GOOD

MORNING
CONTENTS
Introduction
Important terms
History
Philosophies of occlusion
Organization of occlusion
Determinants of occlusal morphology
Importance of occlusal harmony
Treatment goals for occlusion to be in harmony
occlusal equilibration
Occlusal interferences
Occlusal Correction Therapy
Conclusion
References





Introduction
oc
means
up
clusion
means
closing
occlusion
means
closing
up
Occlusion means to block , to shut in , to bring
together

(Oxford English Dictionary)
IMPORTANT TERMS
Occlusion

The static relationship between incising or masticating surfaces of
maxillary and mandibular teeth or tooth analogues
(GPT 8)
Acc. To Ramfjord & Ash

Occlusion =contact between teeth

Multifactorial functional relationship between teeth & other
components of the masticatory system as well as with other areas of
head & neck that directly or indirectly relate to function,
parafunction or dysfunction of the masticatory system
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
(GPT-8)
Maximum Intercuspation

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.(GPT-8)
Articulation



It is the static and dynamic contact relationship between
the occlusal surfaces of teeth during function
GPT(8)
History
Fictional
period (prior
to 1900)
Gliding of
teeth
Hypothetical
period
(1900-1930)
Edward
Hartley
Angle
Mathew
Cryyer
Calvin Case
B.E Lischer
Paul Simon
Millo
hellman
Factual
period (1930
to present )
Concept of
dynamic
occlusion
Pioneers like Fuller, Clark & Imerie propagated antagonism &
meeting or gliding of teeth.
Eugene Talbots text(1900) irregularities of teeth & their treatment
Edward angle (1899) gave the key to occlusion.


Mathew Cryyer & Calvin case

Occlusion refers to the closure of
teeth one upon the other &
normal dental relations, normal
occlusion and typical occlusion
refering to the standard
anatomical occlusion
B.E Lischer & Paul Simon (1922)
Broadened the concept of occlusion.
Related teeth to the rest of the face & cranium.
Milo Hellaman
Advocated racial variation in occlusion
Based on facts rather than fiction.
Holly Broadbent & Haus Planer (1930) occlusion =
interdigitation of teeth + status of controlling
musculature & functional factors
2 School of thoughts

1. Gnathology
2. Functionalism
Gnathological concept of occlusion
Dr. Beverly B. McCollum "Father of Gnathology."
Dr. Harvey Stallard proposed the word Gnathology.
Derived from "Gnathos," jaw + "ology," study of, or knowledge of.
Dr. McCollum founded the Gnathological Society (1926).
McCollum define Gnathology as:
Gnathology is the Science that treats the biologics of the
masticating mechanisms; that is, the morphology, anatomy,
histology, physiology, pathology and the therapeutics of the oral
organ, especially the jaws and teeth and the vital relations of the
organ to the rest of the body."

In 1927, Harvey Stallard recognized that the teeth dictate the arc of
closure and the occluded position of the mandible. If articulators were
to be used to reveal mal-occluded teeth, then "interocclusal records"
would be needed to mount the casts in the centric relation position.

In 1930, Dr. Charles Stuart and Dr. McCollum developed the first
semi-adjustable articulator called the McCollum Gnathoscope.

In 1934, with the aid of Dr. Stuart, McCollum produced the first
mandibular movement recorder known as the McCollum Gnathograph.

ARNE G. LAURITZEN

Direction of occlusal stresses located close to the long axis of teeth allows
restoration of dentition in max. Intercuspation at centric relation position
Occlusal loads fall on as great no. Of teeth as possible
Optimal tooth-to-tooth occlusion should reach terminal hinge-axis
intercuspation without interferences
Ideal relations obtained with canine-guided occlusion
Group contact b/w upper & lower anterior teeth during protrusive
movement

NILES GUICHET & GNATHOLOGY

Explained adv. Of canine guidance by means of biomechanics

Denar articulator was used

Concept followed canines have a mechanical adv. of standing
lateral stress 8 times than 2
nd
premolars
FREEDOM IN CENTRIC CONCEPT
POSSELT 1
st
to describe its principles
Functional occlusion support from Ramfjord &
Ash
Max. Intercuspation & centric relation are
concident but flat areas on the depth of fossae,
on which opposing cusps occlude will allow for a
certain degree of freedom in both centric &
eccentric movements without guiding influences
of occlusal inclines
PANKEY MANN-SCHUYLER CONCEPT
Obj: optimal health, masticatory effeciency, comfort & esthetics

