Principles of Occlusion: Key Terms
Principles of Occlusion: Key Terms
Principles of Occlusion: Key Terms
PRINCIPLES OF
OCCLUSION
110
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Chapter 4 PRINCIPLES OF OCCLUSION 111
0 1 2 3 4
Mandibular fossa
Articular disk
Retrodiscal tissue
Superior joint
cavity
Condylar process
Superior lateral Inferior joint
pterygoid muscle cavity
Capsular ligament
Inferior lateral
pterygoid muscle
B
Fig. 4-1
Temporomandibular joint (lateral section). The mandible is open. (A courtesy Dr. K. A. Laurell.)
of both a hinging and a gliding articulation. An cavities. These are bordered peripherally by the
articular disk separates the mandibular fossa and capsule and the synovial membranes and are filled
articular tubercle of the temporal bone from the with synovial fluid. Because of its firm attachment to
condylar process of the mandible. the poles of each condylar process, the disk follows
The articulating surfaces of the condylar condylar movement during both hinging and trans-
processes and fossae are covered with avascular lation, which is made possible by the loose attach-
fibrous tissue (in contrast to most other joints, which ment of the posterior connective tissues.
have hyaline cartilage). The articular disk consists of
dense connective tissue; it also is avascular and
Ligaments
devoid of nerves in the area where articulation nor-
mally occurs. Posteriorly, it is attached to loose The body of the mandible is attached to the base of
highly vascularized and innervated connective the skull by muscles and also by three paired liga-
tissue, the retrodiscal pad or bilaminar zone,* which ments (Table 4-1): the temporomandibular (also
connects to the posterior wall of the articular called the lateral), the sphenomandibular, and the
capsule surrounding the joint (Fig. 4-1). Medially stylomandibular. Ligaments cannot be stretched sig-
and laterally, the disk is attached firmly to the poles nificantly, and so they limit the movement of joints.
of the condylar process. Anteriorly, it fuses with the The temporomandibular ligaments limit the amount
capsule and with the superior lateral pterygoid of rotation of the mandible and protect the structures
muscle. Superior and inferior to the articular disk of the joint, limiting border movements.1 The sphe-
are two spaces: the superior and inferior synovial nomandibular and stylomandibular ligaments (Fig.
4-2) limit separation between the condylar process
*Called bilaminar because it consists of two layers: an elastic superior layer and the disk; the stylomandibular ligaments also
and a collagenous inelastic inferior layer. limit protrusive movement of the mandible.
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112 PART I PLANNING AND PREPARATION
Ligaments cannot be
Joint capsule stretched, which limits
movement.
Sphenomandibular
ligament
Stylomandibular
ligament
Joint capsule
Temporomandibular
ligament
Stylomandibular
ligament
B
Fig. 4-2
Ligaments of the temporomandibular joint. A, Medial view. B, Lateral view.
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Chapter 4 PRINCIPLES OF OCCLUSION 113
Temporal
muscle
Masseter
muscle
Lateral pterygoid
muscle Mylohyoid
muscle
Stylohyoid
Medial pterygoid muscle
muscle Posterior belly of Anterior belly of
digastric muscle digastric muscle
Hyoglossal
muscle Hyoid bone
Fig. 4-3
The muscles of mastication and the suprahyoid muscles.
The three paired muscles of mastication provide the mandible. The geniohyoid and mylohyoid initi-
elevation and lateral movement of the mandible. ate the opening movements, and the anterior belly
These are the temporal, the masseter, and the medial of the digastric muscle completes mandibular
pterygoid muscles. The lateral pterygoid muscles, depression. Although the stylohyoid muscle (which
each with two bellies (which probably should be also belongs to the suprahyoid group) may con-
considered as two separate muscles), function hori- tribute indirectly to mandibular movement through
zontally during opening and closing; the inferior fixation of the hyoid bone, it does not play a signifi-
belly (or inferior lateral pterygoid) is active during cant role in mandibular movement.
protrusion, depression, and lateral movement; the
superior belly (or superior lateral pterygoid) is active
Dentition
during closure. The latter muscle is thought to assist
in maintaining the integrity of the condyle-disk The relative positions of the maxillary and mandibu-
assembly by pulling the condylar process firmly lar teeth influence mandibular movement. Many
against the disk, because the superior belly has been “ideal” occlusions have been described.2 In most of
shown to attach to the disk and the neck of the these, the maxillary and mandibular teeth contact
condyle. simultaneously when the condylar processes are
The muscles of the suprahyoid group have a dual fully seated in the mandibular fossae and the teeth
function. They can elevate the hyoid bone or depress do not interfere with harmonious movement of the
the mandible. The movement that results when they mandible during function. Ideally, in the fully bilat-
contract depends on the state of contraction of the eral seated position of the condyle-disk assemblies,
other muscles of the neck and jaw region. When the the maxillary and mandibular teeth exhibit
muscles of mastication are in a state of contraction, maximum intercuspation. This means that the max-
the suprahyoid muscles elevate the hyoid bone. illary lingual and mandibular buccal cusps of the
However, if the infrahyoid muscles (which anchor posterior teeth are evenly distributed and in stable
the hyoid bone to the sternum and clavicle) are con- contact with the opposing occlusal fossae. These
tracted, the suprahyoid muscles depress and retract functional cusps can then act as stops for vertical
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114
Table 4-2 MUSCLES OF MASTICATION
PART I
Origin Insertion Innervation Vascular supply Function
Temporal Lateral surface of skull Coronoid process Temporal nerve (branch Middle and deep Elevates and retracts
and anterior of mandibular) temporal arteries jaw, assists in
border of ramus (branches of rotation, active in
superficial clenching
PLANNING
temporal and
maxillary)
Masseter Zygomatic arch Angle of mandible Masseteric nerve Masseteric artery Elevates and
AND
(division of (branch of protracts jaw,
trigeminal) maxillary) assists in lateral
PREPARATION
movement, active
in clenching
Medial pterygoid Pterygoid fossa and Medial surface of Medial pterygoid nerve Branch of maxillary Elevates jaw, causes
medial surface of angle of (division of artery lateral movement
lateral pterygoid mandible trigeminal) and protrusion
plate
Superior lateral Infratemporal surface Articular capsule Branch of masseteric or Branch of maxillary Positions disk in
pterygoid of greater wing of and disk, neck buccal nerve artery closing
sphenoid of condyle
Inferior lateral Lateral surface of Neck of condyle Branch of masseteric or Branch of maxillary Protrudes and
pterygoid lateral pterygoid buccal nerve artery depresses jaw,
plate causes lateral
movement
Mylohyoid Inner surface of Hyoid and Branches of mylohyoid Submental artery Elevates and
mandible mylohyoid nerve (division of stabilizes hyoid
raphe trigeminal)
Geniohyoid Genial tubercle Hyoid First cervical via Branch of lingual Elevates and draws
hypoglossal nerve artery hyoid forward
Anterior belly of Tendon linked to Digastric fossa Branch of mylohyoid Branch of facial Elevates hyoid,
digastric hyoid by fascia (lower border of nerve (division of artery depresses jaw
mandible) trigeminal)
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Chapter 4 PRINCIPLES OF OCCLUSION 115
Translation
Rotation
Fig. 4-4
The Angle Class I occlusal relationship. Fig. 4-5
Three-dimensional movement of a body can be defined by
a combination of translation (all points within the body
having identical movement) and rotation (all points turning
closure without excessively loading any one tooth, around an axis).
while left and right TMJs are simultaneously in an
unstrained position.
