments and an edge to
edge relationship of the anteriors.
This encourages the settling of teeth into centric
relation . Accord ing to Roth, o rth odonti sts tend to think
of treating to ce ntri c relation o nly in terms of antero
posterio r ove rcorrect ing5 . However if the buccolingual
crow n torque of the mo lars is inco rrect, or if arc h width
and forms not coord in ated, a centri c discrepancy may
occur.
Common areas of centric prematurities in
post treatment orthodontic cases are 4 :
a) the buccal cusps of the mandibul ar first or second
bicuspid with th e mes ial inn er in c lin e of the
lingual cusp of the m ax ill ary first o r second
bicuspid
b) Th e mesial inner in cline of th e di stobuccal cusp
of the max ill ary first mol ar with the di sta l outer
in c lin e of th e middl e buccal c u sp of the
mandibul ar first molar
c) The mesial inner incline of the mesiolingual cusp
of the maxillary first mol ar w ith th e distal inner
82
J Ind Orthod Soc 2005; 38 :80-90
in c li ne o f the middle buccal cusp of the
mandibul ar first mo lar
d) The mesia l inner incline of the maxillary second
mol ar with the distal inn er in c lin e of t he
mes iob ucca l cusp of the mandibular seco nd
mola r and
e) The lingua l su rface of the max i Il ary mesio l i ngua l
cusp of th e first and second mo lar with the distal
inn er inc line of the mes io lin gual cusp of the
mandibular first and second mo lars.
Another discrepancy most commo nl y obse rved is the
re lapse to Class II after treatment compl etion. More
ofte n than not the Class II was neve r co rrected but the
mandible o nl y postured forward during app li ance
therapy as a respo nse to contracture of the latera l
pterygoids, elast ic pull and occ lu sa l interdigitation Y •
Upon release from the app li ance the co ndyl es tend to
seat into the fossa. A simil ar situatio n occurs in ske leta l
ope n bite w here anterior up and down elastics are
u'sually empl oyed to close the anterior open bite will
result in sublu xation of the co nd yles and a fu lcrumi ng
of the mandible over the molars to occ lud e the
bicuspids and ante ri ors. In cases of facial asymmetry,
which go unrecog ni zed before treatment, and later
magnify with growth , fa ilures are usua ll y encou ntered.
Rep and ICP coincidence - Is it a rational
goal???
M ost orthodo nti c I iterature promotes the co ncept that
an id ea l treatment goa l sho uld be co in c id ence of
i ntercuspa l position and the retruded co ntact position.
As epid em iological studi es fail to find this type of
occ lu sio n in natura l dentition, the question arises that
is such a goa l acceptab le and rational. The argument
put forward is that no n-coincidence of the two positions
(lCP and RCP) is associated with temporomand ibular
disorders. H owever, the evide nce is inconclusive. Early
workers in thi s field examined the electromyograp hi c
activ ity in the muscles of mast icat io n in indiv id uals
wit h occ lu sa l interfere nces. Th e use of EMC was
ce nte red o n the co ncept th at mu scle activity during
function should be equ al bilaterally. However as no
proper description of the EMC activity in masticatory
mu sc les ex ists, th e interpretation of data from such
studies is of very limited value i ,5, 13 ,14.
Cross sectional population studies have been carri ed
o ut inconclusively to clarify the rel ationship between
occ lus al discrepancy in the RCP-ICP range and
temporomandibular di sorders . Few of the studies have