Characteristics:
i. Stable & static contacts over greatest no. Of teeth in centric relation
ii. Long centric
iii. Group function during lateral excursions
iv. No contact on balancing side
v. During protrusive movements, an immediate disocclusion of post.
Teeth might occur


DAWSONS CONCEPT
CRITERIA FOR IDEAL OCCLUSION:

i. Stable contacts on all teeth at the level of centric relation with
positioning of condyles at highest point aganist eminentia
ii. Anterior guidance must be in harmony with border movements of
envelope of motion
iii. Disocclusion of all post. Teeth during protrusive movements & on
balancing side
iv. Gp. Function on working side


For development of an ideal occlusion ant. Teeth are more capable of
supporting stress than posterior bcoz of:

1. Mechanical position in relation to the fulcrum (tmj) & force
(masticatory muscles)
2. Higher density of bone surrounding ant. Long roots
3. Better crown to root ratio

Dawson presented his theory of nutcracker
The nut ant. Teeth is from fulcrum (condyles), lesser would be the
force exerted on the nut.
European conceptual model
Also k/a Gerbers Condylar Displacement Theory
Any deviation related to this mandibular centralization
constitutes a condylar displacement.
Concepts of
occlusion
Bilaterally balanced
occlusion
Not used in FPD
Unilaterally
balanced occlusion/
Group function
Mutually protected
occlusion
Anterior protected
articulation
Canine protected
articulation
Bilaterally balanced occlusion
Based on the work of Von Spee & Monson.
Not used in fixed prosthodontics today.
It states that a maximum numbers of teeth should contact in all
exursive positions of mandible
Advantages
Useful in complete denture .
Increases stability
Disadvantages
Increases rate of occlusal wear
Accelerated periodontal breakdown
Neuromuscular disturbances


Unilaterally balanced occlusion/ Group
Function
Its origin is in the work of Schuyler.
Who demonstrated the destuctive nature of tooth contacts on the non-working side and
concluded cross-arch balance not required in natural teeth.
Teeth on non- working side are not in contact
Most desirable group function consists of canines, premolars & sometimes the mesio-buccal cusp
of the first molar on the working side.
Any laterotrusive contacts more posterior than the mesial portion of the first molar are not
desirable because of the increased amount of force that can be placed as they are near the fulcrum
and force vectors.

Advantages
Distributes occlusal loads better
Absence of contacts on non-working side prevents those teeth from
being subjected to the destructive
Saves centric holding cusps from excessive wear.
Maintains occlusion
Disadvantages
Excessive load on posterior teeth of working side.


Mutually Protected Occlusion
During the early 1960s the occlusal scheme called Mutually
Protected Occlusion was advocated by Stuart & Stallard
Based on earlier work of DAmico
This concept states that anterior teeth bear all the load and posterior
teeth are disoccluded in any excursive position of the mandible.
Centric relation coincide with maximum intercuspation.
Anterior teeth contact very lightly or slightly out of contact (approx.25
micron)
Anterior teeth protect posterior teeth in excursions & post. Teeth
protects ant. Teeth in intercuspation.
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. Alternatively,
an occlusal scheme in which the anterior teeth disengage the
posterior teeth in all mandibular excursive movements, and
the posterior teeth prevent excessive contact of the anterior
teeth in maximum intercuspation
( GPT -8)
FRONTAL VEIW WITH MOLARS IN CENTRIC RELATION
LATERAL EXCURSION
CONTACT ON
WORKING SIDE
DIS OCCLUSION ON
NON WORKING SIDE
CENTRIC OCCLUSION VIEWED LATERALLY
IN PROTUSION ONLY MAXILLARY AND MANDIBULAR
INCISORS ARE IN CONTACT
Also k/a ORGANIC OCCLUSION

A form of mutually protected articulation in which the vertical and
horizontal overlap of the anterior teeth disengages the posterior teeth
in all mandibular excursive movements(GPT-8)

Centric relation position and maximum intercuspation are coincident .

