OCCLUSION IN FIXED

PROSTHODONTICS

Dr Gayathri Gangadharan
3rd year MDS
Table of contents
 Introduction
 Terminologies
 Mandibular movements
 Evolution of occlusion
 Ideal occlusion
 Concepts of occlusion
 Optimum occlusion
 Pathogenic occlusion
 Occlusal treatment
 Review of literature
 Conclusion
 References
Introduction

Most restorative procedures affect the shape of the

occlusal surfaces.

Proper dental care ensures that functional occlusal

contact relationships are restored in harmony with
both dynamic and static conditions.
• Maxillary and mandibular teeth should contact uniformly on
closing to allow optimal function,
• minimize trauma to the supporting structures, and
• allow for uniform load distribution throughout the dentition.
 Terminologies
 Occlusion is defined as
1. The act or process of closure or
being closed or shut off
2. The static relationship between
the incising or masticating
surfaces of the maxillary or
mandibular teeth or tooth
analogues.
 Articulation is defined as the static
and dynamic contact relationship
between the occlusal surfaces of
the teeth during function.
• The maxillomandibular relationship in
which the condyles articulate with the
thinnest avascular portion of their
respective disks with the complex in the
anterior- superior position against the
shapes of the articular eminences
• This position is independent of tooth
relation
contact
• This position is clinically discernible when
Centric
the mandible is directed superior and
anteriorly
• It is restricted to a purely rotary
movement about the transverse
horizontal axis.
 Maximum intercuspal
position
 The complete intercuspation
of the opposing teeth
independent of condylar
position, sometimes referred
to as the best fit of the teeth
regardless of the condylar
position.
 Centric occlusion
 The occlusion of opposing
teeth when the mandible is in
centric relation. This may or
may not coincide with the
maximal intercuspal position.
 Retruded contact position (RCP)
 relationship between the mandible and maxilla on
the terminal hinge axis when the first point of tooth
contact occurs.
 From here the mandible can slide into ICP
 This slide is usually 0.5 to 1 mm in length when
viewed at the incisors, but depending on the
nature of the tooth contact it can be up to
several millimetres long.
MANDIBULAR MOVEMENT
 Complex three dimensional mandibular
movement can be divided into two basic
components:
 translation, in which all points within a body have
identical motion
 rotation, in which the body is turning about an axis.
With the condylar rotation
and translation, the mandible
is capable of performing the
following movements:
• Opening
• Protrusive
• Lateral excursions- left and right
Opening movement
• For this movement to occur, the condyle rotates
in its place, in the terminal hinge position.
• Pure rotation occurs only till the condyles start to
translate moving out of its centricity. Upon
rotation of the condyle, the mandible opens, and
teeth are discluded.
 The rotational movement is limited to about 12
mm of incisor separation
 As soon as the pure rotation ends, the condyle
begins to translate, moving forward and
downward on the superior and anterior walls of
the glenoid fossa, with the arc of opening
changing, and the mandible opening further till
the maximum opening position.
Protrusive movement
• For this movement to occur
condyles follow the form of
the superior wall of the
glenoid fossa, they slide
downwards and forwards as
the mandible moves in
protrusion. This movement
causes the separation of the
posterior teeth, a state
known as Disclusion.
 During this movement, the opposing inclines of
the tooth should not touch each other.
 The palatal cusp of the upper molar travels
distally from its centric position in the central
fossa of the lower opposing tooth, while the
buccal cusp of the lower travels mesially across
the central groove of the upper opposing tooth.
 The cusp angle should be in harmony with the
angle that the condyle travels during the
protrusive movement, or else a protrusive
interference would exist. The steeper this angle,
the more allowable cuspal angle , the longer the
cusps and deeper the fossae.
Lateral excursion movement
 The mandible is capable of moving towards both
the right and left sides. The side to which the
mandible moves is called the working side, while
the opposite side is called the non-working side.
 The working side: the condyle on the working
side is called the rotating condyle, it rotates in its
fossa with a little downward and backward
movement, rotating against the superior and
posterior walls of the glenoid fossa.
 The buccal cusps of upper and lower molars line up, with the
lower buccal stamp cusp moving from its centric position in the
fossa of the opposing tooth towards the buccal along the
buccal groove, while the stamp cusp move lingually along the
lower lingual groove.
 During this movement, any contact that would exist between
the lower buccal cusps or the upper palatal cusps with their
opposers would be considered as working side interferences.
 The non working side: the condyle on the non
working side is called the orbiting or translating
condyle. The condyle moves medially till it comes
in contact with the medial wall of the glenoid
fossa, then moves downwards, forwards and
medially, on the superior and medial walls of the
fossa.
 The palatal cusps of upper molars line up with the buccal
cusps of lower molars. The buccal cusps of lower teeth
moving lingually from their centric position across the
oblique palatal grooves of their lower opponent
 During this movement any contact that would exist
between the lower buccal cusps or the upper palatal
cusps with their opposers would be considered as non
working side interferences.
 Bennett movement( side shift)
• This is the lateral bodily movement of the rotating
( working) condyle, with the medial movement of
the orbiting( non- working or translating) condyle.
The medial wall of the glenoid fossa on the non
working side determines the amount of this
movement. The non-working condyle moves
medially till it is in contact with the medial wall.
Bennett angle: angle Immediate side shift:
formed between the Progressive side
occurs during the
mid sagittal plane shift: occurs after
initial 2mm of the
and the medial wall the initial side shift,
anterior movement.
of the glenoid fossa Total side shift: the curve of the
The average initial
on the non- working immediate side shift medial wall of the
side shift is 1.7mm
side (7.5-12.8 + progressive side glenoid fossa begins
medially. There is
degrees) shift to straighten, there
more medial
is more anterior
L=H/8 +12 (H- movement than
movement with little
horizontal condylar there is anterior
medial movement.
inclination) movement.
 Border Movements
Definition:
mandibular
●
Extreme movements in
movement at the horizontal plane
limits dictated by ●
Extreme movements in sagittal
anatomic plane
structures, as ●
Extreme movements in frontal
viewed in a given plane
plane
Horizontal- diamond Sagittal-beak Frontal- shield
Early Concepts
The first mechanical articulator was invented by J.B.
Gariot in 1805