However, in many patients, maximal intercuspal
contact occurs with the condyles in a slightly trans- directed superior and anteriorly and is restricted to
lated position. This position is referred to as a purely rotary movement about the transverse hor-
maximum intercuspation which is defined as the izontal axis.
complete intercuspation of the opposing teeth inde- Centric relation is considered a reliable and
pendent of condylar position, sometimes referred to reproducible reference position. If maximum inter-
as the best fit of the teeth regardless of the condylar cuspation coincides with the centric relation posi-
position. If the mesiobuccal cusp of the maxillary tion, restorative treatment is often straightforward.
first molar is aligned with the buccal groove of the When maximum intercuspation does not coincide
mandibular first molar, an Angle Class I orthodon- with centric relation, it is necessary to determine
tic relationship (Fig. 4-4) exists; this is considered whether corrective occlusal therapy is needed before
normal (see glossary). In such a relationship, the restorative treatment.
anterior teeth overlap both horizontally and verti-
cally. This position is defined as the dental relation- MANDIBULAR MOVEMENT
ship in which there is normal anteroposterior
relationship of the jaws, as indicated by correct inter- As for any other movement in space, complex three-
cuspation of maxillary and mandibular molars, but, dimensional mandibular movement can be broken
when a malocclusion is present, there are crowding down into two basic components: translation, when
and rotation of teeth elsewhere (i.e., a dental all points within a body have identical motion, and
dysplasia or arch length deficiency). Orthodontic rotation, when the body is turning about an axis (Fig.
textbooks3 have traditionally described an arbitrary 4-5). Every possible three-dimensional movement
2 mm for horizontal overlap and vertical overlap can be described in terms of these two components.
as being ideal. For most patients, however, greater It is easier to understand mandibular movement
vertical overlap of the anterior teeth is desirable, to when the components are described as projections
prevent undesirable posterior tooth contact as a in three perpendicular planes: sagittal, horizontal,
result of flexing of the mandible during mastication. and frontal (Fig. 4-6).
Empirically, dentitions with greater vertical overlap
of the anterior teeth appear to have a better long- Reference Planes
term prognosis than do dentitions with minimal ver-
tical overlap. Sagittal plane
In the sagittal plane (Fig. 4-7), the mandible is
capable of a purely rotational movement as well as
CENTRIC RELATION translation. Rotation occurs around the terminal
Centric relation is defined as the maxillomandibu- hinge axis, an imaginary horizontal line through the
lar relationship in which the condyles articulate with rotational centers of the left and right condylar
the thinnest avascular portion of their respective processes. The rotational movement is limited to
disks with the complex in the anterosuperior posi- about 12 mm of incisor separation before the tem-
tion against the shapes of the articular eminences. poromandibular ligaments and structures anterior
This position is independent of tooth contact. It is to the mastoid process force the mandible to trans-
also clinically discernible when the mandible is late. The initial rotation or hingeing motion is
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116 PART I PLANNING AND PREPARATION
between the condyle and the articular disk. During and the temporomandibular ligament. Finally, the
translation, the lateral pterygoid muscle contracts mandible can make a straight protrusive (anterior)
and moves the condyle-disk assembly forward along movement (Fig. 4-10).
the posterior incline of the tubercle. Condylar
movement is similar during protrusive mandibular Frontal plane
movement. In a lateral movement in the frontal plane, the
mediotrusive (or nonworking) condyle moves down
Horizontal plane and medially, whereas the laterotrusive (or working)
In the horizontal plane, the mandible is capable of condyle rotates around the sagittal axis perpendicu-
rotation around several vertical axes. For example, lar to this plane (Fig. 4-11). Again, as determined by
lateral movement consists of rotation around an axis the anatomy of the medial wall of the mandibular
situated in the working (laterotrusive) condylar fossa on the mediotrusive side, transtrusion may be
process (Fig. 4-8) with relatively little concurrent observed; as determined by the anatomy of the
translation. A slight lateral translation of the condyle mandibular fossa on the laterotrusive side, this may
on the working side in the horizontal plane—known be lateral and upward or lateral and downward (lat-
as laterotrusion, Bennett movement,4 or mandibu- erosurtrusion and laterodetrusion). A straight pro-
lar side shift (Fig. 4-9)—is frequently present. This trusive movement observed in the frontal plane, with
may be slightly forward or slightly backward (latero- both condylar processes moving downward as they
protrusion or lateroretrusion). The orbiting (non- slide along the tubercular eminences, is shown in
working) condyle travels forward and medially as Figure 4-12.
limited by the medial aspect of the mandibular fossa
Border Movements
Mandibular movements are limited by the TMJs and
Frontal ligaments, the neuromuscular system, and the teeth.
Posselt5 was the first to describe mandibular move-
Sagittal
ment at the limits dictated by anatomic structures,
as viewed in a given plane which he called border
Horizontal movements (Fig. 4-13). His classic work is well worth
reviewing in the attempt to understand how the
determinants control the extent to which movement
can occur.
Posselt used a three-dimensional representation
of the extreme movements that the mandible is
capable of (see Fig. 4-13B). All possible mandibular
movements occur within its boundaries. At the top
of both illustrations, a horizontal tracing represents
the protrusive movement of the incisal edge of
Fig. 4-6 the mandibular incisors (solid numbered line in Fig.
Reference planes. 4-13B).
12 mm
Border movements
comprise pure rotation
and translatory
movement.
A B,C
Fig. 4-7
A, Rotation of the mandible in a sagittal plane can be made around the terminal hinge axis. B, After about 12 mm of incisal opening,
the mandible is forced to translate. C, Maximum opening; the condyles have translated forward.
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Chapter 4 PRINCIPLES OF OCCLUSION 117
Fig. 4-11
Lateral movement in the frontal plane.
Fig. 4-8
Rotation in the horizontal plane occurs during lateral move-
ment of the mandible. (The vertical axis is situated in the
condylar process.) Normally there is relatively little translation
(side shift).
Fig. 4-12
Protrusive movement in the frontal plane.
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1 2 4 5
3
A B
Fig. 4-13
A, Mandibular border movement in the sagittal plane. B, Posselt’s three-dimensional representation of the total envelope of
mandibular movement. 1, Mandibular incisors track along the lingual concavity of the maxillary anterior teeth. 2, Edge-to-edge posi-
tion. 3, Incisors move superiorly until posterior tooth contact recurs. 4, Protrusive path. 5, Most protrusive mandibular position.
ANTERIOR DETERMINANTS
Horizontal overlap of anterior teeth Increased Posterior cusps must be
shorter
Reduced Posterior cusps may be taller
Vertical overlap of anterior teeth Increased Posterior cusps may be taller
Reduced Posterior cusps must be
shorter
OTHER
Occlusal plane More parallel to condylar guidance Posterior cusps must be
shorter
Less parallel to condylar guidance Posterior cusps may be
longer
Anteroposterior curve More convex (shorter radius) The most posterior cusps
must be shorter
Less convex (larger radius) The most posterior cusps
may be longer
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Chapter 4 PRINCIPLES OF OCCLUSION 119
1
2
3
1
2
3
A B
Fig. 4-14
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 side shift.
structures The posterior determinants (Fig. 4-14)— more vertical pathway at the end of the chewing
shape of the articular eminences, anatomy of the stroke. Increased horizontal overlap allows a more
medial walls of the mandibular fossae, configuration horizontal jaw movement.
of the mandibular condylar processes—cannot be Although the posterior and anterior determinants
controlled, and it is not possible to influence the neu- combine to affect mandibular movement, no corre-
romuscular responses of the patient unless it is done lation has been established7; that is, patients with
by indirect means (e.g., through changes in the con- steep anterior guidance angles do not necessarily
figuration of the contacting teeth or by the provision have a steep posterior disclusion, and those with a
of an occlusal appliance). If a patient has steeply steep posterior disclusion do not necessarily have
sloped eminences, there is a large downward com- steep guidance angles.
ponent of condylar movement during lateral and
protrusive excursions. Similarly, the anatomy of
Functional Movements
the medial wall of each fossa normally allows
the condyle to move slightly medially as it travels Functional mandibular movement is defined as all
forward (mandibular side shift, or transtrusion). The normal, proper, or characteristic movements of the
side shift becomes greater as the extent of medial mandible made during speech, mastication,
movement increases. However, the anatomy of the yawning, swallowing, and other associated move-
joint dictates the actual path and timing of condylar ments. Most functional movement of the mandible
movement. Movement of the laterotrusive or (as occurs during mastication and speech) takes
working condylar process is influenced predomi- place inside the physiologic limits established by the
nantly by the anatomy of the lateral wall of the teeth, the TMJs, and the muscles and ligaments of
mandibular fossa. The amount of the side shift is, of mastication; therefore, these movements are rarely
course, a function of the mediotrusive or nonwork- coincident with border movements.
ing condyle; on the working side, however, it is the
anatomy of the lateral aspect of the fossa that guides Chewing
the working condyle straight out or upward and When incising food, adults open their mouths a
downward. The amount of side shift does not appear comfortable distance and move the mandible
to increase as the result of a loss of occlusion.6 forward until they incise, with the anterior teeth
The anterior determinants (Fig. 4-15) are the verti- meeting approximately edge to edge. The food bolus
cal and horizontal overlaps and the maxillary lingual is then transported to the center of the mouth as the
concavities of the anterior teeth. These can be mandible returns to its starting position, with the
altered by restorative and orthodontic treatment. A incisal edges of the mandibular anterior teeth track-
greater vertical overlap causes the direction of ing along the lingual concavities of the maxillary
mandibular opening to be more vertical during the anterior teeth (Fig. 4-16). The mouth then opens
early phase of protrusive movement and creates a slightly, the tongue pushes the food onto the occlusal
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120 PART I PLANNING AND PREPARATION
VO VO
VO
A AGA
AG HO HO HO
A
AG
A B C
Fig. 4-15
Anterior determinants of occlusion. Different incisor relationships with differing horizontal and vertical overlaps (HO and VO) produce
different anterior guidance angles (AGA). A, Class I. B, Class II, Division 2 (increased VO; steep AGA). C, Class II, Division 1 (increased
HO; flat AGA).
