Occlusion The Gateway To Success.2

Invited Review Occlusion: The gateway to success
Bhuvaneswaran Mohan, Dhanasekaran Sihivahanan

Department of Conservative Dentistry and Endodontics, SRM Kattankulathur Dental College and Hospital,
SRM University, Potheri, Kancheepuram Dist, Tamilnadu, India.
Downloaded from http://journals.lww.com/joid by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AW
Address for correspondence: Dr. Bhuvaneswaran Mohan, E‑mail: [email protected]
ABSTRACT
nYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC1y0abggQZXdtwnfKZBYtws= on 10/10/2023
Success of our clinical procedures is not a single‑day entity, but instead survival on a long‑term basis. The clinical longevity of
our work is dependent on so many factors and when we have a closer look, all these ultimately depend on the occlusal stability.
The word occlusion itself creates aversion for almost all and very conviently we try to avoid the occlusal principles thinking
that we have to bother about the principles only for tempeoro‑mandibular joint disorder patients. In an irony, it is true that the
principles of occlusion have to be applied in our day‑to‑day practice to be successful. This article aims to simplify the principles
of occlusion so that the readers develop interest in this most rewarding subject. Also, the clinical implication of the occlusal
concepts and the treatment modalities are explained to give the readers an insight into how important this subject is for our
day‑to‑day practice.
CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

(1) Important to understand the principles of occlusal harmony, to have a better approach to clinical examination, treatment
panning. And problem solving for any restorative cases.
(2) The failure to embrace sound occlusal principles leads to a plethora of fringe‑type treatment modalities and unnecessary
overtreatment.
(3) If the signs of occlusal disease can be easily observed at the earliest stages, the progression of the damage can be
intercepted.
(4) Not respecting the dento‑facial system may result in restoration, prosthesis, or periodontal treatment failures, along
with relapse of orthodontic and orthognathic surgeries.
Key words: Comprehensive dentistry, occlusal discrepancies, occlusion, temperomandibular joint
INTRODUCTION examination, treatment, and problem solving takes

on a new perspective. It is a perspective that pays
A t every level of general practice, a dentist

routinely faces problems of sore teeth,
excessive wear, loose teeth, tempeoro‑mandibular
huge dividends of predictability and increased
productivity, regardless of the type of practice.
Attempting to restore an occlusion, correcting a bite
joint (TMJ) disorders and orofacial pain. A dentist problem, or even reshaping a high restoration without
who does not have a working knowledge of occlusal knowing the precisely correct maxillary‑mandibular
principles must resort to guesswork and time‑wasting relationship, can be a time‑wasting, frustrating, and
trial and error attempts to solve problems. Even unnecessary experience.[1,2]
achieving predictable function and beauty of smile
Even though an understanding of occlusal principles
design is dependent on incorporation of sound
has value to every level of dental practice, there is
occlusal principles. When principles of occlusal
a pervasive misconception that concepts of dental
harmony are understood, the entire approach to
occlusion are not relevant to everyday dentistry.
Access this article online
The failure to embrace sound occlusal principles
Quick Response Code: has also led to a plethora of fringe‑type treatment
Website: modalities, unnecessary overtreatment, and denials
www.jidonline.com of responsibility for problems that are a direct result
of occlusal mismanagement.[1,2]
DOI:
10.4103/2229-5194.100597 A primary tenet of comprehensive dentistry is that
all of the components of the masticatory system are
68 Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2
Mohan and Sihivahanan: Occlusion
intimately related and dependent on one another for The goal of centric relation is a completely released inferior
ideal occlusion. A true understanding of occlusion and lateral pterygoid muscle on both sides. This is the essential
comprehensive dentistry is important for the predictability requirement for a peaceful, coordinated musculature. It
and longevity of all the beautiful restorations that dentist can only be achieved in the absence of deflective occlusal
create, and the overall comfort and functioning of their interferences to centric relation. In short, centric relation
patients. At this point, it is needless to mention that is bone‑to‑bone relationship.[7,8]
achieving a stable occlusion requires a multidisciplinary
approach and the specialist involved should have a sound Please remember that between bone and muscle war,
knowledge of the same. Today’s dentistry is shifting muscle never loses – Harry Sicher.
toward conservative and comprehensive dental care.[3,4]
Maximum intercuspation position
The objective of this article is to explore the role of occlusion