In 1858 Bonwill described his triangular theory whereby

he postulated that the distance from the incisal edges of
the lower incisors to each condyle is 4 inches, and the
distance between the condyles is 4 inches

In 1866 Balkwill discovered that during lateral jaw

movement, the translating condyle moved medially.

In 1890 the German anatomist Von Spee observed that

the occlusal plane of the teeth followed a curve in the
sagittal plane
Age of Occlusal Theories and
Occlusal Articulators

In 1899 Snow devised a method

for transferring articulated casts In 1908 Bennett described the
to the articulator with a face immediate side shift (Bennett
bow.' tnovernent)
Before 1916 Monson formulated a three-dimensional occlusal philosophy by
combining the concepts of Bonwill's 4-inch triangle and bilateral balanced
occlusion, Von Spee's compensating curve, and the observances of Balkwill and
Christensen on condylar movement.This occlusal model was named the Spherical
Theory

In 1910 Gysi improved on Balkwill’s arrow point tracer to allow visual registration of
centric relation.
 In 1918 Hall presented his conical theory, where it was
believed that the condyles were not the guides to
mandibular movement. Instead, the occluding planes
of the teeth were the guides for mandibular
movement.
 In 1921, engineer Hanau introduced an occlusal
instrument that was based on the scientific writings of
Snow and Gysi.’ Hanau rejected the spherical theory and
proposed the “rocking chair” denture occlusion in 1923.
 This rocking chair theory involved heavy contact to the
first molar areas to compensate for the “resiliency and
like effect,” which referred to the resiliency of soft tissue
and temporomandibular joint.
 In 1929 Stansberry modified Gysi’s arrow point
tracer by adding a central bearing point that
allowed convenience in making the centric relation
record and eccentric jaw position records. These
records were then used to transfer casts of the
patient to the articulator, the Stansberry Tripod.
 In the 1930s Meyer was advocating the use of
the functionally generated path or “chew in”
technique for recording bilateral balancing
contacts in eccentric movements.
 The Avery brothers, in 1930, introduced the
“anti- Monson Theory,” which advocated a
reverse occlusal curve of Wilson-lateral
compensating curve
 Pleasure, in 1937, introduced his “Pleasure
curve” which advocates the anti-Monson
reverse curve except for the second molars.
Modern Occlusal Concepts