HORIZONTAL PLANE
Border
movement
Scale
10 mm
Border
movement
FRONTAL PLANE
Fig. 4-16
Comparison of border and chewing movements for soft food at the central incisor. Sagittal, frontal, and horizontal views in an ortho-
graphic projection. (From Gibbs CH, et al: Chewing movements in relation to border movements at the first molar. J Prosthet Dent 46:308, 1981.)
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Chapter 4 PRINCIPLES OF OCCLUSION 121
table, and, after moving sideways, the mandible and perhaps from the musculature itself and from
closes into the food until the guiding teeth (typically the periodontium, may influence this feedback
the canines) contact.8 The cycle is completed as pattern.
the mandible returns to its starting position.9 This
pattern repeats itself until the food bolus has been Speaking
reduced to particles that are small enough to be swal- The teeth, tongue, lips, floor of the mouth, and soft
lowed, at which point the process can start over. The palate form the resonance chamber that affects pro-
direction of the mandibular path of closure is influ- nunciation. During speech, the teeth are generally
enced by the inclination of the occlusal plane with not in contact, although the anterior teeth may come
the teeth apart and by the occlusal guidance as the very close together during soft “c,” “ch,” “s,” and “z”
jaw approaches maximum intercuspation.10 sounds, forming the “speaking space: the space that
The chewing pattern observed in children differs occurs between the incisal and/or occlusal surfaces
from that found in adults. Until about age 10, chil- of the maxillary and mandibular teeth during
dren begin the chewing stroke with a lateral move- speech.”13 When pronouncing the fricative “f,” the
ment. After the age of 10, they start to chew inner vermilion border of the lower lip traps air
increasingly like adults, with a more vertical stroke11 against the incisal edges of the maxillary incisors.
(Fig. 4-17). Stimuli from the pressoreceptors play an Phonetics is a useful diagnostic guide for correcting
important role in the development of functional vertical dimension and tooth position during fixed
chewing cycles.12 and removable prosthodontic treatment.14-17
Mastication is a learned process. At birth, no
occlusal plane exists, and only after the first teeth
Parafunctional Movements
have erupted far enough to contact each other is a
message sent from the receptors to the cerebral Parafunctional movements of the mandible may be
cortex, which controls the stimuli to the masticatory described as sustained activities that occur beyond
musculature. Stimuli from the tongue and cheeks, the normal functions of mastication, swallowing, and
Cheese Carrot
Scale
10 mm
Age 12
Scale Age 6 Right side chewing B
A 10 mm Chewing cheese
Fig. 4-17
Frontal views of chewing. The dashed lines are border movements. A, Chewing in a young person, characterized by a wide lateral
movement on opening and decreased lateral movement on closing. B, In an older child, the chewing pattern resembles that of an
adult. (From Wickwire NA, et al: Chewing patterns in normal children. Angle Orthod 51:48, 1981.)
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122 PART I PLANNING AND PREPARATION
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Chapter 4 PRINCIPLES OF OCCLUSION 123
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124 PART I PLANNING AND PREPARATION
Optimum occlusion
In an ideal occlusal arrangement, the load exerted
on the dentition should be distributed optimally.
Long centric Occlusal contact has been shown37 to influence
As the concept of unilateral balance evolved, it was muscle activity during mastication. Any restorative
suggested that allowing some freedom of movement procedures that adversely affect occlusal stability
in an anteroposterior direction is advantageous. This may affect the timing and intensity of elevator
concept is known as long centric. Schuyler32 was one muscle activity. Horizontal forces on any teeth
of the first to advocate such an occlusal arrangement. should be avoided or at least minimized, and loading
He thought that it was important for the posterior should be predominantly parallel to the long axes of
teeth to be in harmonious gliding contact when the the teeth. This is facilitated when the tips of the func-
mandible translates from centric relation forward to tional cusps are located centrally over the roots and
make anterior tooth contact. Others33 have advo- when loading of the teeth occurs in the fossae of the
cated long centric because centric relation only occlusal surfaces rather than on the marginal ridges.
rarely coincides with the maximum intercuspation Horizontal forces are also minimized if posterior
position in healthy natural dentitions. However, its tooth contact during excursive movements is
length is arbitrary. At given vertical dimensions, long avoided. Nevertheless, to enhance masticatory effi-
centric ranges from 0.5 to 1.5 mm in length have ciency, the cusps of the posterior teeth should have
been advocated. This theory presupposes that the adequate height. Stabilizing contacts involves pri-
condyles can translate horizontally in the fossae over marily the mandibular buccal cusps, and it has been
a commensurate trajectory before beginning to suggested that maintenance or improvement of the
move downward. It also necessitates a greater hori- number of such contacts should be among occlusal
zontal space between the maxillary and mandibular treatment objectives.38
anterior teeth (deeper lingual concavity), allowing The chewing and grinding action of the teeth is
horizontal movement before posterior disocclusion enhanced if opposing cusps on the laterotrusive side
(separation of opposing teeth during eccentric interdigitate at the end of the chewing stroke. The
movements of the mandible). mutually protected occlusal scheme probably meets
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Chapter 4 PRINCIPLES OF OCCLUSION 125
this criterion better than the other occlusal arrange- example of another class III lever would be a fishing
ments. The features of a mutually protected articu- pole. The longer the pole, the more effort it takes to
lation are as follows39: pull a fish out of the water. The same holds true for
1. Uniform contact of all teeth around the arch the muscles of mastication and the teeth: the farther
when the mandibular condylar processes are in anteriorly initial tooth-to-tooth contact occurs (i.e.,
their most superior position. the longer the lever arm), the less effective the forces
2. Stable posterior tooth contacts with vertically exerted by the musculature are and the smaller the
directed resultant forces. load to which the teeth are subjected is. The canine—
3. Centric relation coincident with maximum inter- with its long root, significant amount of periodontal
cuspation (intercuspal position). surface area, and strategic position in the dental
4. No contact of posterior teeth in lateral or protru- arch—is well adapted to guiding excursive move-
sive movements. ments. This function is governed by pressoreceptors
5. Anterior tooth contacts harmonizing with func- in the periodontal ligament, receptors that are very
tional jaw movements. sensitive to mechanical stimulation.41
In achieving these criteria, it is assumed that (1) a The elimination of posterior contacts during
full complement of teeth exists, (2) the supporting excursions reduces the amount of lateral force to
tissues are healthy, (3) there is no reverse articulation which posterior teeth are subjected. Therefore,
(crossbite) and (4) the occlusion is Angle Class I. molars and premolars in group function are sub-
Rationale jected to greater horizontal and potentially more
At first glance, it might seem illogical to load the pathologic force than the same teeth in a mutually
single-rooted anterior teeth as opposed to the multi- protected articulation.
rooted posterior teeth during chewing. However, the
canines and incisors have a distinct mechanical
advantage over the posterior teeth40: The effective-
PATIENT ADAPTABILITY
ness of the force exerted by the muscles of mastica- There are significant differences in the adaptive
tion is notably less when the loading contact occurs response of patients to occlusal abnormalities. Some
farther anteriorly. individuals are unable to tolerate seemingly trivial
The mandible is a lever of the class III type (Fig. occlusal deficiencies, whereas others are able to tol-
4-21), which is the least efficient of lever systems. An erate distinct malocclusions without obvious symp-
F E
A F L B
Fig. 4-21
Lever system of the mandible. A, The elevator muscles of the mandible insert anterior to the temporomandibular joints (TMJs) and
posterior to the teeth, forming a class III lever system. B, The fulcrum (F) is the TMJ, the force or effort (E) is applied by the muscles
of mastication, and the resistance or load (L) is food placed between the teeth. The load diminishes as the lever arm increases. There-
fore, less load is placed on the anterior teeth than on the posterior teeth.