The tooth‑to‑tooth relationship in maximum contact is
in day‑to‑day practice, and to highlight the multispecialty
called as maximum intercuspation position (MIP). Earlier,
approach required in comprehensive dentistry.
this position was called as centric occlusion. The MIP might
not coincide with the centric relation and that is why the
TERMINOLOGIES terminology centric occlusion is obsolete.
To understand the concepts of occlusion, it is necessary that To highlight again, centric relation is bone‑to‑bone relation
certain terminologies are well understood. A thorough and maximum intercuspation is tooth‑to‑tooth relation.
knowledge of the anatomy of the TMJ and the surrounding All the problems related to occlusion begin when there
structures is, also equally important. A few of the is a mismatch between centric relation and maximum
important terminologies and their clinical importance intercuspation (MIP). If this mismatch is minor, then the
are listed here. TMJ adapts itself to MIP and this posture is called as
adapted centric posture.[9]
Centric relation
Adapted centric posture is the manageably stable
Definition: It is the relationship of the mandible to the relationship of the mandible to the maxilla that is
maxilla when the properly aligned condyle–disk assemblies achieved when deformed TMJs have adapted to a
are in the most superior position against the eminentiae, degree that they can comfortably accept firm loading
irrespective of vertical dimension or tooth position. when completely seated at the most superior position
against the eminentiae. Beyond this stage, the muscles
The centric relation refers to the fully seated condylar
try to knock off all the tooth interferences to go back to
position regardless of how the teeth fit. Centric
their position. When succeeded, tooth wear begins; if
relation is not just a convenience position that is
not, TMJ problem starts. This concept is known as Hit
used because it is repeatable. It is the universally
and Slide concept. This clearly explains the reason why
accepted jaw position because it is physiologically and
tooth wear pattern is just not an abrasion of enamel,
biomechanically correct and is the only jaw position
but the formation of wear facets in different sizes and
that permits an interference‑free occlusion. Because the
shapes [Figure 1]. When upper and the lower teeth
position of the condyle‑disk assemblies determines the
contact each other, only a total area of 4mm2 comes in
maxillary‑mandibular relationship during jaw closure, any
contact, if marked with an articulating paper, we would
variation in condylar position will change the closing arc of
get dots in the posterior and lines in the anterior. Most
the mandible teeth against the maxillary teeth. Recording
importantly, anterior stop is necessary for the stability of
of an accurate centric relation is critical for the most
posteriors in centric relation (inverted tripod concept).
cost‑effective, time‑effective, trouble‑free restorative or
When restoring teeth, all these have to be kept in mind
prosthetic dentistry.[5,6] The mandible is in centric relation
to achieve success [Figure 2].
if five criteria are fulfilled:
1. The disk is properly aligned on both condyles.
Anterior guidance
2. The condyle‑disk assemblies are at the highest
point possible against the posterior slopes of the Next to centric relation, the anterior guidance is the
eminentiae. most important determination that must be made when
3. The medial pole of each condyle‑disk assembly is one is restoring an occlusion. The success or failure of
braced by bone. many occlusal treatments hinges on the correctness of
4. The inferior lateral pterygoid muscles have released the anterior guidance. The anterior guidance has similar
contraction and are passive. importance in orthodontic treatment. The functional
5. The TMJs can accept firm compressive loading with movement of mandible constitutes the most fundamental
no signs of tenderness or tension. basis for ideal occlusal design. Every tooth in the mandible
Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 69