The posterior teeth are in a cusp fossa relationship, one tooth to one
tooth contact .
ANTERIOR PROTECTED ARTICULATION
Each functional cusp contacts the occlusal fossa at 3 points ,
while the anterior teeth disocclude .

In protusive movement , the maxillary 4 incisors guide the
mandible and disclude the posterior teeth (Boderson 1978)

Also k/a CANINE GUIDED OCCLUSION

A form of mutually protected articulation in which the vertical and
horizontal overlap of the canine teeth disengage the posterior teeth
in the excursive movements of the mandible
(GPT-8)
CANINE PROTECTED OCCLUSION
Canine acts as natures stress breaker.

Mandibular eccentric movements are guided by the canines except in
protusive movement, so the canine are a key element in occlusion .
Nicely aligned teeth.
Cuspid rise - right
side.
No posterior teeth
in contact.
During crossover, guidance is
from anterior teeth.
During crossover, none of the
posterior teeth on other side
are contacting either.
Cuspid rise in other direction.
No posterior contacts.
Canine-
Guided
Occlusion
CANINE GUIDANCE ON WORKING SIDE
NO CONTACTS ON NON-WORKING
SIDE IN LATERAL EXCURSION
LINGUAL VIEW OF THE CANINE RISE
LINGUAL VIEW OF THE CANINE RISE
ANATOMICAL EVIDENCE IN SUPPORT OF CANINE
GUIDED OCCLUSION
Canines are best suited to accept horizontal forces because:-
Longest & largest roots
Best crown-root ratio
Surrounded by dense compact bone
the location far from T.M.J
Many receptors are present in the periodontal ligament , so it
controls lateral pressure by directing vertical masticatory
movements .


Advantages:-
Absence of frictional wear
Minimizes horizontal loading of post. Teeth as they come in contact at
the very end of chewing stroke.
In intercuspation, no obliquely directed forces on anterior teeth.
Ease of fabrication
Greater tolerance by patients
Disadvantages
Good periodontal health of anterior teeth must
Angles class II or III can not be guided by ant. Teeth
Cannot be used in Crossbite situations
Missing / prosthetic canine


Posterior determinants
Right & left TMJ & associated structures.
Posterior determinants of occlusion. A, Angle of the articular eminence (condylar guidance
angle). 1, Flat; 2, average; 3, steep. B, Anatomy of the medial walls of the mandibular fossae. 1,
Greater than average; 2, average; 3, minimal sideshift.
A shallow protrusive condylar inclination requires short cusps (A), while a
steeper path permits the cusps to be longer(B)

A pronounced immediate lateral translation
requires that the cusps to be short (A), while
gradual lateral translation allows the cusps to
be longer (B).
The angle between the working (W)and the non-working
path(NW) is greater on teeth located farther from the condyle
Anterior Determinants
PATIENT ADAPTABILITY
There may be differences in the adaptive response of a patient to
occlusal abnormalities.

Individuals with a lower threshold will be unable to tolerate even trivial
occlusal deficiencies

Patient with raised threshold may adapt to distinct malocclusions.

IMPORTANCE OF OCCLUSAL HARMONY

Ideal mandibular function results from a harmonious relationship of all
the muscles that move the jaws.

If intercuspation of tooth is not in harmony with the joint- ligament-
muscle balance, a stressful and tiresome protective role is forced onto
the muscle

Williamson using EMG procedures showed that
interfering contacts on posterior teeth in any eccentric
position causes hyperactivity of the elevator muscles.
(JPD 1983;49;816-823)



Mongini showed direct relationship between the shape of
the condyle after remodelling & abrasion patterns on the
teeth.

Muscles must have complete freedom to function with no
extended demands on any muscle or group of muscles.

Ligaments must be permitted to assume their bracing roles
to permit muscles to rest.

If occlusion is in harmony, then least horizontal stresses
fall on teeth.

IF OCCLUSION IS NOT IN HARMONY
Pain, tenderness
Teeth may exhibit hypermobility, open
contacts or abnormal wear.
Widened periodontal ligament space .
Periodontal defects.
Extensive bone loss.
Rapid tooth migration.