Pankey, Mann, Schuyler System

• The Pankey-Mann system was originally
an amalgamation of the Monson theory
and the Meyer functionally generated
path technique, where they attempted
to gain bilateral balance in eccentric
movements.
The technique involved restoring the mandibular
posterior occlusion to a 4-inch sphere as described
by Monson.

The maxillary posterior occlusion was then

fabricated to the mandibular occlusal form by
using the maxillary anterior teeth as guides for the
“chew in” registration as advocated by Meyer
 A suspension instrument was used for
articulating the casts, which had no functional
movement capability
 influence
Schuyler’s
• the balancing side contacts were under
eliminated; however,
• the importance of incisal guidance technique,
was elevated;
•
path
the concept of “long centric” or
“functional centric occlusion” was generated
proposed in which centric occlusion functionally
is thought of as an area ofcontact theory and the
rather than a point contact; and
•
spherical
the Hanau occlusal instrument with
arbitrary face bow and Broadrick
Monson
occlusal plane analyzer was retained the
adopted. system
This occlusal
PMS system
Gnathology- by McCollum and his
associates.
• One assumption was that the horizontal
rotational center passes through both condyles
(collinear hinge axis).
• These researchers believed that if the rotational
centers in the condyles could be located, and if
the border movements of these rotational centers
were recorded and reproduced on a sophisticated
three-dimensional articulator, then all functional
motions for the patient could also be reproduced
by that instrument
Gnathologic theory at this early time included
(1)establishing via a hinge
axis location the rotational
centers of the condyles;

(2) recording the three

dimensional envelope of
motion of the condyles via
the pantographic tracing;

(3) maximum
intercuspation of the teeth
when the condyles are in
their hinge position; and

(4) bilateral balance with

eccentric jaw movements.
 Two of the early gnathologic researchers,
Stallard and Stuart proposed eliminating the
balancing contacts in eccentric jaw movements
by having the canines on the working side
disclude the posterior teeth; they named it the
Cuspid Protection Theory.
 This also became known as the Mutually
Protected System.
During the 1940s and 1950s

Payne and Thomas developed

systematic waxing techniques
that allowed for the
development of an acceptable
occlusal scheme when all the
posterior teeth had been
prepared.
Guichet greatly simplified the
pantographic recorder and
developed his; gnathologic
instrument, the Denar
 Transographics-
engineer Page
Transographic theory questioned the need to record
●

the total envelope of motion (pantographing) and

instead advocated using wax registrations to record
a much smaller functional area within the envelope
of motion, which Page termed the “functional
envelope.”
 Cranial orthopedics
 The most visible proponent of the concept of
cranial orthopedics (also called oral orthopedics) is
Gelb.
 The basic concept centers around the belief
that the movement of the mandible is not
influenced by the shape of the condyles, but
the condyles may assume a certain shape
because the mandible has assumed certain
movements
 Cranial orthopedics is interested in
establishing postural relationships of the
jaws.
 Occlusion is secondary to obtaining optimal
postural relations of the mandible to the
maxilla.
 Ideal occlusion
 According to Hobo (1978) , ideal occlusion is an
occlusion which is compatible with
stomatognathic system providing efficient
mastication and good esthetics without creating
physiologic abnormalities.
 Characteristics
●
Stable posterior contact with vertically directed resultant
forces
●
MIP coincident with CR along with freedom in centric.
●
No posterior contact in eccentric mandibular movements.
●
Contact of anterior teeth in harmony with functional jaw
movement.
●
Occlusion in Angle’s Class 1
Importance of ideal occlusion

