Occlusal

Disease
Examples of occlusal disease
1- Attritional wear
Due to tooth-to tooth
friction.
It results from bruxism,
empty mouth Para function.
Erosion of enamel
 Tooth surface loss due to
chemical or electrochemical
action.
 Endogenous erosion: this is
the result from bulimia and it
is a unique pattern of enamel
loss on the palatal surface of
upper anterior teeth, from
forceful vomitus.
 Gastroesophgeal reflux
disease( GERD) : from
gastric juices , erosion on
lingual surface of lingula
surface of molars is
diagnostic.
Abfraction
-Due to occlusal overload on
non carious cervical lesion it is
a consequence of tensile
stresses through bending of
teeth under occlusal load.
-Occlusal load that would cause
flexure of the teeth and produce
micro-fractures and structural
loss in the cervical area of the
teeth.
-It could be due to the intensity
of brushing strokes, and the use
of abrasive tooth paste.
Splayed teeth
 Signs of mandibular
deflection , will force the
upper anterior teeth
forward. Splaying of the
teeth is a common sign of
occlusal disease that can
be diagnosed and treated
early by removing
deflective interferences.
Destroyed dentition
 Sever wear , which results
in fracture of teeth, and
elongation of the alveolar
process.
 This is very demanding
occlusal problem , that
has to diagnosed early.
Anterior guidance attrition
Anterior teeth interfering
with the centric relation
closure or with functional
jaw movement.
Wear of the lingual enamel
of an upper anterior teeth.
Goes undiagnosed until the
incisal edges become so thin
that they start to break.
Sensitive teeth
 Hypersensitivity due to
occlusal load.
7 signs and symptoms of occlusal
disease
1- Pathological occlusal
wear and fracture of teeth
and restorations
2-Cervical dentine hyper
sensitivity
3-Tooth hyper mobility
4- Fremitus
5-Abfraction
6-Vertical bone loss or
localized bone destruction
7-Pain and tired facial and
masticatory muscles.
What is Occlusal disease ?
 It is the deformation or disturbance
of function of any structures with in
the masticatory system that are in
disequilibrium with a harmonious
inter-relationship between the TMJs,
the masticatory musculature, and the
occluding surface of teeth.
 10 Factors of Masticatory System
Harmony
1- Tempromandibular joint
2-Role of muscle
3-centric relation
4-Anterior guidance
5-vertical dimension
6-Neutral zone
7-Envelope of motion
8-Long centric
9-The occlusal plane
10-Occlusal contact
 1- Temporomandibular joint
 First requirement;
“One of the most important rule to follow in dental
practice is that if TMJ can not accept firm
compressive loading with complete comfort. Always
find out why before proceeding with any irreversible
occlusal treatment”
 1- Temporomandibular joint
The articulating surface

Posterior slope

Disk
Condyle

Inferior lateral
pterygiod
1- Temporomandibular joint

Each condyle form

a 90 degree with
the mandibular
ramus .
Only the medial
poles of the
condyles form a
common axis of
rotation.
2- Role of muscle
2- Role of muscle
 “ when teeth and muscle
war, muscle never losses”
harry Sicher
 Co-ordinated muscle
function during jaw
opening
As the jaw opens , depressor
muscle contracts while
elevator muscle release their
contraction.
The inferior lateral pterygiod
contracts during opening.
2- Role of muscle
 Co-ordinated muscle
function during jaw
Closing
Elevator muscle contracts,
and the pterygiod muscle
release contraction and is
passive.
In the absence of deflective
occlusal contacts it stays
passive.
2- Role of muscle
Co ordinated muscle
movement at maximum
intercuspation
Main goal is release of
inferior head of lateral
pterygoid, while elevator
muscle contracts.
The superior belly of lateral
pterygoid holds the disk in
alignment with contact against
the posterior slope of the
emientia.
 2- Role of muscle
Muscle response to occlusal
interference
- Occlusal interference as
high restoration or
deflective occlusal contacts ,
evokes a response of
hyperactivity and in co-
ordinated contraction o
2- Role of muscle
 Muscle response to occlusal
interference
Posterior dis-occlusion : when
posterior teeth are dis-occluded
in all eccentric movements by
combination of anterior guidance
in front, and condylar guidance
at the back then 2/3 of the
elevator are shut off
MUSCLE INCO-
ORDINATION , BOTH
ELEVATOR AND LATERAL
PTERYGIOD MUSCLES ARE
HYPER-ACTIVE.
1- Temporomandibular joint
 Role of muscle
Muscle response to posterior
dis-occlusion
-When the posterior teeth are separated
during protrusive and lateral excursions
of the mandible.
-At the moment of separation of
posterior teeth , almost all of the
elevator muscles are shut off.
-It has three beneficial effects;
 Reduces the horizontal forces against
the anterior teeth ( which are the only
teeth in contact during excursions).
 Reduce the compressive loading force
on the TMJ
 Makes it impossible to overload or
wear the posterior teeth even if the
patient bruxes.
 3-Centric relation
 Definition:
It is the relationship of the mandible to the maxilla
when properly aligned condyle-disk assemblies are in
the most superior position against the eminentiae
irrespective of vertical dimension or tooth position.
At the most superior position , the condyle disk
assemblies are braced medially, thus centric relation is
in the midmost position.
A properly aligned condyle-disk assembly in centric
relation can resist maximum loading by elevator
muscle with no signs of discomfort.
 Centric relation
Centric relation:
1- it is a fixed axial position of the condyles
2-Centric relation is not to be confused with
centric occlusion
3-Centric relation is not about teeth , it is the
position of the condyles.
4-It is a repeatable ,universally accepted
position , physiologically and biomechanically
correct jaw position.
 3-Centric relation
Two most important criteria for centric
relation are;
1-The complete release of the inferior lateral
Pterygiod muscle.
2- Proper alignment of the disk on the condyle. During
jaw closure with an INTACT Tempromandibular
joint the condyle-disk assembly are pulled up the
eminentiate by strong elevator muscles.
BOTH POSITION &CONDITION of the condyle-
disk assemblies.
 3-Centric relation

