Occlusal

Equilibration

Nehal Abdelrahim
Abdallah Farahat
Samah Ahmed
 How to recognize unstable
Signs of occlusal ?occlusion
instability
hypermobility of-1
.one or more teeth
excessive tooth -2
.wear
migration of one -3
.or more teeth
horizontal-4
.migration
.intrusion-5
.supereruption-6
 Any tooth contact that inhibits the*
remaining occluding surfaces from
achieving stable and harmonious
.contact
.It is An undesirable occlusal contact

Occlusal
interference
 .uneven tooth wear-1

incorrectly performed restorative-2

Causes of procedures Therefore, after conducting
occlusal direct or indirect restorations, occlusal
.analysis should be performed
interferences
 drifted or over erupted teeth as a-3
result of absent or delayed
prosthodontic intervention to restore
function and occlusion
Causes of
occlusal
interferences
 :Occlusal interferences
IF observed at the beginning
occlusal adjustments
.would rarely needed

but unfortunately may pass unnoticed until

serious effects are happened
Introduction
 pains in the neuromuscular system :-1
teeth, muscles, periodontium, gingiva
mucosa and temporomandibular
.joints
Symptoms .head and neck aches -2
experienced .Inability to fully open the mouth-3
by patients
with occlusal
instability
 the neuromuscular system will be
continuously reinforced with each
closure through proprioceptive
feedback(masticatory muscle
Occlusal .memory)
interferences
induce this may induce changes at the level
conditioned state of any components of the
:masticatory system
called ENGRAME
teeth, muscles, periodontium,
gingival mucosa and
.temporomandibular joints
THIS REFLEX, REINFORCED AND STORED IN THE MASTICATORY •
MUSCLES AT EVERY SWALLOW, ADJUSTS MASTICATORY MUSCLE
.ACTIVITY TO GUIDE THE LOWER ARCH UNERRINGLY INTO ITS ICP
THESE MUSCLE ADJUSTMENTS COMPENSATE FOR THE •
CONTINUALLY CHANGING INTERNAL AND EXTERNAL FACTORS
THAT AFFECT THE MANDIBLE'S ENTRY INTO THE ICP
Patients were selected free from any*
occlusal disease, without signs and
symptoms of the TMD and without
previous orthodontic therapy. without
crossbite/openbite and without previous
extensive restorative treatment.

* All recordings were obtained using an

ultrasonic jaw tracking device with six
degrees of freedom.

*paraocclusal tray was firmly fixed to the

lower teeth, and it was not in contact
either with the upper teeth in the
maximum intercuspation position or
.during the jaw movements
an artificial occlusal interference was created on the lingual
cusp of the lower left second premolar using composite resin
with layer thickness of 1 mm Subsequently
the condylar deviations were measured
 We should differentiate between
two terms

Occlusal adjustment Occlusal equilibrium

)localized) (generalized)
 To remove occlusal and temporomandibular-1
joint dysfunctions of the TMJ dysfunction
.syndrome

To protect the harmonious occlusal function-2

against parafunctional activity of neuromuscular
:system which leads to
Aim a. pain around the temporomandibular
joints or the masticatory muscles with or without
.clicking
.b. inability to fully open the mouth
c. head and neck aches (Torii, Chiwata, 2007)
To manage Factors such as the interocclusal-3
distance, envelope of mandibular motion,
chewing stroke, tooth to tooth relations and
determinants of occlusion at the level of working
.or balancing quadrants
 with condyles in the mucoskeletally-1
stable centric relation: all posterior
teeth contact evenly and
.simultaneously