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126 PART I PLANNING AND PREPARATION
A B
C D
Fig. 4-22
Patient adaptability: None of the four patients described here expressed any concern about their occlusion. A, Anterior esthetics
motivated a 45-year-old woman to seek treatment, although loss of posterior occlusal contact probably contributed to the devel-
opment of her anterior diastema. B, A 26-year-old woman had no complaints or neuromuscular symptoms, despite contacting only
on her second and first molars. C, A patient with amelogenesis imperfecta sought care for esthetic reasons rather than functional
complaints. D, A 21-year-old man with congenitally missing lateral incisors had neither functional nor pain complaints when he was
referred for fixed prosthodontic care after orthodontic treatment.
toms (Fig. 4-22). Most patients seem able to adapt to dentition, although a number of signs are evident.
small occlusal deficiencies without exhibiting acute Even in the absence of pain, however, occlusal treat-
symptoms. ment may be advised so as to prevent or minimize
wear on the teeth and damage to the musculature or
TMJs.
Lowered Threshold
Patients with a low pain threshold generally do not
present much difficulty in diagnosis. They readily
PATHOGENIC OCCLUSION
identify every pain. A lowered threshold, however, is A pathogenic occlusion is defined as an occlusal
not to be confused with hypochondria; it is merely relationship capable of producing pathologic
an indication of poor adaptability to occlusal dis- changes in the stomatognathic system. In such
crepancies. The tolerance or adaptability of an indi- occlusions, sufficient disharmony exists between the
vidual patient is likely to vary: It is lower at times of teeth and the TMJs to result in symptoms that neces-
emotional stress and general malaise, when clinical sitate intervention.
symptoms such as severe headaches, muscle spasm,
and pain may surface.
Signs and Symptoms
There are many indications that a pathogenic occlu-
Raised Threshold
sion may be present. Diagnosis is often complicated
Individuals who have adapted to existing malocclu- because patients almost always have a combination
sions may report being quite comfortable with their of symptoms. Although it is often not possible to
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Chapter 4 PRINCIPLES OF OCCLUSION 127
prove a direct correlation between specific symp- periodontal disease who have extensive bone loss,
toms and malocclusion, the following symptoms can rapid tooth migration may occur with even minor
help confirm this diagnosis. occlusal discrepancies. Tooth movement may make
it difficult for these patients to institute proper oral
Teeth hygiene measures, and the result may be a recur-
The teeth may exhibit hypermobility, open contacts, rence of periodontal disease. Precise adjustment of
or abnormal wear. Hypermobility of an individual the occlusion is probably more crucial in patients
tooth or an opposing pair of teeth is often an indica- with a compromised crown/root ratio than in those
tion of excessive occlusal force. This may result from with better periodontal support (see Chapter 32).
premature contact in centric relation or during
excursive movements. Such contacts frequently can Musculature
be detected by placing the tip of the index finger on Acute or chronic muscular pain on palpation can
the crown portion of the mobile tooth and asking the indicate habits associated with tension such as
patient to repeatedly tap the teeth together. Small bruxism or clenching. Chronic muscle fatigue can
amounts of movement (fremitus) that otherwise lead to muscle spasm and pain. In one study,47 sub-
might not be readily seen can often be felt this way. jects were instructed to grind their teeth for approx-
Open proximal contacts may be the result of tooth imately 30 minutes. They experienced muscle pain
migration because of an unstable occlusion and that typically peaked 2 hours after parafunctioning
should prompt further investigation (Fig. 4-23). and lasted as long as 7 days. Asymmetric muscle
Diagnostic casts made during previous treatment activity can be diagnosed by observing a patient’s
help assess any changes in the stability of the occlu- opening and closing movements in the frontal plane.
sion. Abnormal tooth wear, cusp fracture, or chip- A deviation of a few millimeters is quite common,
ping of incisal edges may be signs of parafunctional but any deviation larger than this may be a sign of
activity.42,43 However, extensive tooth destruction is dysfunction and mandates further examination (Fig.
often caused by a combination of acid erosion and 4-25).48 Restricted opening, or trismus, may be a
attrition.44-46 In these cases, the acid may be present result of the fact that the mandibular elevator
in the diet (e.g., excessive citrus fruit consumption) muscles are not relaxing.
or endogenous (caused by regurgitation or frequent
vomiting). Temporomandibular joints
Pain, clicking, or popping in the TMJs can
Periodontium indicate temporomandibular disorders. Clicking
There is no convincing evidence that chronic peri- and popping may be present without the patient’s
odontal disease is caused directly by occlusal over- awareness. A stethoscope is a useful diagnostic aid;
load. However, a widened periodontal ligament one study revealed that joint sounds are generally
space (detected radiographically) may indicate pre-
mature occlusal contact and is often associated with
tooth mobility (Fig. 4-24). Similarly, isolated or cir-
cumferential periodontal defects are often associ-
ated with occlusal trauma. In patients with advanced
Fig. 4-24
Fig. 4-23 Widened periodontal ligament space and increased mobility of
Unstable occlusion. Removal of a tooth without replacement mandibular molars. Occlusal premature contacts were noted in
has led to tilting and drifting. lateral and protrusive movements.
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128 PART I PLANNING AND PREPARATION
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Chapter 4 PRINCIPLES OF OCCLUSION 129
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130 PART I PLANNING AND PREPARATION
teeth, the device must be kept well clear of the 3. Add more resin to the incisor and canine
gingival margins (Fig. 4-27A). On the lingual regions, and guide the patient’s mouth to retru-
surface of maxillary devices, the matrix should sive, protrusive, and lateral closures in the soft
cover the anterior third of the hard palate for resin. Allow the resin to polymerize. Note that
rigidity. the resin should be allowed to polymerize on
2. Try in the matrix for fit and stability. Add a small the cast or with the appliance in place in the
amount of autopolymerizing acrylic resin in the mouth. Otherwise, the heat generated by poly-
incisal region. Guide the mandible into centric merization may distort the thermoplastic
relation, using the bimanual manipulation tech- matrix.
nique (see Chapter 2). Hinge the mandible to 4. With the help of marking ribbon, adjust the
make shallow indentations in the resin (see Fig. resin to give smooth, even contacts during pro-
4-27B). trusive and lateral excursions as well as a defi-
A B,C
G H
Fig. 4-27
Direct procedure for the fabrication of an occlusal device.
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Chapter 4 PRINCIPLES OF OCCLUSION 131
nite occlusal stop for each incisor in centric rela- lead to considerable loss of time at try-in. Particular
tion (see Fig. 4-27C). Confine protrusive contacts attention must be given to occlusal defects or inter-
to the incisors and lateral contacts to the lat- fering soft tissue projections on the casts, which
erotrusive canines (Fig. 4-27D). All posterior could cause errors during mounting.
contacts should be relieved at this stage. 1. Be sure that the device is made at the same
5. Have the patient wear the device for a few occlusal vertical dimension as the centric
minutes in the office. Repeated protrusive and relation record. This reduces mounting
lateral movements overcome most problems in errors derived from the use of an arbitrary
jaw manipulation. On occasion, it is necessary facebow.
for the patient to wear the device overnight 2. Fit the articulator with a mechanical incisal
before the acquired protective muscle patterns guidance table initially set flat.
are overcome. In such cases, if posterior tooth 3. Lower the incisal guide pin until there is
eruption is to be avoided, the patient must be approximately 1 mm of clearance between the
seen again within 24 to 48 hours. posterior teeth (Fig. 4-28A). This should be
6. Add autopolymerizing acrylic resin to the pos- the same occlusal vertical dimension as the
terior region of the device and guide the one at which the centric relation record was
patient’s mouth into centric relation. Hold made.
centric relation until the acrylic resin has 4. Depending on the type of articulator used, it
polymerized. may be necessary to reposition the incisal guide
7. Remove the device and examine the impres- table after step 3.
sions of the opposing arch in the resin (Fig. 4- 5. Check the clearance between opposing casts
27E). Polymerization can be accelerated by during protrusive movement of the articulator.
placing the device on the cast in warm water in Where this is less than 1 mm, increase it by
a pressure pot (Fig. 4-27F). tilting the incisal guidance table.