used co ntro l groups, and th e signs and sympto ms used
to desc ribe TMD remain in co nsistent and diverse .
Furthermo re th e defini tio n of and evalu ati on of occ lu sa l
di sc rep anc ies in th ese studi es lac k co nse nsus and
agreement. So o ur interpretati o n o f currentl y avail abl e
data woul d suggest th at an intercuspal pos itio n th at
does not exac tl y co i nc ide w ith th e retru ded co ntact
positi o n should be considered as no rm al. Converse ly
th ere is no ev ide nce th at th ere is any di sa dvantage to
th e pati ent of hav ing a retrud ed contact pos ition, but
trea tment need not be unduly length ened to achi eve
thi s goa l 130 17.
Occlusal schemes
Balanced Occlusion : Durin g th e entir e l ate ra l
movement, posteri o r teeth o n both th e w o rkin g and
th e no n-wo rki ng side are in co ntact. Early w o rkers in
th e fi eld of occ lu sio n assumed th at thi s ty p ~ of occ lu sa l
co nstru cti o n was necessa ry to ac hieve th e best resu Its
fo r both compl ete dentures and th e natural dentiti o n.
Prese nt day thinkin g has compl etely di smi sse d thi s
co ncept fo r resto rin g th e natural dentiti o n. Prese nt day
thinkin g has co m p letely di smi ssed thi s co ncept fo r
resto rin g the natural de ntitio n, altho ugh it is still useful
in compl ete denture co nstru cti o n I8,19.
Group Function Occlusion: During lateral movement,
the bu cca l cusps of th e posteri o r teeth o n th e w o rkin g
sid e are in co ntact. Th ere is no co ntact o n th e no n-
wo rkin g side.
Canine Protec te d Occlusion : Durin g th e lateral
excursio n co ntact occurs o nl y between th e upper and
lowe r ca nines and first premo lar o n the workin g side.
Th e th eo ry of ca nine protected occ lu sio n is attri buted
to D ' Ami c0 20 , N aga0 21and Sh aw 22 and is based o n the
im p ress i o n th at th e ca nin e too th i s the guid e to
mand ibul ar exc ursio n. Th ere are a num be r of reaso ns
w hy thi s mi ght be so:
1. Th e ca nin e has a good crow n: root rati o, capabl e
of to lerating hi gh occ lu sa l fo rces.
2. Th e ca nin e root has a greate r surface area than
adj ace nt teeth , prov idin g greater propri ocepti o n
3. Th e shape of the pa lata l surface of th e upper ca nine
i s co ncave and is sui ta bl e fo r guidin g l atera l
movements.
In th e spec ialty of resto rati ve dentistr y, w here it is
possibl e to introd uce a spec ific occl usa l sc heme durin g
occlu sa l rehabili tati o n, attempts have bee n m ade to
Batra et al
esta bli sh a rati o na l b as i s fo r c hoos in g b etw ee n
guid ance and group fun ctio n. Th e studi es o n occ lu sa l
co ntac t p att ern s durin g lat eral exc ur sio n s repo rt
co nt ra di cto ry res ults but thi s m ay reflec t th at th e
m et h o d o l og i es we re di ffe re nt 23028. Idea ll y su c h
investi gati o ns sho uld consider th e tooth contacts fro m
th e intercuspal pos iti o n throu gh th e entire range o f
fun cti o nal lateral movements, b ut thi s is difficult to
ac hi eve c lini ca ll y and too th co ntact patt ern s have
th erefore bee n record ed at vari o us stati c m andibul ar
pos iti o ns. As it is commo n to find lateral exc ursio ns
th at are initi ated by group functio n, but termin ate in
ca nin e co nt act o nl y at t he l ate ral ed ge to ed ge
pos iti o n, it is esse nti al th at investi gato rs spec ify at
w hich tooth position tooth co ntact recordin gs are made.
Inco nsistent results of occ lu sa l co ntacts have in cluded