●
Use it as a benchmark for assessment of pre treatment records and examination
(diagnostic cast)
●
Correcting TMD and occlusal interferences before commencing restorative procedures.
●
For final prosthodontics rehabilitation- to accomplish this a confirmative approach
( where patients pretreatment occlusion is retained for the prosthodontic rehabilitation),
or a reorganized approach ( where a change in occlusal scheme is planned ) is utilized.
Concepts of occlusion

Bilaterally balanced
occlusion

Mutually Unilaterally
protected balanced
occlusion occlusion
Bilaterally Balanced Articulation

 maximum number of teeth in contact in

maximum intercuspation and all excursive
positions
 In fixed prosthodontics
 extremely difficult to accomplish,
 high rates of failure
 rate of occlusal wear was increased,
 periodontal breakdown was increased or
accelerated,
 neuromuscular disturbances occurred.
Unilaterally Balanced Articulation(Group
Function)

 This type of occlusion occurs when all facial ridges of working

side teeth contact the opposing dentition while the non
working side teeth do not contact.
 Beyron (1954,1969) listed characteristics of
this type of occlusion:

●
Teeth should receive stress along the tooth long
axis
●
Total stress should be distributed among the
tooth segment in lateral movement.
●
Keep proper interocclusal clearance
●
Teeth contact in lateral movement without
interferences.
 On the mediotrusive side, no contact occurs until the
mandible has reached centric relation.
 load is distributed among the periodontal support of
all posterior teeth on the working side.

•On the working side, the occlusal

load during functional movement
is then distributed over the
periodontal surface area of all
teeth in the quadrant while the
posterior teeth on the nonworking
side do not contact.
•In the protrusive movement, no
posterior tooth contact occurs.
 Long Centric- (freedom from centric) freedom of
movement in an antero posterior direction
 Schuyler was one of the first to advocate such an
occlusal arrangement.
 According to him, it was important for the
posterior teeth to be in harmonious gliding contact
when the mandible translates from centric relation
forward to make anterior tooth contact.
 Long centric involves primarily the anterior teeth
 According to Dawson, it is the freedom to
close the mandible either into CR or slightly
anterior to it, without varying the vertical
dimension at the anterior teeth.
 At given vertical dimensions, long centric
lengths ranging from 0.5 to 1.5 mm have
been advocated.
 Freedom in centric-MIP and CR are coincident
but flat areas on the depths of fossa on which
the opposing cusps occlude, will allow for a
certain degree of freedom in both centric and
eccentric movements without the guiding
influences of the occlusal inclines .
 Mutually Protected
Articulation
 1963- Stuart and Stallard
 An occlusal scheme in
which the posterior teeth
prevent excessive contact
of the anterior teeth in
maximum intercuspation ,
and the anterior teeth
disengage the posterior
teeth in all mandibular
excursive movements.
 Advantages of mutually
protected occlusion:
●
Minimum amount of tooth contact is involved and this makes for
better penetration of food.
●
A cusp to fossa relationship produces an interlocking of the upper and
lower components, thereby giving maximum support in centric relation
in all directions. The force is closer to the long axis of the tooth.
●
The arrangement of the marginal, transverse and oblique ridges such
that they have a shearing action, which makes for a much more
efficient chewing apparatus.
 The term mutually protected occlusion was
changed to organic occlusion by Stallard and
Stuart(1961) and then described by
Thomas(1967).
 In organic occlusion, the centric relation and
maximum intercuspation are coincident.
The posterior teeth are in cusp-fossa relation,
one tooth to one tooth contact.
 Each functional cusp contacts the occlusal
fossa at 3 points while the anterior teeth
disclude by 25 microns.
 Contraindications for mutually protected
occlusion:
 When the masticatory cycle is horizontal
 The periodontium is compromised
 Missing canine or a prosthetic canine
 Arbitrary amounts of posterior disclusion
Optimum Occlusion
Uniform contact of all teeth around the arch when the mandibular condylar
processes are in their most superior position

Contact of stable posterior teeth with vertically directed resultant forces

Centric relation coincident with maximum intercuspation (intercuspal position)