8. Place pencil marks in the depressions formed 6. Raise the platform wings of the incisal guidance
by the opposing functional cusps. If a cusp reg- table so there is at least 1 mm of clearance in all
istration is missing, new resin can be added and lateral excursions (Fig. 4-28B). It may be neces-
the device reseated. sary to raise the incisal pin occasionally to
9. Remove excess resin with a bur or wheel to leave ensure adequate clearance.
only the pencil marks (Fig. 4-27G). All other 7. Mark the height of contour of each tooth on the
contacts must be eliminated if posterior disclu- cast, and block out undercuts with wax (Fig.
sion is to be achieved. 4-28C).
10. Check the device in the patient’s mouth for 8. Form wire clasps to engage facial undercuts,
centric relation contacts, marking them with a seal the cast with a separating medium (e.g., Al-
ribbon. Relieve heavy contacts by continued Cote), and allow it to dry (Fig. 4-28D). The
adjustment until each functional cusp has an opposing cast can be soaked in water to prevent
even mark. the acrylic resin from sticking to it.
11. Identify protrusive and lateral excursions with 9. Fabricate the device with autopolymerizing
different-colored tape. Adjust excursive contacts clear acrylic resin (Fig. 4-28E), applied by alter-
as necessary, being careful not to remove the nating liquid and powder (Fig. 4-28F). To avoid
functional cusp stops. porosities, the resin should always be kept wet
12. Smooth and polish the device, again being with monomer and added in small increments
careful not to alter the functional surfaces (Fig. (Fig. 4-28G).
4-27H). 10. While the resin is still soft, close the articulator
13. After a period of satisfactory use, the device (Fig. 4-28H). Add resin where necessary until a
can be duplicated in heat-polymerized resin slight depression is formed by each functional
with the careful use of a standard denture reline cusp.
technique. 11. Again, while the resin is still soft, close the artic-
ulator into protrusive and lateral excursions.
Add or remove resin until it is in constant
Indirect procedure with autopolymerizing contact with the anterior teeth when the incisal
acrylic resin guide pin contacts the incisal guidance table.
Accurately mounted diagnostic casts are essential for This adjustment need only be approximate
this procedure. A relatively small mounting error can because the working time of the acrylic resin is
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132 PART I PLANNING AND PREPARATION
A B,C
D E,F
G H
I J
Fig. 4-28
A to J, Indirect procedure with autopolymerizing resin for the fabrication of an occlusal device.
limited and the occlusal contacts will be refined b. A stop should exist for each anterior tooth in
after the resin has polymerized. centric relation.
12. Place the device and cast in warm water in c. Protrusive contact on the incisors should be
a pressure vessel to polymerize. When this is smooth and even.
complete, flush wax from the cast with boiling d. There should also be smooth and even
water. lateral contact on the laterotrusive (working
13. Refine the occlusion on the articulator (Fig. side) canines.
4-28I). 14. Remove the device from the cast, and smooth
a. There should be even contact for each func- and polish it, taking care not to alter the func-
tional cusp in centric relation. tional surfaces (Fig. 4-28J).
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Chapter 4 PRINCIPLES OF OCCLUSION 133
A B,C
D E,F
G H,I
J K,L
Fig. 4-29
A to U, Alternative technique for occlusal device fabrication with autopolymerizing resin.
15. At try-in, check for fit and stability. Also check 3. Stainless wire clasps (Fig. 4-29F) and two sheets
the occlusal contacts and adjust as necessary, of baseplate wax are adapted to the maxillary
using different-colored marking ribbon for cast (Fig. 4-29G).
centric and eccentric contacts. 4. Develop an anterior ramp (Fig. 4-29H),
and establish evenly distributed occlusal contact
Indirect procedure with autopolymerizing resin with the mandibular teeth (Fig. 4-29I).
(alternative technique) 5. Wax sprues are added to the posterior aspect of
1. Obtain accurate casts and an interocclusal the completed waxed device (Fig. 4-29J).
record (Fig. 4-29A and B). 6. Laboratory Silicone is adapted over the waxup
2. Articulate the casts in centric relation, and (Fig. 4-29K and L).
adjust the setting of the articulator pin until 7. After the wax is boiled off the cast, reposition the
approximately 2 mm of interocclusal clearance clasps and lute them in place with some sticky
results (Fig. 4-29C to E). wax (Fig. 4-29M and N).
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134 PART I PLANNING AND PREPARATION
M N,O
P Q,R
S T,U
8. Apply a separating agent to the cast (Fig. shaped in wax on articulated diagnostic casts, or the
4-29O). direct device made with a vacuum-formed matrix
9. Autopolymerizing resin is then mixed in can be used as a pattern. This is flasked and
accordance with manufacturer’s instructions; processed in a manner similar to that for a complete
fill the mold cavity between the cast and denture. Because of processing errors, it is important
the repositioned silicone external surface to remount the cast and make necessary adjustments
form with the liquid resin (Fig. 4-29P before finishing and polishing are completed.
and Q). 1. Articulate the casts in centric relation. Allow for
10. Place the model in a pressure pot and allow the a remount procedure by notching the base of the
resin to cure (Figure 4-29R). cast on which the device will be processed.
11. After the cast is reattached to the articulator, 2. Create the desired configuration of the device in
mark and adjust occlusal contacts until a mutu- wax, obtaining centric stops and anterior guid-
ally protected articulation is established (Fig. ance. Use the mechanical anterior guidance table
4-29S and T) as for an autopolymerizing resin device.
12. The completed occlusal device (Fig. 4-29U) is 3. Separate the cast from its mounting and flask as
then removed from the cast and polished prior for conventional processing of complete dentures.
to clinical try-in and delivery. 4. Process in clear, heat-cured resin.
5. Rearticulate and adjust the occlusion.
Indirect procedure with heat-polymerized 6. Remove the stone cast with a shell blaster. Polish
acrylic resin the external surfaces on a lathe with pumice and
A more durable device can be made with heat-poly- an appropriate polishing compound.
merized acrylic resin. The desired occlusal surface is 7. Store in 100% humidity.
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Chapter 4 PRINCIPLES OF OCCLUSION 135
?
? STUDY QUESTIONS
1. Discuss the various functions of the mandibular ligaments, and relate them to their respective origins and
insertions.
2. Discuss the various functions of the mandibular muscles, and relate them to their respective origins and
insertions.
3. What are border movements? Draw and label Posselt’s solid.
4. What are the determinants of occlusion, and what do they determine?
5. Give examples of pathologic occlusion, and list five categories with multiple associated symptoms for each
category.
6. Describe a mutually protected occlusal scheme, its advantages, and indications. When is a mutually protected
articulation undesirable? Why?
7. Discuss typical mandibular movement during normal function and during parafunction. What is the influence
of age on chewing patterns?
8. What is the difference between a bilateral balanced occlusion, a unilateral balanced occlusion, and mutual
protection?
9. What are the purposes of an occlusal device? Describe a scenario justifying its use, and explain how the device
should be designed. Explain your rationale for this design.