impr e ssion m at e ri a l , occ lu sa l indi cato r wax,
arti c ul atin g p ap er, dental fl oss and direc t v i sio n.
Willi am so n a nd Lund q ui st 14 exa min ed
electro myographi ca ll y th e act iv ity of the tempo rali s
and m asseter mu sc le d urin g late ral exc ursi o ns in
indi v idu als w ith ca nine guid ance .
Th e ev idence in favo ur of o ne type of occ lu sa l sc heme
over anoth er is sca rce. Pragmati ca lly, how ever, it is
w o rth co nsidering th at a ca nine protected occ lu sio n is
fa r l ess lik e ly t o b e assoc i at ed w ith occ lu sa l
interfe rence o n th e no n wo rkin g sid e than a gro up
functi o n occ lu sio n du e to th e steepl y in clined palatal
surface of th e ca nine2so ;o .
A cusp fossa relati onshi p is preferred for centri c stability.
In a Class I occlu sio n the o nl y cusp margin al rid ge
relati o nship th at ex ists are the bu cca l cusps of th e
mandibul ar bi cuspid s w ith the adjacent marginal rid ges
of the max ill ary bicusp ids, th e mandi bul ar first b icusp id
w ith the mesial margin al ri dge of the m ax ill ary first
bi cuspid and lin gual co ncavi ty o n th e di stal of th e
m ax ill ary c uspi d and th e di sto lin gual c usp o f th e
m ax ill ary f irst m o l ar w ith t he o pp os in g adj ace nt
margin al rid ges of th e mandibul ar mo lars. Th e rest of
the ce ntri c co ntacts are cusp fossa relatio nshi ps in a
Class I occ lu sio n40(,.
A good articul atio n of all anteri o r teeth with a ge ntl e
li ft in pro tru sive helps suppo rt the retracted in c iso r
stability, beca use w ith sufficient to rq ue of th e in ciso rs
the six anteri o r teeth of th e m ax ill a w ill arti cul ate
eve nl y w ith th e six m andibul ar ante ri o rs and th e
max ill ary cusp ids w ill art icul ate w ith th e m andi bul ar
first bicuspid s. In thi s way th e stress is di stributed ove r
14 teeth w ithout interfe ring w ith the fo rwa rd mandi bul ar
83
 J L ~I ~
gli de path to any great extent. It mu st be kept in mind
th at to prov id e di socclu sio n of the posteri or teeth upo n
l ateral and p rot ru sive m ove m e nt with minimum
ove rbite of the anteri o rs, th e curve of Spee sho uld be
leve l and th e ca nt of th e occl usa l p lane di ve rge nt fro m
the slope of the eminentia. Thi s ho ld s tru e fo r both
late ral and protru sive excursio ns. In add itio n improper
to rque of the max ill ary mo lars, particul arl y th e seco nd
mo lars, is still necessa ry to elimin ate th e balancing
interfe rence. Good stress di stribu tio n is a necessity fo r
stability of th e post o rth odo nti c result4 ,5,29 ,3o .
Centric relation
The co ncept of ce ntri c relati o n seems to have shown a
paradi gm shi ft in the course o f th e ce ntury and need s
to be und erstood. In the 195 0's it was "th e most
retruded relation ship of the mandibl e to the max ill a
w hen the co ndy les are in thei r most posterior u nstrai ned
pos iti o ns in th e glenoid fossa fro m whi ch late ral
movem ents co uld be m ade, at any deg ree of j aw
se pa rati o n " . In th e 19 8 0 's " RUM " th e rea rm os t
uppermost and midmost position w as th e definiti o n of
ce ntri c. Acco rdi ng to glossa ry of prosthodon tic term s
(2001) ce ntri c re lati o n (CR) is th e max illomandibul ar
re lati o n in w hi ch th e co nd yles arti cul ate w ith th e
thinnest avasc ul ar porti o n of their respective di scs w ith
th e compl ex in th e anteri o r- superi o r position again st
th e shapes of th e arti cul ar eminences. Thi s position is
