OCCLUSION

1. Please define Maximum Intercuspation?

➢ It is the most closed complete interdigitation of mandibular and maxillary
teeth irrespective of condylar centricity. In other words, maximum
intercuspation may or may not coincide with centric occlusion, depending
on the position of the condyle.

If in maximum intercuspation the condyles are physiologically centered,

then both the maximum intercuspal position and the centric occlusion
position are the same.

However, if maximum intercuspation occurs with the condyles being out

of centricity, then both positions would not coincide, with the maximum
intercuspation in that case, referred to as the habitual closure, and is
considered as an eccentric position. In that case the intercuspal position is
in a position forward to the centric position, and at a lower vertical
dimension.

2. Please describe Mandibular Lateral Excursion Movement: The

Working Side, The Non-Working, Side, Bennett Movement?
➢ The mandible is capable of moving towards both the right and left sides.
The side to which the mandible moves is called the working side, while
the opposite side is called the non-working side.
❖ The Working Side:
- This is the side on which we chew.
- The condyle on the working side is called the rotating
condyle. It rotates in its fossa with a little downward and
backward movement, rotating against the superior and
posterior walls of the glenoid fossa.
- The buccal cusps of upper and lower molars line up, with the
lower buccal stamp cusp moving from its centric position in
the fossa of the opposing upper tooth towards the buccal
along the buccal groove, while the upper stamp cusp move
lingually along the lower lingual groove.
 - During this movement, any contact that would exist between
the lower buccal cusps or the upper palatal cusps with their
opposers would be considered as working side interferences.
❖ The Non-Working Side:
- This is the side opposite to where we chew.
- The condyle on the non-working side is called the orbiting or
translating condyle.
- The condyle moves medially till it comes in contact with the
medial wall of the glenoid fossa, then moves downwards,
forwards and medially, on the superior and medial walls of
the fossa.
- The palatal cusps of upper molars line up with the buccal
cusps of lower molars.
- The buccal cusps of the lower teeth moving lingually, from
their centric position across the oblique palatal grooves of
their upper opponent, while the upper palatal cusps move
buccally through the oblique buccal grooves of their lower
opponent
- During this movement, any contact that would exist between
the lower buccal cusps or the upper palatal cusps with their
opposers would be considered as non-working side
interferences.
❖ Bennett Movement
- This is the lateral bodily movement of the rotating (working)
condyle, with medial movement of the orbiting
(non-working or translating) condyle.
- The medial wall of the glenoid fossa on the non-working
side determines the amount of this movement. The
non-working condyle moves medially till it is in contact with
the medial wall.
- The Initial side shift: occurs during the initial 2 mm of the
anterior movement. The average initial side shift is 1.7mm
medially. There is more medial movement than there is
anterior movement .
- The Progressive side shift: occurs after the initial side shift,
the curve of the medial wall of the glenoid fossa begins to
straighten, there is more anterior movement with little
 medial movement Total side shift = Initial side shift +
Progressive side shift
- The Bennett Angle: angle formed between the mid-sagittal
plane and the medial wall of the glenoid fossa on the
non-working side (7-8 degrees)
3. Please define Overbite and Overjet?
➢ Teeth are so arranged in our jaws such that forces of mastication would be
transmitted along their long axes. In addition the anterior teeth show a
state of overlap in which the mandibular arch is contained within the
maxillary arch.
➢ This overlap may be either an Overbite (vertical overlap of the maxillary
incisors over the mandibular incisors)
➢ An Overjet (horizontal overlap of the maxillary incisors over the
mandibular incisors).
4. Please describe Stamp Cusps and Shear Cusp?
➢ From a coronal or frontal view of a section of the post canine teeth, the
lingual cusps of the upper teeth stamp into the fossae of the lower teeth
and the buccal cusps of the lower teeth stamp into the fossae of the upper
teeth.
➢ The lingual cusps of the upper teeth and the buccal cusps of the lower
teeth are therefore called Stamp Cusps.
➢ The buccal cusps of the upper teeth and the lingual cusps of the lower are
called the Shear Cusps, which is because they pass closely by the stamp
cusps on their way to occlusion to shear the food.
➢ A stamp cusp constitutes about 60% of the bucco-lingual dimension of a
molar, while the shear cusp constitutes the remaining 40%.
5. Please describe Closure Stoppers and Equalizers?
➢ By looking from the Sagittal view, we will notice that the closure of the
mandible does not occur in a straight upward movement but rather in a