Widened periodontal ligament space
and increased mobility of mandibular
molars. Occlusal premature contacts
were noted in lateral and protrusive
movements
Unstable
occlusion.
Removal of a
tooth without
replacement has
led to tilting
and drifting.
Bruxism & clenching.
Muscle spasm & pain.
Excessive deviation in closing & opening
of mandible due to asymmetric muscle
activity.
Restricted opening & trismus due to
mandibular elevator muscles spasm.
Pain, clicking or popping in TMJ.
Midline deviation during opening and
closing movements can be indicative of
asymmetric muscle activity or joint
derangement. Here, during opening, less
than optimal translation occurs on the
patient's left side.

MYOFACIAL PAIN DYSFUNCTION
Diffuse unilateral pain in pre-auricular area with muscle tenderness,
clicking or popping noises in the contra lateral TMJ & limitation of jaw
function .


TREATMENT GOALS FOR OCCLUSION TO BE IN
HARMONY
The Objectives of occlusal treatment are as follows:
1. To direct the occlusal forces along the long axes of the teeth
2. To attain simultaneous contact of all teeth in centric relation
3. To eliminate any occlusal contact on inclined planes to enhance the
positional stability of the teeth
4. To have centric relation coincide with the maximum intercuspation
position
5. To arrive at the occlusal scheme selected for the patient (e.g., unilateral
balanced versus mutually protected)

Occlusal treatment should be:-
tooth movement through orthodontics,
elimination of deflective occlusal contacts
through selective reshaping of the occlusal
surfaces of teeth,
the restoration and replacement of missing
teeth resulting in more favorable distribution
of occlusal force.

The modification of the occlusal form of the teeth with the
intent of equalizing occlusal stress, producing
simultaneous occlusal contacts or harmonizing cuspal
relations
( GPT 8)
EQUILIBRATION PROCEDURES :

1. Reduction of all contacting tooth surfaces that interfere
with terminal hinge axis closure
2. Selective reduction of tooth structure that interferes
with lateral excursions
3. Elimination of all post. tooth structure that interferes
with protrusive excursions
4. Harmonization of ant. guidance
Interferences are undesirable occlusal contacts that may
produce mandibular deviation during closure to maximum
intercuspation or may hinder smooth passage to and from
the intercuspal position.
(GPT-8)

Types of occlusal interferences.
1. Centric 2. Lateral
Working
Nonworking
Protrusive
LOCATING OCCLUSAL INTERFERENCES
The centric relation position for each condyle must be
confirmed before tooth contacts are marked

Firm pressure must be used to test the position

Pressure should not be applied until after the condyles have
been gently manipulated to the suspected CR seat
Loading pressure should be directed to seat the condyles against
the eminence while firm upward pressure is also being applied
Distalization of condyles should be avoided
CR located at open position
Now hold mandible on its terminal axis & close on that arc by
increments of a mm or two at a time
Continue a slow opening closing movement until the first tooth
contact occurs 1
st
INTERFERENCE
Let pt. Feel the first contact, hold that position for a sec. & Then
squeeze it determines direction & degree of slide from CR

The CENTRIC INTERFERENCE is a premature contact --
occurs when the mandible closes with the condyles in their optimum
position in the glenoid fossae .
It will cause deflection of the mandible in a posterior, anterior, and/or lateral
direction.


ELIMINATING INTERFERENCES TO CENTRIC
RELATION
Differentiated into two types :

1. INTERFERENCES TO THE ARC OF CLOSURE
2. INTERFERENCES TO THE LINE OF CLOSURE
If the patient slides his mandible to obtain tight closure it
indicates the presence of occlusal discrepancies.
INTERFERENCE TO THE ARC OF CLOSURE
As condyles rotate on their terminal hinge axis, each lower tooth follow
an arc of closure all the way to the most closed occlusal position
without any deviation off this arc.