independent of tooth contact. Thi s pos iti o n is clini ca lly
di scernibl e when th e mandible is directed superi o rly
and ante ri o rl y. It is restri c ted to a purely ro t ary
movement about the transverse ho ri zo ntal ax is3 1•3B •
Occlusal interferences
Acco rdin g to Ash and Ram fjo rd 39 th e term occ lu sa l
interfe rence refers to an occlu sa l co ntact relati o nship
th at interferes in a mea ningful w ay with fun cti o n o r
parafun cti o n. A number of wo rk ers reac hed o n a
consensus on th e features of occlu sion I ikely to interfere
w ith fun ction or parafun cti o n by giving ri se to signs o r
sympto ms o f TMD. Th ese features are
• Occl usa l contacts o n th e no n work ing side
• U ni lateral co ntacts in th e retrud ed co ntact positi o n
• Lo ng slid es (g rea te r th an 1 mm ) betwe e n th e
retruded contact position and the intercuspal position
• A symm etry in th e slid e betw ee n th e retrud ed
co ntact position and th e intercuspal positi o n
Th e limitati o ns o f th ese studi es in cl ud e the lac k of
agreement amo ng autho rs o n w hi ch features co nstitute
84
J Ind Orthod Soc 2005; 38:80-90
of TMD . lack of co nsiste ncy in di agnos in g occl usa l
interfe rence and lac k of any co ntro l group s. Prese nce
o f occ lu sa l inte rfe rence is w id espread in all popul at io n
groups, and that th ere are mo re peopl e w ith no n-idea l
fun cti ona l occ lu sa l re latio nshi ps th an peop le w ith signs
and symptoms of functi o nal occl usa l di sorders, Possib le
consequences of occ lu sa l interfe rence, such as bruxism
and toothwea r and re lapse of tooth positi o n may also
occ ur so m e tim e after co mpl et io n of o rt hodo nt i c
tr eat m ent, bu t m ay nev erth e less be tri gge red by
interfe rences indu ced by orth odo nti c treatment39 -48 ,
Acco rd ing to Roth 4 o nly after chec kin g th e pati ent
int rao ra ll y, i f th e p ati e nt will not m ake g li d in g
excursio ns into protru sive and keep th e anterio r teeth
in co ntact, yo u are sure th at posteri or inte rfere nce
ex ists. A lso if pati ent ca nnot make lateral excu rs io ns
and keep th e cuspid s together o r the pati ent w i II not
readil y all ow mandibul ar m anipul ation inte rfe rence
ex ist. Individu al tooth positi o ning needs to be ga uged
so t h at th ey ca n b e m ove d to ac hi ev e an id ea l
anatom ica l and fun ctio nal goa I49 -59 •
Occlusal equilibration
Two pri nc ipl es are to be fo llow ed
1) Post treatment cases should not be equilibrated until
growth has bee n co mpl eted. Th e changes w ith
growth are likely to alter th e results o f equilibrat io n,
2) Equilibration sho uld always be don e w hen prope r
indi cation ex ists
• To elimin ate centric and excursive prematuriti es
and interfe rences in th e p rese nce of occ lu sa l
di sharmony.
• To all ev iate temporomandibul ar pain d ysfun ctio n
syndrome
• To eliminate occ lu sa l wea r
• To better di stribute stress to th e peri odo ntium in
th e prese nce of symptom ato logy of peri odo ntal
di sease
• To allevi ate sensitivty due to occlusal interfe rences
• To elimin ate j igg ling of teeth and un stable tooth
positio ns due to occlu sa l interferences
• To eliminate ce ntri c and excu rs ive interferences
pri o r to pl acement of go ld crow ns, bridges etc.
• To eliminate adapti ve tongue th rust if th e cause is
occlu sa l interfe rences
Goals of equilibration
1. To establi sh a positive one-pl ace closure in whi ch
centric relati o n and occl usio n are one and th e same