Figure 1: Occlusal wear facet

Figure 2: Maximum intercuspation contacts
(the only moving jaw) has an envelope of motion
(envelope of function) that outlines the outer limits of each prosthetic work should be to get the ideal position of the
lower tooth to be moved. During full range of anterior anteriors and establishing perfect anterior guidance.[6,7]
guidance, there should be no posterior interferences. As
the lower anterior slide out, all the posterior teeth should Vertical dimension of occlusion
be in complete dis-occlusion. Failure to properly establish
the correct guidance is a major cause of post‑treatment Definition: It is the vertical position of the mandible in
instability. One thing every dentist should know before relation to the maxilla when the upper and lower teeth
attempting to restore anterior teeth is that besides being are intercuspated at the most closed position.[10,11]
the key to esthetics, the anterior teeth are also the key
factor in protecting the posterior teeth. The relationship of The mandible‑maxilla relationship, established by the
the anterior teeth in function is the principle determinant repetitive contracted length of the elevator muscles,
of posterior occlusal form. The formula to analyze the determines the vertical dimension of occlusion (VDO).
anterior guidance: dots signify centric relation contact Even though the VDO occurs when the teeth are fully
only, on posterior teeth. Lines signify the role of the articulated, the teeth are not the determinants of vertical
anterior teeth to disclude the posterior teeth in all dimension. Rather their position is determined by the
excursions. vertical dimension of the space available between the fixed
maxilla and the muscle‑positioned mandible. There is an
There is no way to standardize anterior guidance. There ever‑present eruptive force that causes teeth to erupt until
are no cephalometric norms that work for all patients, and they meet an equal, opposite force. If the opposing force
there are no arbitrary guidelines for interincisal angulation is greater than the eruptive force, the teeth are intruded
that fit all patients. One of the most important concepts until the eruptive force equals the resistive force against
to understand about anterior guidance is that it is highly them. If the resistive force is less than the eruptive force,
variable from patient to patient. Minute changes can make the teeth will continue to erupt.[12,13]
a major difference in patient comfort, and slight mistakes
in incisal edge position can profoundly affect the stability The dimension of the jaw‑to‑jaw relationship is consistent
of the anterior teeth over time. enough that even severe bruxing, clenching, and abrading
parafunction do not alter the jaw‑to‑jaw dimension
In a perfected occlusion, the combination of condylar between bony landmarks in each jaw. Because of
guidance and anterior guidance determines the path elongation of the alveolar process, even severe abrasion of
that the mandible follows in function. In an ideal teeth does not cause a loss of vertical dimension. Patients
occlusal relationship, all contact by the posterior teeth is can wear their teeth down to the gum line and still not lose
determined by the combined border paths at both the front vertical dimension because the eruptive process matches
and back ends of the mandible. Thus, the anterior guidance the wear to maintain the original vertical dimension.
plays a dominant role in establishing the functional path
that the mandible can travel. In very rare situations, tooth wear supersedes the bone
formation and the VDO requires a change. If the VDO
Any disturbances seen in the palatal surface of anteriors must be changed, it should be determined at the point of
simply means that the anterior guidance is not proper. anterior teeth contact, and it should be changed as little as
Hence, the primary aim of any treatment restorative or necessary to reduce the requirements for adaptation to the

minimum. Changes in the true VDO are not permanent. makes it readily apparent why so many orthodontic
The VDO will return to its original dimension measurable results do not remain stable. It also explains why many
at the masseter muscle. post‑restorative problems occur and even why some
periodontal procedures are unsuccessful. Relapses with
Failure to understand the physiology and biomechanics of orthognathic surgery can almost always be explained by
vertical dimension will lead to inappropriate overtreatment neutral zone imbalance. Also, complete or partial denture
and result in iatrogenic damage to dentition and missed failures are often related to noncompliance with neutral
diagnosis of temperomandibular joint disorders [TMD].[14,15] zone factors. Regardless of the treatment, any part of the
dention out of harmony with the neutral zone will result
Vertical dimension at rest (VDR) in instability, interference with function, or some degree
of discomfort[17] [Figures 5 and 6].
When a muscle is neither hypotonic nor hypertonic, it is

said to be at rest. Even resting muscle is in mild state of Plane of occlusion
contraction. This mild contraction of antagonist muscles
is necessary to maintain the posture and alignment of the The term plane of occlusion refers to an imaginary surface
skeletal parts. Despite the popularity of using rest position that theoretically touches the incisal edges of the incisors
as a starting point for determining VDO, it is an unreliable and the tips of the occluding surfaces of the posterior teeth.
approach because the dimension between the teeth at the Together, the curve of Spee, the curve of Wilson, and the
rest position is not consistent for different patients. The curve of the incisal edges are properly referred to as the
rest position is not consistent even in the same patient. curve of occlusion[18] [Figure 7].
The rest position is also altered by the presence of any
noxious stimuli from occlusal interferences that can cause Curve of spee
varying degrees of muscle incoordination. The effects of It is the anterioposterior curvature of the occlusal surfaces,
masticatory muscle incoordination can range from slight beginning at the tip of the lower canine and following
hyper‑contraction to severe trismus, all of which can have the buccal cusp tips of the bicuspids and molars, and
a profound effect on the postural position of the mandible continuing to the anterior border of the ramus. The curve
at rest [16] [Figures 3 and 4]. of Spee aligns each tooth for maximum resistance to
functional loading. The long axis of each lower tooth is
Please remember that between teeth and muscle war, aligned nearly parallel to its arc of closure around the
muscle never loses – Peter E. Dawson. condylar axis.
Neutral zone Curve of monson