Any tooth structure that interferes with this closing arc has the effect of
displacing the mandible forward of interference to reach the most
closed occlusal position
Primary interferences that deviate the condyle forward produce
Anterior Slide

CORRECTION -
MUDL : Grind the mesial inclines of upper teeth or distal
inclines of lower teeth
INTERFERENCE TO LINE OF CLOSURE

Interferences that cause mandible to deviate
to left or right from 1
st
point of contact to
most closed position
Grinding rules are :
1. Interfering incline causing mand. To deviate off the line of closure
towards the cheek
Grind the buccal incline of the upper or the lingual incline
of the lower, or both inclines

2. If interfering incline causes the mandible to deviate off the line of
closure towards the tongue :
Grind the lingual incline of upper or buccal incline of lower, or
both inclines

If interferences produce deviations off both arc of closure & the line of
closure at same time :
Upper inclines are adjusted on inclines that face the same
direction as slide.
Lower teeth are adjusted by grinding off inclines that face the
opposite direction from path of slide.
LATERAL EXCURSION INTERFERENCES
Path followed by lower posterior teeth as they leave CR &
travel laterally is dictated by :
1. Border movements of condyle which act as the post.
Determinant
2. Anterior guidance, which act as ant. Determinant
A WORKING INTERFERENCE
may occur when there is contact between the maxillary and mandibular
posterior teeth on the same side of the arches as the direction in which the
mandible has moved.
If that contact is heavy enough to disocclude anterior teeth, it is an
interference.

A NONWORKING INTERFERENCE is an occlusal contact
between maxillary and mandibular teeth on the side of the arches opposite the
direction in which the mandible has moved in a lateral excursion .
The nonworking interference is of a particularly destructive nature.
The potential for damaging the masticatory apparatus has been attributed to
changes in the mandibular leverage, the placement of forces outside the long
axes of the teeth, and disruption of normal muscle function.

LOCATING LATERAL INTERFERENCES
Manipulate mand. To CR

Teeth to be closed on terminal axis arc until they contact, hold onto
this position

On working side, thumb is released & all 4 fingers used to exert upward
pressure on working condyle
On balancing side pressure to be exerted towards working condyle

While maintaining pressure with both hands, ask pt. To slide jaw to left
or right

Assistant should insert marking ribbon in dry mouth to record
interferences
ELIMINATING LATERAL INTERFERENCES
Balancing side interferences
Eliminate all contact on inclines as soon as lower teeth move out of
CR & start towards the tongue
Grinding rule :
BULL - grind the buccal inclines of upper or lingual inclines
of lower

Protrusive interferences
A premature contact
Only front teeth should touch in protrusive excursions
Occurring between the mesial aspects of mandibular posterior teeth and the
distal aspects of maxillary posterior teeth.
Grinding rule DUML : grind
distal inclines of upper or,
mesial incline of lower teeth
Occlusal splints, occlusal appliances or orthotics
Used extensively in the management of TMJ disorder & bruxism
Helpful in determining where a proposed change in a patients occlusal
scheme will be tolerated
Fabricated in an acrylic resin overlay
Fabrication of the device:-
Direct procedure with a vacuum-formed
matrix(autopolymerized)
Indirect procedure with autopolymerizing acrylic
resin
Indirect procedure with heat-polymerized acrylic
resin
CONCLUSION
Most restorative procedures affect the shape of occlusal surfaces.
Proper dental care ensures that functional contact relationships are
restored in harmony with both dynamic & static conditions.

Therefore, maxillary & mandibular teeth should contact to allow
optimum function, minimal trauma to supporting structures, & an
even load distribution throughout dentition

References
Books
Iven klineberg,rob jagger; Occlusion And Clinical Practice-an
Evidence-based Approach
John Dos Santos Jr; Occlusion- Principles & concepts
Dawson; functional occlusion From TMJ To Smile Design
Dawson; Evaluation, diagnosis & treatment of occlusal problems
Okeson;
Shillingburg , Hobo, Whitsett, Jacobi, Brackett; Fundamentals Of Fixed
Prosthodontics
Rosensteil, Land, Fujimoto; Contemporary Fixed Prosthodontics

Journals
JPD1983;49;816-823
Ogawa, Ogimoto: Pattern Of Occlusal Contacts In Lateral Position:
JPD 1998;80;67
Schuyler: Factors of Occlusion As Applicable To Restorative
Dentistry; JPD 1953;3; 772-715
Pokorny, Weins,Livtak: Occlusion For Fixed Prosthodontics A
Historical Perspective of the Gnathological Influence; JPD
2008;99;299-313
Johnson: Variations in Organic Occlusion ;JPD 1979;41;625-629
Clark, Evans: Functional Occlusion: A Review; JO 2001;28;1;76-81
Stuart: Good Occlusion For Natural Teeth; JPD 1964;14;716-724