with equalized occlusal stops for all posterior centric
cusps.
2. To establish proper coupling of anterior teeth and
as ideal as possible anterior guidance for posterior
disocclusion
3. To organize the posterior occlusion so as to
harmonize ridges and groove direction with
mandibular border movements.
4. To maintain maximum cusp height
5. To remove a minimum amount of tooth material
6. To achieve stability of centric relation.
Roth technique before debonding
- A Clinical report
An 18-year-old female patient reported to our OPD with
a complaint of protrusive upper and lower lips. On
examination extraorally she presented with midface
convexity (Fig 1) and intraorally a Class I bimaxillary
protrusion (Fig 2). After routine cephalometric, facial
and model analysis it was decided to extract all first
premolars. The patient was to be treated with standard
edgewise mechanotherapy (.022 X .028) as a maximum
anchorage case. The Nance button in the upper arch
and the lingual arch in the lower arch were used as
adjuncts to conserve the anchorage. Separate canine
retraction was done after achieving the levelling,
alignment and anchorage preparartion followed by
separate incisor retraction. Once the extraction spaces
were closed torque was incorporated in the upper
archwire to compensate for the torque loss encountered
due to carryi ng out the retraction ina 021 X .025 wi re
in the .022X .028 slot. An OPG was taken and root
paralleling was carried out with bends in the archwire.
Once the case was clinically and radiologically nearly
complete we proceeded with the steps required for
debonding according to Roths functional setup (Fig 3).
Now the upper and lower impressions were made and
were duplicated. Prior to the mounting the centric was
recorded and i nterocclusal records for centric, lateral
and protrusive mandibular movements were taken (Fig
4). Bimanual technique (Dawson) was used with fingers
at right angles with upward pressure thumbs on chin
with downward pressure. The mandible was
manipulated into pure hinge movement. This technique
to record centric is accurate and has been supported
in the literature. Interposing recording medium between
occlusal rims made direct interocclusal records. It is
recommended because of its simpl icity, but the
accuracy is dependent on clinical judgement of the
Batra et al
orthodontist. Careful trimming of the interocclusal
recording material is critical because the soft tissue is
recorded in a compressed state. The stone casts record
the soft tissue in an uncompressed state. The two areas
that must be trimmed are the gingival tissues of the
maxillary teeth (palatal) and the distal tissue of the
terminal maxillary tooth. Elastomeric material is stable,
easy to use and acceptable accuracy. Semi-adjustable
Whip Mix articulator was used, along with arbitrary
facebows for mounting the casts (Fig 5). After transfer
of the maxillary cast the lower model is articulated
along with the interocclusal record (Fig 6). Using
articulating paper or carbon paper we can now
visualize the interferences on the casts (Fig 7). It can
be seen that the mesiolingual cusp of both the
maxillary molars showed prematurity along with the
lingual aspects as well as the incisal edges of the upper
anteriors. In the mandibular arch there were
prematurities in the distobuccal cusp of the left first
molar as well as the buccal cusps of the second and
third molars. Prematurity was also seen along the incisal
edges of the anteriors and canines. The interference
in the second and third molars were equilibrated while
those in the first molar to anterior part of the arch are
corrected by bends in the archwires (Roth strongly
believes that better tooth positioning can eliminate 80%
of the equilibrations.). Buccal root torque was
incorporated in the upper arch in the molar region
(progressive torque) while lingual root torque was
incorporated along with tip back for the lower left first
molar. Bite opening was done to eliminate the
prematurities in the anterior teeth. The corrections could
be achieved in 4 months following which the case was
debonded (Fig 8,9). The models were again made and
mounted as before and tooth positioners were
fabricated in centric (Fig 10).
The purpose of a hinge axis positioner is to settle teeth
so that occlusion is closer to centric relation, rather
than to allow them to settle on their own. Thus it aims
to control the settling process so the occlusion is closer
to centric by utilizing the available band space and
some buccolingual adjustment of the teeth to get to a
centrically related occlusion in a case that has been
set up orthodontically so that teeth can fit into centric.
In addition it closes the band space and tones the
gingival tissue. It can be used as a passive retainer if
so desired. The hinge axis positioner is also used to
control the settling of the anterior teeth and to help
develop an idealized anterior guidance. The tooth setup
for such a case requires the skill and temperament of
85
 J Ind Orthod Soc 2005 ; 38:80-90