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136 PART I PLANNING AND PREPARATION
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Chapter 4 PRINCIPLES OF OCCLUSION 137
ar·tic·u·lar \är tı̆k¢ya-ler\ adj (15c): of or relating to a joint sive movements of the mandible—comp ANTERIOR
PROTECTED ARTICULATION
articular capsule \är tı̆k¢ya-ler kăp’sel\: the fibrous liga-
ment that encloses a joint and limits its motion. It is lined cap·su·lar \kăp¢su-ler\ adj (ca. 1730): pertaining to a
with the synovial membrane capsule
articular cartilage \är tı̆k¢ya-ler kär¢tl-ı̆j\: a thin layer of capsular fibrosis \kăp¢su-ler fı̄-brō¢sı̆s\: fibrotic contracture
hyaline cartilage located on the joint surfaces of some of the capsular ligament of the temporomandibular joint
bones not found on the articular surfaces of the tem-
poromandibular joints which is covered with an avascu- capsular ligament \kăp¢su-ler lı̆g¢a-ment\: as it relates to
lar fibrous tissue the temporomandibular joint, a fibrous structure that
separately encapsulates the superior and inferior syn-
attrition \a-trı̆sh¢un\ n (14c): 1: the act of wearing or ovial cavities of the temporomandibular articulation
grinding down by friction 2: the mechanical wear result-
ing from mastication or parafunction, limited to contact- cap·sule \kăp¢sal,-sōōl\ n (1693): a fibrous sac or ligament
ing surfaces of the teeth—comp ABRASION, EROSION that encloses a joint and limits its motion. It is lined with
synovial membrane
balanced articulation \băl ansd är-tı̆k¢ya-lā¢shun\: the
bilateral, simultaneous, anterior, and posterior occlusal centric relation \sĕn¢trı̆k rı̆-lā¢shun\: 1: the maxillo-
contact of teeth in centric and eccentric positions—see mandibular relationship in which the condyles articulate
CROSS ARCH B.A., CROSS TOOTH B.A. with the thinnest avascular portion of their respective
disks with the complex in the anterior-superior position
balancing interference \băl¢ans ı̆ng ı̆n¢ter-fear¢ans\: against the shapes of the articular eminencies. This posi-
undesirable contact(s) of opposing occlusal surfaces on tion is independent of tooth contact. This position is clin-
the nonworking side ically discernible when the mandible is directed superior
and anteriorly. It is restricted to a purely rotary move-
Bennett angle \Bĕn¢ĕt ăng¢gal\ obs: the angle formed
ment about the transverse horizontal axis (GPT-5) 2: the
between the sagittal plane and the average path of the
most retruded physiologic relation of the mandible to
advancing condyle as viewed in the horizontal plane
the maxillae to and from which the individual can make
during lateral mandibular movements (GPT-4)
lateral movements. It is a condition that can exist at
Bennett’s movement [Sir Norman Godfrey Bennett, British various degrees of jaw separation. It occurs around the
dental surgeon, 1870–1947]: see LATEROTRUSION terminal hinge axis (GPT-3) 3: the most retruded relation
Bennett NG. A contribution to the study of the move- of the mandible to the maxillae when the condyles are
ments of the mandible. Proc Roy Soc Med (Lond) in the most posterior unstrained position in the glenoid
1908;1:79–88 (Odont Section) fossae from which lateral movement can be made at any
given degree of jaw separation (GPT-1) 4: The most
bilateral balanced articulation: also termed balanced posterior relation of the lower to the upper jaw from
articulation, the bilateral, simultaneous anterior and which lateral movements can be made at a given verti-
posterior occlusal contact of teeth in centric and excen- cal dimension (Boucher) 5: a maxilla to mandible rela-
tric positions tionship in which the condyles and disks are thought to
bo·lus \bō¢lus\ n (1562): a rounded mass, as a large pill or be in the midmost, uppermost position. The position
soft mass of chewed food has been difficult to define anatomically but is deter-
mined clinically by assessing when the jaw can hinge on
border movement \bôr¢der mōōv¢ment\: mandibular a fixed terminal axis (up to 25 mm). It is a clinically
movement at the limits dictated by anatomic structures, determined relationship of the mandible to the maxilla
as viewed in a given plane when the condyle disk assemblies are positioned in
their most superior position in the mandibular fossae
brux·ism \brŭk-sı̆z¢em\ n (ca. 1940): 1: the parafunctional
and against the distal slope of the articular eminence
grinding of teeth 2: an oral habit consisting of involun-
(Ash) 6: the relation of the mandible to the maxillae
tary rhythmic or spasmodic nonfunctional gnashing,
when the condyles are in the uppermost and rearmost
grinding, or clenching of teeth, in other than chewing
position in the glenoid fossae. This position may not
movements of the mandible, which may lead to occlusal
be able to be recorded in the presence of dysfunction of
trauma—called also tooth grinding, occlusal neurosis
the masticatory system 7: a clinically determined
canine protected articulation \kā¢nı̄n pra-tĕk¢tid är- position of the mandible placing both condyles into their
tı̆k¢ya-lā¢shun\: a form of mutually protected articula- anterior uppermost position. This can be determined
tion in which the vertical and horizontal overlap of the in patients without pain or derangement in the TMJ
canine teeth disengage the posterior teeth in the excur- (Ramsfjord)
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138 PART I PLANNING AND PREPARATION
Boucher CO. Occlusion in prosthodontics. J PROS- de·tru·sion \dē-trōō¢shun\ n: downward movement of the
THET DENT 1953; 3:633–56. Ash MM. Personal com- mandibular condyle
munication, July 1993.
de·vi·a·tion \dē¢vē-ā¢shun\ n (15c): with respect to move-
Lang BR, Kelsey CC. International prosthodontic
ment of the mandible, a discursive movement that ends
workshop on complete denture occlusion. Ann Arbor:
in the centered position and is indicative of interference
The University of Michigan School of Dentistry, 1973.
during movement
Ramsfjord SP. Personal communication, July 1993.
disk-condyle complex \dı̆sk-kŏn¢dı̄l, -dl kŏm¢plĕks¢\: the
Christensen’s phenomenon \Krı̆s¢chen-senz fı̆-nŏm¢a-
condyle and its disk articulation that functions as a
nŏn¢, -nen\ [Carl Christensen, Danish dentist and edu-
simple hinge joint
cator]: eponym for the space that occurs between
opposing occlusal surfaces during mandibular protrusion disk \dı̆sk\ n (1664): with respect to the temporo-
Christensen C. The problem of the bite. D Cosmos mandibular joint, the avascular intraarticular tissue—
1905;47:1184–95. spelled also disc
clench·ing \klĕn¢chı̆ng\ vt (13c): the pressing and clamp- dis·oc·clu·sion \dı̆s′a-kiōō′zhen\ vb: separation of opposing
ing of the jaws and teeth together frequently associated teeth during eccentric movemets of the mandible—see
with acute nervous tension or physical effort DELAYED D., IMMEDIATE D.
click·ing \klı̆¢kı̆ng\ n (611): a series of clicks, such as the dynamic relations \dı̄-năm¢ı̆k rı̆-lā¢shunz\ obs: relations of
snapping, cracking, or noise evident on excursions of the two objects involving the element of relative movement
mandible; a distinct snapping sound or sensation, usually of one object to another, as the relationship of the
audible (or by stethoscope) or on palpation, which mandible to the maxillae (GPT-4)
emanates from the temporomandibular joint(s) during
dys·func·tion \dı̆s-fŭngk¢shun\ n (ca. 1916): the presence
jaw movement. It may or may not be associated with
of functional disharmony between the morphologic form
internal derangements of the temporomandibular joint
(teeth, occlusion, bones, joints) and function (muscles,
condylar path \kŏn¢da-lar păth\: that path traveled by the nerves) that may result in pathologic changes in the
mandibular condyle in the temporomandibular joint tissues or produce a functional disturbance
during various mandibular movements
eccentric \ı̆k-sĕn¢trı̆k\ adj (14c): 1: not having the same
condylar path element \kŏn¢da-lar păth ĕl¢a-ment\: the center 2: deviating from a circular path 3: located else-
member of a dental articulator that controls the direc- where than at the geometric center 4: any position
tion of condylar movement of the mandible other than that which is its normal
position
coronoid process \kôr¢a-noid¢, kŏr¢- pro-sĕs\: the thin
triangular rounded eminence originating from the edge to edge articulation \ĕj tōō ĕj är-tı̆k¢ya-lā¢shun\:
anterosuperior surface of the ramus of the mandible—see articulation in which the opposing anterior teeth meet
HYPERPLASIA OF THE C.P. along their incisal edges when the teeth are in maximum
intercuspation
defective occlusal contact \dı̆-fĕk¢tı̆v a-klōō¢sal kŏn¢tăkt¢\
obs: contact that is capable of guiding the mandible elevator muscle \ĕl¢a-vā¢ter mŭs¢el\: one of the muscles
from its original path of action into a different path of that, on contracting, elevates or closes the mandible
motion or capable of disturbing the relation between a
envelope of function \ĕn¢va-lōp ŭv fŭngk¢shun\: the
denture base and its supporting tissues (GPT-1)
