Introduction to Occlusion

Fundamentals of Occlusion & Articulation

Course Introduction and Characteristics of an Ideal Occlusion

Course Textbook & References

Textbook:

Management of Temporomandibular Disorders and Occlusion; Jeffrey P. Okeson. 5th Edition

Secondary

Reference: Textbook Main Reference: PowerPoint Files

Exam Format and Use of References:
All examination questions will be obtained from the PowerPoint files that all students have access to. Textbook reading is secondary, but still somewhat essential to the understanding of the material. Exam questions are multiple choice format (40 for midterm and 50 for final examination).

Occlusion Course Schedule Dr. Arcorias session

Date
Wednesday Feb. 23, 2011 Dr. Arcoria

Morning (8 am - 12 pm)
Ironwood lecture hall; no SimLab 1. Introduction to Occlusion 2. Characteristics of An Ideal Occlusion (Chapter 5, pp. 109-125 Ironwood lecture hall; no SimLab 1. Articular Disc Displacement 2. Review for Quiz #1

Afternoon (1 - 5 pm)
Ironwood lecture hall; SimLab available 3. TMJ Anatomy 4. Muscles of Mastication (Chapter 1 pp. 1-26) 5. Verification of Articulator mountings and settings Ironwood lecture hall; SimLab available 3. Video/PowerPoint of waxing technique for occlusal contacts and cusp/fossa relationships 4. Lab Project 1: Wax-up teeth # 8 and # 9 (Pass or Fail) Ironwood lecture hall; no SimLab 4. Interferences & Muscle Responses/Actions 5. Review for Occlusion Exam 1

Thursday Feb. 24, 2011 Dr. Arcoria

Friday Feb. 24, 2011 Dr. Arcoria

Ironwood lecture hall; SimLab available 1. Quiz #1 on 2/23 & 2/24 material 2. Quiz #1 follow-up and discussion 3. Lab Project 2: Wax-up tooth # 12 (Pass or Fail)

Occlusion Course Schedule Dr. Krupps session

Date
Monday Feb. 28, 2011 Dr. Krupp

Morning (8 am - 12 pm)
Ironwood lecture hall; no SimLab 1. Occlusion Exam 1 (covers Feb 23 25 material) 2. Mandibular Movement (Chapter 4 pp. 93108)

Afternoon (1 - 5 pm)
Ironwood lecture hall; no SimLab 3. Alignment, Static and Moving Occlusion (Chapter 3: pp. 67-91) 4. Determinants of Occlusal Morphology(Chapter 6 pp. 127-146)

Tuesday Mar. 1, 2011 Dr. Krupp

Ironwood lecture hall; SimLab available 1. Quiz #2 Review 2. Laboratory Project 3: Wax-up tooth # 3 (Pass or Fail) Ironwood lecture hall; SimLab available
Need to finish at 11:30 and be back at 1:30 (vendor fair)

Ironwood lecture hall; SimLab available 3. Project 4: Wax-up tooth # 19 (Pass or Fail) 4. Review for Laboratory Practical Exam

Wednesday Mar. 2, 2011 Dr. Krupp

Monday Mar. 7, 2011 Faculty

1. Quiz 2 on 2/28 material 2. Articulators (Chapter 18 pp. 567-588) 3. Review for Occlusion Exam 2 1. Occlusion Exam #2 (covers Feb 28 Mar 2 material)

Ironwood lecture hall; SimLab available 4. Laboratory Practical Exam: Static and Moving Occlusion 5. Project 5: Wax-up tooth # 6 (Pass or Fail)

Occlusion Course Evaluation

Range

Introduction to Occlusion
% of total Grade

Assessment Methods

Final Grade A B+ B

90-100% 85-89%

Exam # 1
Exam # 2 Quiz # 1 Quiz #2 Practical Exam Sim-clinic projects Total

25 %
25% 10% 10% 20% 10% Pass* 100%
80-84%

75-79%
70-74%
All successfully remediated modules 69% or below 69% or below

C+
C

I* F**

Occlusion Course Description

Static & Moving Occlusion Diagrams Practical Examination: You will be given a flash card booklet with quadrant diagrams displaying various mandibular movements. This booklet will be the entire basis of the moving occlusion practical examination. The National Board has about 3 or 4 of these questions on the exam every year. Interferences and Muscle Actions Concept on Lecture Examination #1: It is important for the student to know the location of various mandibularmaxillary tooth interferences and which muscles are involved as a result of these types of interferences.

D-1 Occlusion Download Site:

http://www.carcoria.com/asdoh-d1-occ/asdoh-d1-occ.htm
Constant Communication from me to you. Updated every day during the course.

Right click on your mouse and save the files to your drive

**Note: this is a different web-site than the Dental Anatomy Course

Criteria for Optimum Functional Occlusion

Key Anatomical Landmarks:
Temporal Bone: a portion of this bone forms the glenoid or mandibular fossa. The shape of this fossa determines many of the limits of mandibular movement Mandible: a moveable structure which is suspended by musculature and whose movement is limited by ligaments. Condyle: the portion of the mandible that articulates in the mandibular fossa. There is a right and left condyle, about which movement of the mandible occurs. The shape of the heads of the condyles determine many of the limits of mandibular movement. The mandible is the only bone in the human body that possesses two axes of rotation. Dentition: the size, shape and alignment of the teeth determine many of the limits of mandibular movements. The role of the dentition is considered to be secondary to the role of muscles, ligaments and the bony structures which comprise the temporomandibular joint.