Definition: The potential space between the lips and cheeks If the curved line continued further back, it would ideally
on one side and the tongue on the other. follow an arc through the condyle. The curvature of the
arc would relate, on average, to part of a circle with a
Teeth are the most movable part of the masticatory 4‑inch radius. The posterior part of the occlusal plane will
system. If outward horizontal forces from the tongue always be flat enough and low enough to be discluded
are greater than inward forces exerted by the buccinator by the normal condylar path on its steeper eminentiae. It
muscle bands and the lips, the teeth will move is because of this geometric design that the 4‑inch radius
horizontally until the opposing forces are equal. This of the Monson curve works so effectively if the condyle
is the neutral zone. Understanding of the neutral zone is used for a survey point.
Figure 3: Compensation of bone for loss of VDO Figure 4: Changes in bone during loss of VDO

certain that the occlusal plane is correctly evaluated as a

part of every complete examination.
Curve of wilson
It is the mediolateral curve that contacts the buccal and
lingual cusp tips on each side of the arch. The curve
of Wilson results from inward inclination of the lower

posterior teeth. There are two reasons for this inclination
of posterior teeth. One has to do with resistance to loading
and the second has to do with masticatory function.
The form of the occlusal plane is directly related to specific

functional requirements. In addition to alignment of teeth
in relationship to the arc of closure for best resistance to
loading, it should permit ease of access for positioning of
Figure 5: Neutral zone role of tongue and cheeks
the food on the occlusal surfaces. The occlusal plane is a
critical consideration in solving many different problems
of occlusion. But if basic requirements for acceptability of
an occlusion plane are understood, resolution of problem
occlusions can be achieved more readily. When restoring
multiple teeth or rehabilitating using prosthesis removable
or fixed, it is very important that all these principles are
taken care of.[19,20]
TYPES OF OCCLUSION
For many years, the standard classification for occlusion has
been Angle`s classification of malocclusion. The problem
with Angle`s classification is that it does not consider TMJ
position or condition when relating the mandibular arch
to the maxillary arch. Analysis of any occlusion requires
Figure 6: Neutral zone tongue and lip careful inspection of MIP in relation to both the position
and condition of the TMJs. Probably, this is the reason
why sometimes, Angle`s Class I patients develop severe
TMJ problems and Angle`s Class III patients live happily
without any problems.
Dawson's classification
In the analysis of any occlusion in relation to the TMJs, the
condition and position of the TMJs must be determined
before the occlusion can be analyzed.[21‑24]
Type I: Maximal intercuspation is in harmony with centric

relation.
Type IA: Maximal intercuspation occurs in harmony with

adapted centric posture.
Figure 7: Plane of occlusion
Type II: Condyles must displace from a verifiable centric
relation for maximum intercuspation to occur.
The anterior posterior curvature of the occlusal plane is
designed to permit protrusive disclusion of the posterior Type II‑A: Condyles must displace from an adapted centric
teeth by the combination of anterior guidance and condylar posture for maximum intercuspation to occur.
guidance. Prevention of increased muscle loading on the
teeth and the joints is the dominant reason for making Type III: Centric relation cannot be verified.

Type IV: The occlusal relationship is in active stage of occlusal disease are readily recognized, then they respond
progressive disorder because of pathologically unstable to treatment at a high level of predictability.[25,26]
TMJs.
Lytle was the first to introduce the term occlusal disease.
Group function occlusion He defined it as “the process resulting in the noticeable
loss or destruction of the occluding surfaces of the
Refers to distribution of lateral forces to a group of teeth. teeth.” He postulated that the disease is primarily, but
not necessarily precipitated by bruxism or parafunction.