curve. As the lower teeth come in contact with the upper teeth, contacts
occur between mesial inclines of lower teeth and distal inclines of uppers.
These contacts are called: Closure Stoppers. This is actually what they
do: they stop the closure of the mandible.
➢ At the same time, simultaneously, the distal inclines of the lowers come
in contact with the mesial inclines of the uppers. These contacts are
known as the Equalizers. Their function is to equalize the stoppers so that
torque would not be exerted on the teeth.
➢ If the closure of an Equalizer is simultaneous with the closure of the
Closure Stopper, then the closure forces are equal and opposite. If the
Equalizer contacts in closure before the Closure Stopper, the Equalizer
becomes a deflector of the closure.
➢ It is very important to the interdigitation of the occlusion to have
simultaneous contacts between the Equalizers and Closure Stoppers in
Centric Occlusion.
➢ From a Horizontal view, the closure stoppers, equalizers, A, B, and C
contacts are so arranged in centric occlusion in such a way that they form
pinpoint simultaneous contacts, in Tripods of three points of contacts in
each fossa.
➢ These tripods of interocclusal contacts are immediately separated or
discluded in any eccentric movements. Upon protrusive, right or left
lateral movements, the centric contacts are immediately discluded into the
depressions or grooves.
6. Please describe Concepts of Unilateral Balanced Occlusion?
➢ This type of occlusion is seen when all the facial ridges of teeth on the
working side contact their opposers, while those on the nonworking side
do not.
➢ This concept is characterized by:
- Applying the theory of Long Centric.
- All working side teeth share lateral forces during lateral
movements
- Nonworking side teeth are free from contacts during lateral
movements
➢ It was felt that all working side teeth should share and bear the lateral
pressures during lateral movements by eliminating the nonworking
contacts. However, the pressure differences in molars as compared to
anterior teeth were not thought of. The lateral pressure on a canine is
approximately one-eighth that on a second molar. By that, a molar would
bear a much greater burden than a canine, and as such, all teeth would not
be sharing the same amount of load.
➢ To summarize:
- On the working side: canine and post canine teeth are in contact
with their opposers.
- On the nonworking side: no contacts exist between teeth.
 - This type of occlusion is found naturally, and may cause wear and
mobility
7. Please describe Concepts of Organic Occlusion?
➢ This is a therapeutic type occlusion that was introduced by Stuart and
Stallard in 1972, as an approach for treatment in full mouth
reconstructions.
➢ Stuart and Stallard studied patients over 60 years of age, without attrition
and studied their occlusion.
➢ It was observed that molars did not contact during eccentric movements
but only in maximum intercuspation, while the anterior teeth had no
contacts. The molars were responsible for bearing the vertical occlusal
loads. It was concluded that anterior teeth protect the posterior teeth and
the posterior teeth protect the anteriors.
➢ The criteria set forth were: Cuspid protected occlusion.
- Fossa relation
- Simultaneous contact of posterior teeth in centric.
- Anterior teeth are in contact in the protrusive movement.
- Tripoding of the stamp cusps as they occlude in their opposing
fossae.
8. Please define articulators?
➢ An Articulator is a mechanical instrument capable of maintaining
opposing casts in their correct interocclusal relationship while allowing
certain mandibular movements to be simulated. This device acts as the
patient in his absence.
➢ The number of achievable mandibular movements and the accuracy of
reproduction are used to classify different types of articulators.
9. Please define Centric Occlusion?
➢ This is a relation between the lower and the upper teeth, that is, it is a
tooth-to-tooth relation. Defined as being the occlusion of teeth as the
mandible closes in centric relation. It is a reference point from which all
other relations are eccentric.
10.Please describe Mandibular Movements?
➢ With the condylar rotation and translation, the mandible is capable of
performing the following movements:

1-Opening

2-Protrusive
 3-Lateral Excursions: right and left

For studying the mandibular movements, we will always start from the
starting point of centric occlusion.

11.Please describe Mandibular Protrusive Movement?

➢ For this movement to occur, Condyles follow the form of the superior
wall of the glenoid fossa, they slide downwards and forwards as the
mandible moves in protrusion. This movement causes the separation of
the posterior teeth, a state known as Disclusion.

During this movement, the opposing inclines of the teeth should not touch
each other. The palatal cusp of the upper molar travels distally from its
centric position in the central fossa of the lower opposing tooth, while the
buccal cusp of the lower travels mesially across the central groove of the
upper opposing tooth.