Definition:
“It is the relationship of the mandible to the maxilla”
 3-Centric relation
-Casts mounted in centric
relation would enable the
dentist to bring the teeth in
harmony with the correct
maxilla-mandibular relation
ship.
- It provides proper diagnosis
for any occlusal interferences.
 3-Centric relation
“It is the relationship of the mandible to the maxilla
when properly aligned condyle-disk assemblies are
in the most superior position against the
eminentiae”
 3-Centric relation
 Definition:
It is the relationship of the mandible to the maxilla
when properly aligned condyle-disk assemblies are
in the most superior position against the eminentiae
irrespective of vertical dimension or tooth position.
 3-Centric relation
Most superior position
The properly aligned condyle disk assemblies are
completely seated in the most superior of their
respective sockets.
 3-Centric relation
 What other factor than the contraction of the
elevator muscle helps in seating the condyles in
the upper most position?
 3-Centric relation

 The inferior lateral pterygoid has the

sole responsibility for forward
positioning of the mandible to align
with maximal inter-occlusal contact
whenever the centric relation is not
coincident with maximal
intercuspation?
Mid most
3- Centric relation
Centric relation ( co-ordinated
muscle movement most superior)
3- Centric relation
3- Centric relation
Why Do we need a centric relation
record?????
Centric relation
 Centric relation
 Recording centric relation using
a leaf gauge
The four common uses for the leaf
gauge are:
-Loading the TMJ
-Deprogramming the lateral pterygoid
-Identifying first point of contact in
centric relation
-obtaining centric relation bite records
The leaf gauge not be seen as one tool
with many uses, but to actually be
viewed as two different tools:
-The joint loader tool
-The muscle releasing tool
 Centric relation
 Identification of first point of contact
 Centric relation
 obtaining centric relation bite records
Load testing for verification of centric relation
 Load testing is important
for the diagnosis of intra-
capsular TMJ disorders.
 In Centric relation all forces
go through avascular non-
innervated structures, and
the inferior lateral pterygoid
muscles will be relaxed.
 If condyle-disc assemblies
are in their superior position
in their fossa , all upward
movement is stopped by
bone, at this point the
inferior lateral pterygoid
release all contraction
Load testing for verification of centric relation

First increment of load

testing is done with
gentle compression.
It is done to verify that
the condyles are
completely seated to a
freely hinging position
which is centric relation.
 Load testing for verification of centric relation

Common mistakes in load testing;

-Applying too much pressure
-Not applying enough upward loading force at the
final increment.
Hand position is very important for effective load
testing.
Load testing for verification of
centric relation
 Load testing for verification of centric relation

Response to load testing , if condyles are not

completely seated ( muscle braced).
If the condyle assembly is downward and forward
from centric , it was pulled by contraction of the
lateral pterygoid.
 Load testing for verification of
centric relation
 If the disk is displaced
 Load testing for verification of
centric relation
 If there is intra-capsular pathology or injury
Occluso-muscle disease