three-dimensional space contained within the envelope
delayed disclusion \dı̆-lād¢ dı̆s-klōō¢shun\: deferred sepa- of motion that defines mandibular movement during
ration of the posterior teeth due to the anterior guidance masticatory function and/or phonation
dental articulation \dĕn¢tl är-tı̆k¢ya-lā¢shun\: the contact envelope of motion \ĕn¢va-lōp ŭv mō¢shun\: the three-
relationships of maxillary and mandibular teeth as they dimensional space circumscribed by mandibular border
move against each other—usage: this is a dynamic process movements within which all unstrained mandibular
movement occurs
determinants of mandibular movement \dı̆-tûr¢ma-
nent\: those anatomic structures that dictate or limit e·ro·sion \ı̆-rō¢zhun\ n (1541): 1: an eating away; a type of
the movements of the mandible. The anterior determi- ulceration 2: in dentistry, the progressive loss of tooth
nant of mandibular movement is the dental articulation. substance by chemical processes that do not involve
The posterior determinants of mandibular movement bacterial action producing defects that are sharply
are the temporomandibular articulations and their asso- defined, wedge-shaped depressions often in facial and cer-
ciated structures vical areas—comp ABFRACTION, ABRASION, ATTRITION
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Chapter 4 PRINCIPLES OF OCCLUSION 139
group function \grōōp fŭngk¢shun\: multiple contact rela- intercondylar distance \ı̆n¢ter-kŏn¢da-lar dı̆s¢tans\: the
tions between the maxillary and mandibular teeth in distance between the occluding surfaces of the maxillary
lateral movements on the working side whereby simul- and mandibular teeth when the mandible is in a specific
taneous contact of several teeth acts as a group to dis- position
tribute occlusal forces in·ter·fer·ence \ı̆n¢ter-fîr¢ans\ n (1783): in dentistry, any
Hanau’s Quint [Rudolph L. Hanau, (1881–1930) Buffalo, tooth contacts that interfere with or hinder harmonious
New York, U.S. engineer, born Capetown, South Africa]: mandibular movement
rules for balanced denture articulation including incisal isometric contraction \ı̄¢sa-mĕt¢rı̆k kon-trăk¢shun\: mus-
guidance, condylar guidance, cusp length, the plane of cular contraction in which there is no change in the
occlusion, and the compensating curve described by length of the muscle during contraction
Rudolph Hanau in 1926
Hanau R. Articulation defined, analyzed, and formu- lateral condylar path \lăt¢ar-al kŏn¢da-lar păth\: the
lated. J Am Dent Assoc 1926;13:1694–709. path of movement of the condyle-disk assembly in the
joint cavity when a lateral mandibular movement is
horizontal plane \hôr¢ı̆-zŏn¢tl, hŏr- plān\: any plane
made
passing through the body at right angles to both the
median and frontal planes, thus dividing the body into lateral mandibular relation \lăt¢ar-al măn-dı̆b¢ya-lar rı̆-
upper and lower parts; in dentistry, the plane passing lā¢shun\: the relationship of the mandible to the maxil-
through a tooth at right angles to its long axis lae in a position to the left or right of the midsagittal
plane
horizontal overlap \hôr¢ı̆-zŏn-tl, hŏr¢- ō¢ver-lăp¢\: the pro-
jection of teeth beyond their antagonists in the horizon- lateral movement \lăt¢ar-al mōōv¢ment\ obs: a movement
tal plane from either right or left of the midsagittal plane (GPT-4)
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140 PART I PLANNING AND PREPARATION
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Chapter 4 PRINCIPLES OF OCCLUSION 141
mylohyoid concavity \mı̄¢la-hoid kŏn-kăv¢ı̆-tē\: the fossa occlusal disharmony \a-klōō¢zal, -sal dı̆s-hăr¢ma-nē\: a
in the mandible below the mylohyoid line in the molar phenomenon in which contacts of opposing occlusal
region surfaces are not in harmony with other tooth contacts
and/or the anatomic and physiologic components of the
my·o·cen·tric \mı̄¢a-sĕn¢trı̆k\ adj: that terminal point in
craniomandibular complex
space in which, with the mandible in rest position, subse-
quent colonic muscle contraction will raise the mandible occlusal wear \a-klōō¢zal, -sal wâr\: loss of substance on
through the interocclusal space along the myocentric opposing occlusal units or surfaces as the result of attri-
(muscle balanced) trajectory. Also described as the initial tion or abrasion
occlusal contact along the myocentric trajectory (isotonic
closure of the mandible from rest position)
occlusion \a-klōō¢shun\ n (1645): 1: the act or process of
closure or of being closed or shut off 2: the static rela-
Jankelson B. Dent Clin North Am 1979;23:157–68.
tionship between the incising or masticating surfaces of
Jankelson BR, Polley ML. Electromyography in clinical
the maxillary or mandibular teeth or tooth analogues—
dentistry. Seattle: Myotronica Research Inc, 1984:52.
see CENTRIC O., COMPONENTS OF O., ECCENTRIC O.,
myogenous pain \mı̄¢a-jēn¢ŭs\: deep somatic muscu- LINE OF O., LINEAR O., MONOPLANE O., PATHOGENIC
loskeletal pain originating in skeletal muscles, fascial O., SPHERICAL FORM OF O.—comp ARTICULATION
sheaths, or tendons
open occlusal relationship \ō¢pan a-klōō¢zal, -sal rı̆-
neck of the condylar process \nĕk ŭv tha kŏn¢dah lĕr prŏ lā¢shun-shı̆p¢\: the lack of tooth contact in an occluding
sĕs\: the constricted inferior portion of the mandibular position—see ANTERIOR O.O.R., POSTERIOR O.O.R.
condylar process that is continuous with the ramus of the
opening movement \ō¢pa-nı̆ng\ obs: movement of the
mandible; that portion of the condylar process that con-
mandible executed during jaw separation; movement
nects the mandibular ramus to the condyle
executed during jaw separation (GPT-1)—see ENVELOPE
nonworking side \nŏn-wûr¢kı̆ng sı̄d\: that side of the OF MOTION
mandible that moves toward the median line in a lateral
para·func·tion \păr¢a-fŭngk¢shun\ adj: disordered or per-
excursion. The condyle on that side is referred to as the
verted function
nonworking side condyle
pathogenic occlusion \păth¢a-jĕn¢ı̆k\: an occlusal rela-
nonworking side condyle \nŏn-wûr¢kı̆ng sı̄d kŏn¢dı̆l\: the tionship capable of producing pathologic changes in the
condyle on the nonworking side
stomatognathic system
nonworking side interference \nŏn-wûr¢kı̆ng sı̄d ı̆n¢tar- posterior \pŏ-stîr¢ē-ar, pō-\ adj (1534): 1: situated behind
fîr¢ans\: undesirable contacts of the opposing occlusal or in back of; caudal 2: in human anatomy, dorsal
surfaces on the nonworking side
posterior border movement \pŏ-stîr¢ē-ar, pō- bôr¢dar
noxious stimulus \nŏk¢shas stı̆m¢ya-las\: a tissue damag- mōōv¢mant\: movements of the mandible along the
ing stimulus posterior limit of the envelope of motion
oc·clu·sal \a-klōō¢zal, -sal\ adj (1897): pertaining to the posterior determinants of mandibular movement
masticatory surfaces of the posterior teeth, prostheses, \pŏ-stîr¢ē-ar, pō- dı̆-tûr¢ma-nant ŭv măn¢dı̆b-ū-lar
or occlusion rims mōōv¢mant\: the temporomandibular articulations
occlusal balance \a-klōō¢zal, -sal băl¢ans\: a condition in and associated structures—see DETERMINANTS OF
which there are simultaneous contacts of opposing teeth MANDIBULAR MOVEMENT
or tooth analogues (i.e., occlusion rims) on both sides of posterior determinants of occlusion: see DETERMI-
the opposing dental arches during eccentric movements NANTS OF MANDIBULAR MOVEMENT
within the functional range
progressive mandibular lateral translation \pra-grĕs¢ı̆v
occlusal contact \a-klōō¢zal, -sal kŏn¢tăkt¢\: 1: the touch- măn-dı̆b¢ya-lar lăt¢ar-al trăns-lā¢shun\: 1: the translatory
ing of opposing teeth on elevation of the mandible 2: any portion of mandibular movement when viewed in a
contact relation of opposing teeth—see DEFLECTIVE O.C, specified body plane 2: the translatory portion of
INITIAL O.C mandibular movement as viewed in a specific body
plane that occurs at a rate or amount that is directly pro-
occlusal device \a-klōō¢zal, -sal dı̆-vı̄s¢\: any removable
portional to the forward movement of the nonworking
artificial occlusal surface used for diagnosis or therapy
condyle—see MANDIBULAR TRANSLATION
affecting the relationship of the mandible to the maxil-
lae. It may be used for occlusal stabilization, for treat- proprioception \prō¢prē-ō-sĕp¢shun\ n (1906): the recep-
ment of temporomandibular disorders, or to prevent tion of stimulation of sensory nerve terminals within
wear of the dentition the tissues of the body that give information concerning
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142 PART I PLANNING AND PREPARATION
movements and the position of the body; perception used to keep in place and protect an injured part 2: a
mediated by proprioceptors rigid or flexible material used to protect, immobilize, or
restrict motion in a part—see ANDERSON S., CAP S.,
pro·tru·sion \prō-trōō¢zhan\ n (1646): a position of
ESSIG S., FUNCTIONAL OCCLUSAL S., GUNNING’S S.,
the mandible anterior to centric relation—see
INTERDENTAL S., KINGSLEY S., LABIAL S., LINGUAL
LATEROPROTRUSION
S., PROVISIONAL S., RESIN-BONDED S., SOFT S.,
protrusive condyle path \prō-trōō¢sı̆v kŏn¢dı̄l¢, -dl păth\: SURGICAL S., WIRE S.