The cusp angle should be in harmony with the angle that the condyle
travels during the protrusive movement, or else a protrusive interference
would exist. The steeper this angle, the more allowable cuspal angle, the
longer the cusps and the deeper the fossae.

12.Please define Incisal Guidance?

➢ The incisal guidance is defined as the inclination of the lingual surfaces
of the upper six anterior teeth. Both the horizontal and vertical Overjet
and Overlap influence it.
➢ The incisal guidance is the predominating factor on occlusion, when
compared to the condylar guidance. This is due to the fact that the incisal
control is in a closer proximity to occlusion, and that it is made of hard
non-resilient tooth structure as opposed to the condylar controls that
contain compressible elements.
➢ The inclined planes of the posterior teeth must be in full coordination
with the incisal guidance
13.Please describe A, B, C Contacts?
➢ From the Frontal view, we will find a contact between the upper shearing
buccal cusps and the lower buccal stamp cusps. This contact is called an
A contact. Any contact between the buccal cusps of the post canine teeth
is an A contact.
➢ The contact between the lingual stamp cusp of the upper and the buccal
stamp cusp of the lower is called a B contact. In other words, the common
contact between the stamp cusps is a B contact.
➢ A third contact exists between the upper lingual stamp cusp and the
lower lingual shear cusp. This is called a C contact. Any contact between
the lingual cusps of the post canine teeth is a C contact.
➢ If we obtain an A and a B contacts in centric occlusion without the C, or
if we obtain a B contact with a C contact without the A, we will still have
good stability. This is because the closure forces will still be within the
perimeter and in the long axis of the teeth.
➢ However, if we obtain an A and a C contacts without the B in centric, the
parallelogram of force will be toward the buccal of the upper and the
lingual of the lower.
➢ In other words, if the B contact is not obtained, we will have a case of
malocclusion, or an unstable centric. The B contacts are the most difficult
to obtain and the most difficult to maintain and without them we have
malocclusion.
14.Please describe the unit of occlusion?
➢ The unit of occlusion is a cusp in a fossa. This cusp has in its fossa a
working groove through which it moves in a working movement. It also
has an idling or nonworking groove through which it idles in a
non-working movement when the opposite side is working.
➢ It also posses an idling protrusive groove, through which it passes
through during the protrusive movement.
➢ These grooves serve as pathways in the fossae for their cusps to move
freely and disclude in any eccentric movements.
➢ The cusp in a fossa must have interocclusal contact: closure stoppers and
equalizers in the sagittal plane, it must also have an A, B and a C
interocclusal contacts in the frontal plane. Looking on this contact from
the horizontal plane a resultant three-point contact between the cusp and
fossa should exist.
➢ This is what we call Tripodization of a cusp in a fossa; it supplies
occlusion stability mesio-distally as well as bucco-lingually.
15.Please describe Concepts of Long Centric: Occlusion?
➢ Long centric or “Freedom in Centric” is an occlusal concept, in which a
flat region is built between the retruded position and the maximum
intercuspation, without a change in the vertical dimension.
➢ This flat region, having a length of 0.5-1mm, gives the mandible freedom
to close in Centric or slightly anterior to it without any interference.
Schuyler first introduced this concept in the 1930’s.
➢ According to him the reasons for such a line of treatment were:
- The fit of the condyle into the disc is not like the fit of a
mechanical ball into its bearing, in other words, there is some front
to back movement within the boundaries of the disc.
- There is a difference that exists between a firm and a light closure.
In a firm closure there is strong contraction of the elevator muscles
pulling the condyles to the back of the disc. In a light closure, there
is insufficient pull by the muscles to completely place the condyle
at the back of the disc. These leads to a situation were there is a
difference between the firm and light terminal hinge closures.
- There is a difference in closure according to the patient’s posture
16.Please describe Fully Adjustable Articulators?
➢ These instruments can provide the greatest amount of accuracy. They are
capable of accurately reproducing all mandibular movements both in
direction and form.

The movements are recorded and reproduced on the articulator from the
point of initiation to the point of termination, that is they are capable of
reproducing the entire character of movements including that of the
immediate and the progressive side shifts, the direction and inclination of
condylar movements, and the intercondylar distance.