Treatment
goals of
occlusal
equilibration

when the mandible moves laterally,-2

latrotrusive contacts on the anterior
.teeth disclude posterior teeth
 when the mandible is protruded, -3
contact on the anterior teeth will
.disclude posterior teeth

in the upright head position,-4

Treatment posteror teeth contact more heavily
goals of than anterior teeth

occlusal
equilibration
Types of occlusal
interferences:
1-centric
2-working
3-non working
4-protrusive
Occlusal dysfunctions can be cured by using deprogramming
.methods (Popa S, 2004)
One of the frequently used deprogramming techniques is occlusal
equilibration
or selective )Wenneberg et al, 1988; Constantinescu, Ene, 1995(
grinding (Winstanley, 1986; Saito, 1990; Acosta, Roura, 2009)
 Occlusal equilibration
is a therapeutical abrasive technique that*
can remove or correct occlusal
interferences using the selective grinding
of the cuspal slopes or ridges of the teeth
interfered with normal functional occlusal
.paths
Definition
can be applied at the occlusal surface of*
natural teeth or prosthetic
.reconstructions
Centric relation (CR) is considered refrence position*
for the mandible (why?)
 DUE TO the stability of the
WHY (CR) is physiologic hinge axis position during
relaxed and asymptomatic function of
considered as the the elevator muscles of the mandible
best transfer and and the pain releasing of the
reproducibility temporomandibular joint dysfunction
on patients to whom occlusal
reference .adjustments are to be made
position of the
?mandible SO the recording of precise and
reproducible (CR) is the first step of a
method claimed to provide a true and
correct
.occlusal equilibration
 Immediate complete anterior guidance*
.development

.computer- assisted technique*

ICAGD
(another technique) Aim: obtain a successful reduction in
Kerstein et al (1990, disocclusion time, reducing contractile
1991, 1992, 1997, muscle activity and interrupting
2010) fatigue and spasm in masticatory
.muscles

this technique let all jaw movements*

free and unguided by the operator and
the sequence of adjustments were
completely reversed as compared to that
.of traditional occlusal equilibration
 TO achieve functional occlusion through -1
improving the functional mandibulo-maxillary
.interrelations
To remove occlusal trigger factors and-2
.muscle spasms
To remove the pain dysfunction TMJ-3
.syndrome
Indications to provide steady and equilibrated occlusal -4
.function before any prosthetic treatment

to improve masticatory efficacy and-5

.periodontal tissues protection

To stabilize the therapeutical results-6

.obtained from orthodonticTreatments
 Gothic pyramid

The cusp slope of every tooth

resembles a gothic pyramid:
it has a base, ridges (slopes)
and a tip Woelfel. An image
of the teeth occlusal contacts
between the ridges of the
teeth in occlusal
.intercuspation is explanatory
The buccal cusps are the functional cusps for
mandibular teeth
The (most mesial) buccal cusp of a
mandibular tooth occludes with the mesial
marginal ridge (MMR) of its corresponding
maxillary tooth

:EXAMPLE

Buccal cusp of mandibular 1st premolar

occludes on the MMR of the maxillary 1st
premolar

Mesial buccal cusp of mandibular 1st molar

occludes on the MMR of the maxillary 1st
.molar

The distal buccal cusp of a mandibular

molar occludes in the central groove of its
corresponding maxillary tooth
The palatal cusps are the functional
cusps for maxillary teeth

The mesial lingual cusp of a

maxillary molar occludes in
the central groove of its
corresponding mandibular
tooth
The (most distal) lingual cup of a
maxillary tooth occludes with the
distal marginal ridge (DMR) of its
corresponding mandibular tooth

:EXAMPLE
Lingual cusp of maxillary 1st
premolar occludes on the DMR of
the mandibular 1st premolar

Distal lingual cusp of maxillary 1st

molar occludes on the DMR of the
mandibular 1st molar
 EQUILIBRATION PROCEDURES CAN BE
:DIVIDED INTO FOUR PARTS
Reduction of all contacting tooth .1
surfaces that interfere with the
completely seated condylar position
(centric relation)

Selective reduction of tooth structure .2

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 stresses on weak teeth
 EQUILIBRATION PROCEDURES CAN BE
:DIVIDED INTO FOUR PARTS

Elimination of all posterior tooth .3

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

Harmonization of the anterior .4

guidance. It is most often necessary to do
this in conjunction with the correction of
lateral and protrusive interferences
Mandibular movements
 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 *
Armamentarium in miller ribbon holders
for occlusal
equilibration