No contact of posterior teeth in lateral or protrusive movements

Harmonizing of anterior tooth contacts with functional mandibular movements

To achieve these criteria, it is assumed that
 (1) a full complement of teeth exists,
 (2) the supporting tissues are healthy,
 (3) there is no reverse articulation (crossbite),
 (4) the occlusion is Angle class I.
Pathogenic occlusion

 A pathogenic occlusion is an occlusal

relationship capable of producing pathologic
changes in the stomatognathic system. In
such occlusions, disharmony between the
teeth and the TMJs is sufficient to result in
symptoms that necessitate intervention.
 Teeth: The teeth may exhibit
hypermobility, open contacts, or
abnormal wear.
●
Hypermobility of an individual tooth or an opposing pair of teeth
is often an indication of excessive occlusal force. This may result
from premature contact in centric relation or during excursive
movements
●
Open proximal contacts may be the result of tooth migration
because of an unstable occlusion and should prompt further
investigation
Abnormal tooth wear, cusp fracture, or chipping of incisal edges may be signs
of parafunctional activity.

Extensive tooth destruction is often caused by a combination of acid erosion

and attrition.
 Periodontium :
●
A widened periodontal ligament space (detected radiographically) may
indicate premature occlusal contact and is often associated with tooth
mobility
●
Isolated or circumferential periodontal defects are often associated with
occlusal trauma.
●
In patients with advanced periodontal disease who have extensive bone
loss, rapid tooth migration may occur with even minor occlusal
discrepancies
 Musculature:
●
Acute or chronic muscular pain on palpation can indicate
habits associated with tension, such as bruxism or
clenching.
●
Chronic muscle fatigue can lead to muscle spasm and pain.
●
Restricted opening, or trismus, may be a result of the fact
that the mandibular elevator muscles are not relaxing.
 TMJ:
●
Pain, clicking, or popping in the TMJs can indicate temporomandibular
disorders.
●
Clicking may also be associated with internal derangement of the joint.
●
A patient with unilateral clicking during opening and closing (reciprocal
click) in conjunction with a midline deviation may have a displaced
articular disk.
●
The midline deviation typically occurs toward the side of the affected
joint because the displaced articular disk can prevent (or slow down) the
normal anterior translator movement of the condyle
 MPDS:
The myofascial pain dysfunction (MPD)
●

syndrome manifests as diffuse unilateral pain in

the preauricular area, with muscle tenderness,
clicking, or popping noises in the contralateral
TMJ and limitation of mandibular function.
Psychophy Mechanical
siologic
Muscle displaceme
theory theory nt theory
●
MPD results from bruxism and continuous muscle
●

clenching, whereby chronic malocclusion of the

●

muscle fatigue leads to muscle hyperactivity is

spasm and alterations in
mandibular movement. Tooth
movement may follow, and the
malocclusion becomes apparent
when spasm is relieved.
●
According to this theory,
treatment should focus on
emotional rather than physical
therapy.
teeth displaces the
responsible for
condyles, and the
MPD; pain is
feedback from the
referred to the TMJ
dentition is altered,
and other areas of
which results in
the head and neck
region. muscle spasm.
 Patients with MPD may require
multidisciplinary treatment involving occlusal
therapy, medications, biofeedback, and
physical therapy. Extensive fixed prosthodontic
treatment should be postponed until the
patient’s conditions have been stabilized at
acceptable levels.
OCCLUSAL TREATMENT

 When a patient exhibits signs and symptoms

that appear to be associated with occlusal
interferences, occlusal treatment should be
considered.
 The ●
To direct the occlusal forces along the long
axes of the teeth
objectives ●
To attain simultaneous contact of all teeth in
centric relation
of occlusal ●
To eliminate any occlusal contact on inclined
plane to enhance the positional stability of the
treatment ●
teeth
To have centric relation coincide with the
maximum intercuspation position
are as ●
To arrive at the occlusal scheme selected for
the patient
follows:
REVIEW OF LITERATURE
 Long-term follow-up of cross-arch fixed partial
dentures in patients with advanced periodontal
destruction: evaluation of occlusion and subjective
function
S.W. YI, G.E. CARLSSON, * I. ERICSSO N & J.L. WENNSTRO M