Figu re 1 - Pret reatm ent extrao ral photograp hs of th patie nt

Figure 2 - Pretreatm ent in traora l photograp hs of th e patie nt

Figure 3 - Intro ral photograp hs of th e pati ent after space closure and radi o logica ll y acceptabl e root positi o ns.

Figure 4 - Intrao ral photog rap hs w ith interoccl usa l reco rd s in ce ntric

86
 Batra et al

Figure 5 - M ou nting of th e max ill ary cast after

facebow transfer to the Whip mi x
arti cu lator

Figure 6 - Mounting of th e m andibul ar cast wit h the interoccl usa l reco rd s in ce ntr ic

Figure 7 - Upper and lower member of th e Whip mi x arti cul ator show in g
th e maxi ll ary and mandibul ar casts w ith prematuriti es mark ed
wit h the arti cul at i ng paper

87
 J Ind Orthod Soc 2005; 38:80-90

Figure 8 - Post treatment extrao ral

photographs of the pati ent.
Note th e redu ction in mid
fac e co nvex ity

Figure 10 - Positi o ner made fo r th e

Figure 9 - Post treatment in trao ral photographs of th e patient pati ent for fin al fin ishi ng &
detailin g

Figure 11 - Six months fo ll owup ce ntri c and lateral exc ursive reco rd s fo r equil ibrati ng any prematuriti es.