Introduction to Occlusion

Basic Structure of the TMJ

Two TMJ: When one moves, the other must move as well.

Basic Structure of the TMJ

Glenoid or mandibular fossa

Movement is characterized by position of condyle in glenoid fossa

Articular eminence

Basic Structures of the Temporomandibular Joint

Articular Disc

Condyle
>Mandibular/Glenoid Fossa >Articular eminence: 1) Posterior slope, 2) Steepness/flatness guides movement >Synovial cavities: 1) Joint lubrication, 2) boundary lubrication from motion

Ligaments Supporting the TMJ and the Mandible

Limit movement Protect muscles Non-elastic

Lateral Side of Mandible (outside)

Medial Side of Mandible (inside)

The Temporomandibular Joint

Basic Structures

Condyle
Anatomic variations guide mandibular movement
Retrodiscal

tissue

elasticity Highly innervated and vascular Loading is painful Trauma can cause inflammation

The Temporomandibular Disc

Fibrous

tissue Interface between bones, somewhat pliable Bi-concave shape Collateral ligaments No Innervation No Vascularization

connective

Terminology Related to Mandibular Position and Tooth Position

Basic Premises:

When the mandible closes against the maxilla:

1. There is an ideal way for the teeth to contact 2. There is an ideal place for the condyle and disc to be situated.

Our task is to accomplish these two criteria in as non-obtrusive fashion as possible

Terminology Describing Tooth Position: MAXIMUM INTERCUSPATION

a.k.a. centric occlusion (CO) Habitual occlusion, habitual centric Maximum intercuspation describes an occlusal relationship Teeth are contacting in a position that the patient finds the most comfortable Easily achievable, but not always reproducible, by the patient

MAXIMUM INTERCUSPATION What is considered Ideal?

Angle Class I: 1st Molars and Canines relationship Adequate Overlap Long axis of teeth Simultaneous contact
Posterior

tooth dominance Anterior tooth passive contact Multiple contacts on all teeth adequately distributes forces

Term Describing Mandibular Position CENTRIC RELATION

Centric Relation
A condylar position Superior and Anterior Thin portion of disc Describes the most stable position of the condyle Superior and anterior position of the mandible with the disc properly interposed

Terms Describing Mandibular Position

Centric

Relation

Why a superior and anterior position? The Muscles of Mastication drive this process

In an Ideal Occlusion, CR and MI Occur Simultaneously.

Maximum Intercuspation
An occlusal position If CR and MI do not coincide, the patient will have a slide Most patients have some degree of a slide into maximum intercuspation (approximately 1-2 mm) MI is simultaneous contact Forces concentrated on long axis Posterior contacts should dominate

Slide from CR to MI

Only 15% of the population have no CR to MI discrepancy After the first contact in CR (usually on 2 or more posterior teeth), the patient continues to close, and the teeth come together more completely (MI). The condyles must move out of their most ideal position when the teeth come fully together.

An ideal occlusion
Basic Premises:

When the mandible closes,

1. There is an ideal way for the teeth to contact 2. There is an ideal place for the condyle and disc to be situated.

Characteristics of an Ideal Occlusion

The condyle seats in CR simultaneous with the teeth occluding in MI. No slide occurs.

Terms for Describing Eccentric Movements of the Mandible

Protrusive - anterior movement of the mandible Retrusive - posterior movement of the mandible Eccentric - movement away from a centric position (CR or MI)

Protrusive

Terms for Describing Eccentric Movements of the Mandible

In an ideal occlusion, protrusive movement is guided by anterior teeth.

Early lateral movements are ideally canine-guided.

Terms for Describing Eccentric Movements of the Mandible

Lateral movementsmoving the mandible to the left or to the right.

Shown is a left lateral movement

Terms for Describing Eccentric Movements of the Mandible

Lateral movementsDuring a left lateral movement, the left side of the arch is considered to be the working side.
Shown is a left lateral movement

Terms for Describing Eccentric Movements of the Mandible

Lateral movementsDuring a left lateral movement, the right side is considered to be the balancing side or nonworking side.
Shown is a left lateral movement

Terms for Describing Eccentric Movements of the Mandible

Lateral movements are guided by either:

canine guidance (ideal)

group function (secondary choice)

Terms for Describing Eccentric Movements of the Mandible

Crossover is an extreme movement where the mandibular
canine crosses over the maxillary canine.

This position is outside the envelope of function It is critical to the success of anterior restorations.

Extended lateral movements should smoothly

transfer from the canines to the incisors

Summary of Characteristics of an Ideal Occlusion

CR

and MI occur simultaneously All teeth contact simultaneously All occlusal forces are longitudinal Posterior tooth contacts dominate Eccentric movements are anteriorguided No cross-over contacts on posterior teeth

Summary of Criteria for an Optimal Functional Occlusion

Condylar position- Centric relation Tooth position- Maximum intercuspation Protrusive movements are guided by anterior teeth Lateral movements are canine guided. Axial loading of occlusal forces In MI, posterior tooth contacts dominate. During crossover, guidance is smoothly transferred to the incisors.