the path the condyle travels when the mandible is
static relation \stăt¢ı̆k rı̆-lā¢shun\: the relationship
moved forward from its initial position
between two parts that are not in motion
pterygoid plates \tĕr¢ı̆-goid¢ plātz\: broad, thin, wing- stomatognathic system \stō-măt¢a-nā¢thı̆k sı̆s¢tum\: the
shaped processes of the spheroid bone separated by the combination of structures involved in speech, receiving,
pterygoid fossa. The inferior end of the medial plate ter- mastication, and deglutition as well as parafunctional
minates in a long curved process or hook for the tendon actions
of the tensor veli palatini muscle. The lateral plate gives
attachment to the medial and lateral pterygoid muscles synovial fluid \sı̆-nō¢vē-al flōō¢ı̆d\: a viscid fluid contained
in joint cavities and secreted by the synovial membrane
retrodiscal tissue \rĕt¢rō-dı̆s¢kal tı̆sh¢ōō\: a mass of loose,
highly vascular and highly innervated, connective tissue temporomandibular disorders \tĕm¢pa-rō¢măn-dı̆b¢ya-lar
attached to the posterior edge of the articular disk and dı̆s-ôr¢derz\: 1: conditions producing abnormal, incom-
extending to and filling the loose folds of the posterior plete, or impaired function of the temporomandibular
capsule of the temporomandibular joint—called also bil- joint(s) 2: (obs) a collection of symptoms frequently
aminar zone observed in various combinations first described by
Costen (1934, 1937), which he claimed to be reflexes
retruded contact position \rı̆-trōō¢dı̆d kŏn¢tăkt pa- due to irritation of the auriculotemporal and/or chorda
zı̆sh¢an\: that guided occlusal relationship occurring at tympanic nerves as they emerged from the tympanic
the most retruded position of the condyles in the joint plate caused by altered anatomic relations and derange-
cavities. A position that may be more retruded than the ments of the temporomandibular joint associated with
centric relation position loss of occlusal vertical dimension, loss of posterior tooth
re·tru·sion \rı̆-trōō¢shun\ vb: movement toward the posterior support, and/or other malocclusions. The symptoms can
include headache about the vertex and occiput, tinnitus,
re·tru·sive \rı̆-trōō¢sı̆v\ adj: denotes a posterior location pain about the ear, impaired hearing and pain about the
ro·ta·tion \rō-tā¢shun\ n (1555): 1: the action or process tongue—acronym TMD
of rotating on or as if on an axis or center 2: the move- temporomandibular joint \tĕm¢pa-rō¢măn-dı̆b¢ya-lar
ment of a rigid body in which the parts move in circular joint\: 1. the articulation between the temporal bone
paths with their centers on a fixed line called the axis of and the mandible. It is a bilateral diarthrodial, bilateral
rotation. The plane of the circle in which the body moves ginglymoid joint 2: the articulation of the condylar
is perpendicular to the axis of rotation process of the mandible and the intraarticular disk with
sag·it·tal \săj¢ı̆-tl\ adj (1541): situated in the plane of the the mandibular fossa of the squamous portion of the
cranial sagittal suture or parallel to that plane—usage: see temporal bone; a diarthrodial, sliding hinge (ginglymus)
SAGITTAL PLANE joint. Movement in the upper joint compartment is
mostly translational, whereas that in the lower joint
sagittal plane \săj¢ı̆-tl plān\: any vertical plane or section compartment is mostly rotational. The joint connects the
parallel to the median plane of the body that divides a mandibular condyle to the articular fossa of the tempo-
body into right and left portions ral bone with the temporomandibular disk interposed
silent period \sı̄¢lant pı̆r¢ē-ad\: a momentary electormyo- terminal hinge axis: see TRANSVERSE HORIZONTAL
graphic decrease in elevator muscle activity on initial AXIS
tooth contact presumably due to the inhibitory effect of
stimulated periodontal membrane receptors
TMD: acronymfor TemporoMandibular Disorders—see
TEMPOROMANDIBULAR DISORDERS
speaking space \spē¢kı̆ng spās\: the space that occurs
trans·la·tion \trăn-zı̆sh¢an, -sı̆sh¢-\ n (14c): that motion of
between the incisal or/and occlusal surfaces of the max-
a rigid body in which a straight line passing through any
illary and mandibular teeth during speech
two points always remains parallel to its initial position.
1
splint \splı̆nt\ n (14c): 1: a rigid or flexible device that The motion may be described as a sliding or gliding
maintains in position a displaced or movable part; also motion
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Chapter 4 PRINCIPLES OF OCCLUSION 143
translatory movement \trăns-lă¢tōr-ē\ obs: the motion of ally disclusive angles. II. Study of a population. J
a body at any instant when all points within the body are Prosthet Dent 63:536, 1990.
moving at the same velocity and in the same direction 8. Hayasaki H, et al: A calculation method for the
(GPT-1) range of occluding phase at the lower incisal point
during chewing movements using the curved mesh
transverse horizontal axis \trăns-vûrs¢, trănz-, trăns¢vûrs¢,
diagram of mandibular excursion (CMDME). J
trănz¢-\: an imaginary line around which the mandible
Oral Rehabil 26:236, 1999.
may rotate within the sagittal plane
9. Lundeen HC, Gibbs CH: Advances in Occlusion.
traumatogenic occlusion \trou¢ma-ta-jĕn¢ı̆k a-klōō¢zhun\ Boston, John Wright PSG, 1982.
obs: an occluding of the teeth that is capable of produc- 10. Ogawa T, et al: Inclination of the occlusal plane and
ing injury to oral structures (GPT-4) occlusal guidance as contributing factors in masti-
cation. J Dent 26:641, 1998.
vertical axis of the mandible \vûr¢tı̆-kul ăk¢sı̆s ŭv tha
11. Wickwire NA, et al: Chewing patterns in normal
măn¢dı̆-bal\: an imaginary line around which the
children. Angle Orthod 51:48, 1981.
mandible may rotate through the horizontal plane
12. Lavigne G, et al: Evidence that periodontal pres-
vertical overlap \vûr¢tı̆-kal ō¢var-lăp\: 1: the distance soreceptors provide positive feedback to jaw
teeth lap over their antagonists as measured vertically; closing muscles during mastication. J Neurophys-
especially the distance the maxillary incisal edges extend iol 58:342, 1987.
below those of the mandibular teeth. It may also be used 13. Burnett CA, Clifford TJ: Closest speaking space
to describe the vertical relations of opposing cusps 2: the during the production of sibilant sounds and its
vertical relationship of the incisal edges of the maxillary value in establishing the vertical dimension of
incisors to the mandibular incisors when the teeth are in occlusion. J Dent Res 72:964, 1993.
maximum intercuspation 14. Pound E: The mandibular movements of speech
and their seven related values. J Prosthet Dent
wear facet \wâr făs¢ı̆t\: any wear line or plane on a tooth
16:835, 1966.
surface caused by attrition
15. Pound E: Let /S/ be your guide. J Prosthet Dent 38:
working side \wûr¢kı̆ng sı̄d\: the side toward which the 482, 1977.
mandible moves in a lateral excursion 16. Howell PG: Incisal relationships during speech. J
Prosthet Dent 56:93, 1986.
working side contacts \wûr¢kı̆ng sı̄d kŏn¢tăkts\: contacts
17. Rivera-Morales WC, Mohl ND: Variability of
of teeth made on the side of the articulation toward
closest speaking space compared with interoc-
which the mandible is moved during working
clusal distance in dentulous subjects. J Prosthet
movements
Dent 65:228, 1991.
18. Duckro PN, et al: Prevalence of temporomandibu-
lar symptoms in a large United States metropolitan
area. Cranio 8:131, 1990.
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