88

so meone who has a knowled ge of anatomi ca l and
functional requirements of an ideal occlusion. A ca nine
guida nce was given to the patient with a can in e
protected occlusal scheme. After 3 weeks of positioner
wear the patient was given Begg type of retain ers for
maintaining the occlusal rel ationships attained.
Six months after debonding, new centric, lateral and
protrusive reco rds were made and interferences if any
were eliminated (Fig 11). Thus a stable functional
occlusion was achieved. Though the above-described
procedure appears to be very cumbersome, it can be
useful in selective cases to achieve a stable occlusion
not only static but also functional.
Communications
Dr Ritu Duggal, MDS, FIMSA, FPFA
Associate Professor, Division of Orthodontics,
Department of Dental Surgery
All India Institute of Medical Sciences, New Delhi.
E-mail: rituduggal@rediffmail.com
References
1. Aubrey RB. Occlusal objectives in orthodontic
treatment. Am J Orthod 1978;74:162-175.
2. Roth RH . Five year clinical evaluation of the
Andrews straight wire appliance. J Clin Orthod
1976;10:836-850.
3. Roth RH. Functional occlusion for the orthodontist.
J Clin Orthod 1981;15:32 -51.
4. Roth RH. Functional occlusion for the orthodontist.
J Clin Orthod 1981 ;15:1 00-123.
5. Roth RH. Functional occlusion for the orthodontist.
J Clin Orthod 1981 ;15:174-198.
6. Roth RH . Functional occlusion for the orthodontist.
J Clin Orthod 1981 ;15:246-265.
7. Bates JF, Srafford GO and Harrison A. Masticatory
function-review of literature I. The form of the
masticatory cycle. J Oral Rehab 1978;2:281-301.
8. Takai A, Nakano M , Hewlett ER. Evaluation of
three occlusal examination methods used to record
tooth contacts in lateral excursive movements. J
Prosthet Dent 1993;70:500-505.
9. Tipton RT, Rinchuse OJ. The relationship between
static occlusion and functional occlusion in a dental
school popu lation. Angle Orthod 1991 ;61 :57-66.
10. Utt TW, Meyers CE, Wierzba TF, Hondrum SO. A
three dimensional comparison of condylar position
between centric relation and centric occlusion
using the mandibular position indicator. Am J
Orthod Dentofac Orthop 1995;107:298-308.
Batra et al
11. Weiland FJ. The role of occlusal discrepancies in
the long-term stability of the mandibul ar arch. Eur
J Orthod 1994;16:521-529.
12. Williamson RL . Occlusal treatment for
postorthodontic patient. Am J Orthod 1971 ;59:43 -
442.
13. Williamson EH. Occlusion and TMJ dysfunction
Part I. J Clin Orthod 198;15:333-350.
14. Willi amson EH, Lindquist DO. Anterior guidance:
its effects on electromyographic activity of the
temporal and masseter muscle . J Prosthet Dent
1983;49:816-823.
15. Parker WS. Centric Relation and centric occlusion-
an orthodontists responsibility. Am J Orthod
1978;74:481-500.
16. Ingervall B. Tooth contacts on the functional and
nonfunctional side in children and young adults.
Arch Oral Bioi 1972;17:191-200.
17. Egermark- Eriksson L, Ingervall B, Carlsson GE. The
dependence of mandibular dysfunction in children
on functional and morphological maloccl usion. Am
J Orthod 1983;83: 187-194.
18. Monson GS. Applied mechanics to the theory of
mandibular movements. Dental Cosmos
1932;74:1039-1053 .
19. Sc huyler CH. Fundamental principles in the
correction of occlusal disharmony, natural and
artificial. JADA 1935;22:1193-1202.
20. D'Amico A. The canine teeth-normal functional
relation of the natural teeth of man. J Can Dent
Assoc 1958;26:6-241.
21. Nagao M . Comparative studies on the curve of
spee in mammals, with a discussion of its relation
to the form of the fossa mandibularis. J Dent Res
1919;1:159-202.
22. Shaw OM. Form and function in teeth and a rational
unifying principle applied to interpretation. Int J
Orthod 1924; 10:703-718.
23. Beyron HL. Occlusal relations and mastication in
Australian aborigines. Acta Odontol Scand
1964;22:597-678.
24. Droukas B, Lindee C , Carlsson GE. Occlusal and
mandibular dysfunction: a clinical study of patients
referred for functional disturbances of the masticatory
system. J Prosthet Dent 1985;53:402-406.
25. Scaife RR Jr Holt JE. Natural occurrence of cuspid
guidance. J Prosthet Dent 1969;22:225-229.
26. Shefter G), McFall WT. Occlusal relations and
periodontal status in human adults. J Periodontol
1984;55:368-374.
27. Belser UC, Hannam AG. The influence of altered
working side interferences on masti catory muscles
89