 A study was done to investigate occlusal factors

in fixed partial dentures (FPDs) still in service for
more than 10 years, and to assess the patients'
opinions regarding oral function with these
constructions
 34 patients with 43 FPDs were examined
clinically concerning occlusion and by means of a
questionnaire on functional aspects.
 The most common occlusal contact pattern
was group function (51% on both sides, 7% on
one side) while canine protected occlusion was
recorded in 16% on both sides, 7% on one side.
 Balanced occlusion (19%) was mainly found
when the FPD occluded against a complete
denture and when there were few abutments
and a small amount of abutment supporting
tissue.
 The number and intensity of the occlusal
contacts were assessed by means of thin
occlusal sheets
 On average, one occlusal contact was
observed on each dental unit with antagonist.
The average number of sheets that could be
introduced between the antagonists when
the patient bit hard in the intercuspal position
was two without significant differences
between different areas (anterior/posterior)
or type of dental unit (abutment, pontics,
cantilever section).
 In the cantilever sections there were looser
contacts (more interocclusal sheets) more
distally.
 Subjective function was not significantly
influenced by FPD design, occlusal factors or
number of FPD units.
Influence of Fixed Prosthodontic Treatment on
Occlusal Contacts in Centric Occlusion: A
Preliminary Study
Jaafar abduo

 A study was done to evaluate the impact of

prosthodontic treatment on intercuspal
occlusal contacts in relation to contact
number and contact area.
 The pre-treatment and post-treatment
models of 13 patients who underwent fixed
prosthodontic treatment on several teeth
were retrieved.
 All the models were scanned by a Micro-CT
scanner and 3D virtual images were
established.
 Two occlusion variables were evaluated:
 (1) contact number and
 (2) contact area.
 In addition, the impact of the inter-arch
location (maxillary vs. mandibular arches) and
intra-arch location (anterior vs. posterior
teeth) was assessed.
 It was found that the prosthodontic treatment
had significantly increased the contact number
and contact area.
 The effect of the inter-arch location was
insignificant.
 The intra-arch location had significantly affected
the contact number and area, where the
posterior teeth had a significantly greater contact
number and area
Conclusion

 Peter E Dawson states that “ without specific

treatment goals, treatment success cannot
be measured”
 5 requirements of occlusal stability according
to Dawson:
 Stable holding contacts on all teeth when the
condyles are in centric relation
 Anterior guidance in harmony with the
envelope of function
  Immediate disclusion of all posterior teeth the
moment the mandible moves forward of centric
relation
 Immediate disclusion of all posterior teeth on the
nonworking side
 Non interference of all posterior on the working side
with either the lateral anterior guidance or the border
movements of the condyles.
 All occlusal treatments should have specific goals.
Criteria for success are an essential requirement
for achieving successful complete dentistry.
References
 Rosenstiel SF, Land MF, editors. Contemporary fixed prosthodontics-e-book. Elsevier
Health Sciences; 2015 Jul 28.
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prosthodontics. Quintessence Publishing Company; 1997 Jan.
 Pokorny PH, Wiens JP, Litvak H. Occlusion for fixed prosthodontics: a historical
perspective of the gnathological influence. The Journal of prosthetic dentistry. 2008
Apr 1;99(4):299-313.
 Yi SW, Carlsson GE, Ericsson I, Wennström JL. Long‐term follow‐up of cross‐arch fixed
partial dentures in patients with advanced periodontal destruction: evaluation of
occlusion and subjective function. Journal of oral rehabilitation. 1996 Mar;23(3):186-96.
 Abduo J. Influence of fixed prosthodontic treatment on occlusal contacts in centric
occlusion: a preliminary study. Journal of Advances in Medicine and Medical Research.
2015:1580-9.
 Dawson PE. Functional occlusion-e-book: from TMJ to smile design. Elsevier Health
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 Becker CM, Kaiser DA. Evolution of occlusion and occlusal instruments. Journal of
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