The fully adjustable articulators can reproduce all mandibular movements

so accurately that Stuart described it as a (Gnathological Computer). The
word Programming the articulator is used to denote adjusting the
articulator to the individual readings of a patient, as if a computer was
programmed.

These articulators are expensive, and the technique requires a great

degree of skill and is time consuming

17.Please describe Arcon Articulators?

➢ An Arcon articulator refers to that category of semi-adjustable
articulators in which the design is anatomically normal. The condyles are
attached to the lower member, while the condylar control is attached to
the upper member.

These articulators are available in two different models, with the condylar
guidance having either a straight or a curved pathway. Having this
advantage of using a curved pathway for the condyles, although still
arbitrary, would make the movements of the condyles more close to
normal, than would the straight line pathway.
 The curvature of the superior wall has a fixed curvature equivalent to a
circle with a 0.75- inch radius, while the medial surface forms a fixed
angle of 7 degrees with the mid-sagittal plane of the skull. The
intercondylar distance is adjustable to three different sizes: small (96mm),
medium (110mm), and large (124mm).

A facebow is used to mount the upper cast. The horizontal condylar

inclinations are set by means of lateral and protrusive interocclusal
records. The amount of side shift is set by means of lateral interocclusal
record.

The upper and lower members are mechanically attached by means of a

spring latch assembly, and can be separated from each other during
operation.

The Arcon articulators are capable of reproducing both the immediate and
the progressive side shifts.

These articulators also have the capability of accepting a terminal hinge

axis transfer, made with a mandibular facebow. This would make the use
of articulator more accurate as it would be possible to mount the upper
casts at a relation with the actual hinge axis of the patient.

18.Please define TMJ?

➢ The craniomandibular articulation and the capabilities of movements and
limitations of the TMJ are very important to the dental profession,
especially in the field of Prosthodontics.
➢ This is due to the fact that there is a relationship between the motion of
the condyles and the positioning of artificial teeth and the allowable
occlusal morphology of restored teeth.
19.Please define Centric Relation?
➢ Centric relation is a bone-to-bone relation. It is the relation between the
maxilla and the mandible when the Condyles are in the rear most upper
most mid most in the Glenoid fossae (known as the “rum” position). It is
a relation where the condyle is in a hinge position.

It may also be defined as the untranslated hinge position of the mandible

in its relation to the maxilla. More simply, it may be defined as the
physiologic centering of the condyles in the cranium. At this centered
position, there is an absence of translation.
 The most recent definition is that “the centric relation is the
maxillo-mandibular relationship in which the condyles articulate with the
thinnest avascular portion of their respective disks with the complex in
the anterior-superior position against the shapes of the articular
eminencies”

20.Please describe 2 basic Condylar Movements: Rotation and

Translation?
➢ 1-Rotation

Rotation is the motion of a body around its axis. Mandibular rotation

occurs in the lower compartment of the T M J, between the mandibular
Condyle and the articular disc.

Mandibular rotation occurs around the rotational centers of the condyles.

The Hinge Axis: is the imaginary line connecting the rotational centers of
one condyle with that of the opposite condyle, and around which the
mandible makes the opening and closing rotational movements.

➢ 2-Translation

Translation is the movement of a body when all its parts move at the
same time. Mandibular translation occurs in the upper compartment of
the TMJ between the disc and the glenoid fossa.

In mandibular translation, there is a change in the relationship of the

condyle and its articular disc with the articular fossa.

21. Please describe Mandibular Opening Movement?

➢ For this movement to occur, the condyle rotates in its place, in the
terminal hinge position. Pure rotation occurs only till the condyles start to
translate moving out of its centricity. Upon rotation of the condyle, the
mandible opens, and teeth are discluded.

As soon as the pure rotation ends, the condyle begins to translate, moving
forward and downward on the superior and anterior walls of the glenoid
fossa, with the arc of opening changing, and the mandible opening further
till the maximum opening position

22. Please describe Posselt’s Envelope of Motion?

➢ Posselt described the influence of tooth contact on mandibular
movements. He traced a point on the incisal edge of a mandibular incisor.
 By this tracing, he came up with what is called “Posselt’s envelope of
motion”.
➢ The upper extent of this envelope is a product of tooth contact, while the
movements of the mandible along all other borders of the envelope and
movements within it are without tooth contact, and are controlled by the
cranio-mandibular articulation (TMJ), and the muscles of mastication
23. Please describe Concepts of Bilateral Balanced Occlusion?
➢ Balanced occlusion is characterized by having all teeth in contact both in
centric occlusion and during all eccentric mandibular movements. Since it
has simultaneous tooth contacts during eccentric movements, all the teeth
along with the TMJ share the lateral occlusal forces generated during
these movements.
➢ This theory was built on the basis that the forces generated are all
horizontal rather than vertical. Since these lateral forces are harmful to
the periodontium, and in order to reduce the lateral pressure, these forces
need to be distributed as widely as possible to limit their harmful effect.