and re l ated jaw m ov eme nts. J Pros th et De nt
1985;53:406-41 3.
28. Yaffe A, Ehrli ch J. The fu nctio nal ra nge of tooth
co ntacts in latera l gli d ing movement rs. J Prosth et
Dent 1987;57:730-733.
29. MacDo na ld JWc, H an nam AG. Re l ati o nshi p
betwee n occl usa l co ntacts and jaw clos ing mu scles
act iv ity d uring tooth cl enc hin g. J Prosth et D ent
1984;52 :718-728.
30. Supe RJ, M ohamed SE, Christensen l V, Finger 1M,
Wein be rg R. Effects of occ lu sa l guid ance o n jaw
mu scle act ivity. J Prosthet De nt 1984;5 1:8 1-88.
31. lu c ia VO . A tec hni q ue for reco rdin g ce ntri c
re lati o n. J Prosthet Dent 1964;14:492 -505.
32. Meye rs, CR reco rd s - hi storica l I'ev iew J Prosthet
Dent 1982; 47 :14l.
33. Wood, Repro du c ibility of CR b ite reg istr ati o n
tec hni que. Angle O rth od 1994; 64(3):2 1l.
34. Dawso n, P. E. O ptimum TM J co ndy lar pos iti o n in
cl ini ca l practi ce. Int J Pe ri o Rest Dent 1985; 3:11 .
35. Ki ngery, R. H. A rev i ew of so m e p ro bl em s
assoc iated w ith ce ntri c relati o n. J Prosthet D ent
1952;2:307 -319.
36. lu cia VO. Ce ntri c relatio n - theo ry and practi ce. J
Prosthet Dent 1960; 10:849-856.
37. Gui chet NF Bi o logica l laws gove rnin g fun cti o ns
of mu sc les th at m ove the m and ibl e. Pa rt I:
Occ l usa l p rog rammin g. J Pros th et D e nt
1977;37:648-656.
38. Willi am so n, E. H. et a l. Ce nt ri c re l ati o n: A
co m pa ri so n of mu sc le determin ed pos iti o n and
operato r gui da nce. Am J O rth od 1980;77: 133 -14 5.
39. As h MM, Ram fjo rd S. Occlusio n. WB Saunders Co,
Phil ade lphi a 1996.
40. Geer ing AH . Occl usa l interfe rences and functi o nal
d istur ba nces of th e m ast ica to ry system . J Clin
Peri odonto l1 974; 1:12- 19.
4 1. De Boever JA, Adri ae ns PA. Occl usa l relati o nshi p
in -pat ients w ith pain dysfunctio n symptoms in th e
te m po ro m andibul ar j o int s. J O ra l Re h ab
1983; 10:1-7.
42. M o hlin B , Thil and er B. Th e impo rt ance of th e
re l ati o nship b et wee n m a locc lu sio n a nd
m a nd ibul ar d ysfun c ti o n a nd so m e c lini ca l
app li cat io ns in adults. Eur J O rth od 1984;6: 192 -
204 .
43. Del aat A, Va n Steenberghe D, l esaffre E. Occ lu sa l
re l ati o n ship s a nd t e m po ro m a ndibul a r j o int
dysfuncti o n. Part II: Co rrelat io n's between occlu sa l
and articul ar parameters and sympto ms of TMJ
dysf un ct i o n by m ea ns o f st epw i se l og i sti c
progressio n. J Prosthet Dent 1986;55: 16-1 21.
90
J Ind Orthod Soc 2005 ; 38:80-90
44. Nilner M . Fun ct io nal d istu rba nces and diseases of
th e stomatgnathi c system. A cross sec ti ona l study.
J Pedod 1986; 10:21 -235.
45. Ege rm ark- Erik sso n I, In ge rva ll B, Car lsso n GE,
M agnu sson T. A lo ng term ep idemio logica l study
of the re lat io nsh ip betwee n occ lu sa l factors and
m a ndi b ul ar dysfun ct i o n in c hil d re n a nd
ado lesce nts. J Dent Res 1987;66:67-7.
46. Se ligman DA, Pullinger AG. The ro le of functi onal
occl usa l re lationshi p in temporomandibul ar disorders.
A revi ew. J Craniomand Dis 199;5:265-279.
47. Pullin ge r AG, Se li gm an D A, Go rn be in JA. A
mu ltipl e logisti c regressio n analys is of th e risk and
re lati ve odds of te mporomandi bul ar di sorders as a
functi o n of commo n occl usa l fea tures. J Dent Res
1993; 72:968-979.
48. So lbe rg WK, Woo MW, H ousto n JB . Preva lence of
mandibul ar dysfun ct io n in yo un g ad u lts. JADA
1979;98:25-34.
49. De l aat A , Va n Stee n be rg he D. Occ lu sa l
re l ati o nship s and te m po ro m a ndi b ul a r j o in t
dysfun c ti o n. Part I: ep id emi o log ica l fin d in gs . J
Prosthet De nt 1985;5 4:835-842.
50. Heikinheimo K, Sa lmi K, M y ll arni em i S, Kirveska ri
P. A lo ngitudin al study of occ lu sa l in terfe rences
and signs of cra ni o mandi bul ar di so rder at the ages
of 12 and 15 years. Eur J O rth od 1990; 12:90-1 97.
51. Ingerva ll B, H ahner R , Kessi S. Patte rn of toot h
co ntacts in eccentri c mandibul ar positi o ns in you ng
adults. J Prosthet Dent 199 1;66: 169 -1 76.
52. Sto rey AT. Fun cti o nal stabilit y o f or th o d o nt i c
tr ea tm e nt- occ lu sio n as a ca u se of
temp roro mandib ul ar di sorders. In Retentio n and
Sta bilit y in Or th o d o nti cs. WB Sau nde rs Co.
Phil ade lphi a .p. 203-2 15.
53. Sved A. Eq uili brati o n as post retenti o n measu re.
Dent Clini cs No rth Ameri ca 1960 :203 -215.
54. Faulkner KD B. Bru xism: a rev iew of literatu re . A ust
Dent J 1990;35:266-276 .
55. G raf H, Z ander HA. Functi o nal tooth co ntacts in
late ral and ce ntri c occ lusio n. J Pr os th et D ent
1963; 13: 1055 -1 066.
56 . Pameij er JH . Intrao ral occlu sa l telemetry v. Effect
of occlu sa l adju stment upon tooth co ntact during
c hew in g a nd swa ll ow in g J Prost het D e n t
1970;24:492 -4 97 .
57. Ram fj or d SP. Bru x i sm , a c lini ca l a nd
electromyographi c study. JADA 196 1;62:2 1-44.
58. Rey no ld JM . Occlu sa l w ea r face ts. J Prosth et Dent
1970;24:36 7-372 .
59. Clark JR , Ev ans RD . Fun ct io nal occ lu sio n: I A
rev iew. J Orthod 200 1;28:76-81.