In order to produce a full balance, it is sometimes necessary to increase

the vertical dimension to an intolerable limit.

This technique is both difficult to fabricate and to maintain.

➢ To summarize:
- All teeth contact each other during centric and all eccentric
movement.
- There is cross mouth and cross tooth contacts.
- It is not a healthy occlusion.
- Does not normally occur.
- Complete dentures are made with this type of occlusion for the
purpose of stability.
24.Please describe Concepts of Cuspid Protected (Mutually Protected)
Occlusion?
➢ This type of occlusion occurs when the posterior teeth protect the anterior
teeth in centric position. The centric stops on the posterior teeth also
prevent excess loading to be transferred to the TMJ.
➢ The anterior teeth protect the canine and the posterior teeth during the
protrusive movement, while the canine protects the incisors and posterior
teeth during lateral movements.
➢ D’Amico advocated the Canine guided occlusion in 1958, after
performing studies on the canines in animals and humans.
➢ He considered the canine as being the key of occlusion. This was based
on the facts that:
- The canine has a good, if not superb, crown-root ratio.
- The presence of the canine eminence formed of hard compact bone
surrounding the tooth.
- The location of the canine being far from the TMJ, thus receiving
less stress.
- The canine has many receptors in the periodontium.
➢ To summarize:
- Posterior teeth are in contact in the centric position.
- Anterior teeth guide the mandible in the protrusive movement.
- Canines guide the mandible in the lateral movements.
- Posterior teeth are separated and are not in contact in all eccentric
movements.
25. Please describe Semi-Adjustable Articulators?
➢ These articulators are anatomically nearly normal in size and design.
They can be adjusted to individually different mandibular movements.

Although they are more accurate than non-adjustable articulators, as they

are more normally sized, and capable of duplicating eccentric
movements, they still possess the disadvantage of being arbitrary. This is
due to the fact that the clinical information used to set these instruments
is recorded only at the starting and ending points of the movements, while
the character of the actual movement is duplicated on the articulator with
an average path.

➢ Another reason is that the upper casts are usually mounted to the upper
element of the articulator with a face bow that uses an arbitrary hinge
axis.

It should be clear that the semiadjustable articulators are capable of

approximately following the mandibular movements, however this
capability by no means should be considered accurate. Nevertheless, the
amount of accuracy is much greater than would be expected from a
non-adjustable articulator.

Finished restorations fabricated on these instruments need less intraoral

adjustments. The adjustments might be needed especially in eccentric
movements.
 With the Semi-Adjustable articulators being close to being normal in size,
both the arc of closure and the intercondylar distance of the lower
member are very close to that found in the skull. This would in return
minimize the adjustments that would be needed in a restoration upon
insertion in the mouth.

➢ Two designs of Semi-adjustable articulators are available, namely Arcon

and NonArcon.

The word Arcon is derived from the first halves of the words: Articulator
and Condyle.

The Arcon articulator would thus refer to an anatomically correct design,

while the NonArcon refers to an anatomically incorrect designed
articulator.

26.Please describe Non-Arcon Articulators?

➢ The NonArcon articulators have their condyles attached to the upper
member, while their condylar controls are attached to the lower member.

These articulators are available only with a straight condylar guidance

pathway. This would only allow the condyles to move in a straight line
during eccentric movements.

In addition, the Bennett movement or side shift can only be reproduced in

a straight progressive form, with no provision for the immediate shift.

The Hanau H2 articulator, an example for the Non-Arcon articulators has

a fixed intercondylar distance of 110 mm.

➢ It can accept a facebow transfer, relating the maxillary cast to the

rotational centers of the articulator. The lateral horizontal condylar
inclinations are simulated by means of a protrusive interocclusal record.

The amount of side shift is calculated from the lateral horizontal condylar
inclination and the vertical condylar posts are rotated accordingly.

➢ One point to be noted is that both the upper and lower members are
mechanically attached to each other by means of the condyles and their
guidances.