Group function of the working side is indicated whenever
Occlusal disease is deformation or disturbance of function
the arch relationship does not allow the anterior guidance to
of any structures within the masticatory system that are
do its job of discluding the non‑functioning side. Problems
in disequilibrium with a harmonious interrelationship
with group function result from improper harmony of the
between the TMJs, the masticatory musculature, and

contacting lines. Attempts at group function with convex
the occluding surface of the teeth. To appreciate the full
inclines are invitations to hypermobility. For group function
scope of occlusal disease, it is necessary to understand
to be effective in reducing stress, the cusp inclines must
how interdependent all parts of the masticatory system
be in perfect harmony with the lateral border movements
are. Any disharmony between the teeth, the muscles,
of the jaw. Incline interferences on posterior teeth get
and the TMJs is sufficient to cause stress, deformation,
progressively more stressful as they get closer to the
or dysfunction on any or all of the other parts in the
condyle fulcrum; a slight interference on a second molar
system.[27,28]
would probably be more stressful than a more noticeable
interference on a canine.
Basic mechanisms for tooth surface
Canine‑protected occlusion deformation
Refers to disclusion by the canines of all other teeth in According to Grippo et al., it is now apparent that
lateral excursions. It usually serves as the cornerstone of deformation of tooth structure results from three basic
what is called mutually protected occlusion. physical and chemical mechanisms that can act alone or
in combination.
When it is impractical to distribute the lateral guidance 1. Stress results in compression, flexure, and tension. It
stresses over several teeth, disclusion of the posterior can produce microfracture and abfraction as a dental
teeth can be accomplished by use of the canines in one manifestation.
form or another of canine‑protected occlusion. In natural 2. Friction includes abrasion from exogenous material
canine‑protected occlusions, the pattern of function is and attrition, which is endogenous. The end point of
rather vertical, and so the mandible does not use lateral both is wear of tooth surfaces.
movements that would subject the canines to stress in 3. Corrosion is the result of chemical or electrochemical
that direction either. The canines actually assume the role degradation.
more as a guidance that actuates vertical function rather
than as a resistor to lateral stress. These three basic mechanisms often overlap and interact
to accelerate structural damage to the teeth. Thus, much
Balanced occlusion of the structural deformation of teeth must be considered
as multifactorial.
The balanced occlusion originally referred to actual
balancing contact to stabilize the dentures on the side of Examples of occlusal disease[29]
the downward moving, orbiting condyle. When the same
1. Attritional wear: This type of wear on the lower
concept of balanced occlusion is applied to the natural
anterior teeth is one of the most common untreated
dention, it results in hypermobility, excessive wear, and
problems. The posterior teeth with deflective incline
periodontal breakdown. Bilaterally balanced occlusion
interferences to centric relation are so often the cause
does not work because there is no way to harmonize the
of a forward slide of the mandible during closure
balancing inclines of the teeth to all of the variations of
to maximum intercuspation. This forces the lower
muscle force against the unbraced orbiting condyle.
anterior teeth forward into a collision with the upper
anterior teeth.
OCCLUSAL DISEASE 2. Erosion of enamel: A combination of acid from fruit,
abrasion from mulling fruit between end‑to‑end
It is a puzzling observation that the most prevalent anterior contacts, and attrition from bruxing produces
evidence or damage to teeth is so routinely ignored. invagination of incisal enamel.
The signs of occlusal disease are so easily observed even 3. Splayed teeth: Splaying of teeth is a common sign of
at the earliest stages when progression of the damage occlusal disease that should be diagnosed and treated
can usually be intercepted. If the signs and symptoms of early by eliminating the deflective interferences that

force the mandible forward. Improperly contoured or periodontal treatment, and relapse of orthodontic and
restorations that are too thick on the lingual of orthognathic surgeries are nothing, but not respecting the
the upper anterior teeth or overcontoured lower dentofacial system.[32]
restorations are common cause of splaying.
4. Destroyed dentition: This is the result of not A proper diagnosis considering all the etiological factors
intercepting occlusal disease early. Signs of severe will avoid most of the failures in day‑to‑day practice.
wear, fractured maxillary and mandibular teeth, and Let it be restorative treatment, prosthetic rehabilitation,
elongated alveolar process are typical. or a periodontic surgery, all concepts of occlusion have
5. Advanced occlusal disease: This disease results to integrate to achieve success and all these branches
from a combination of attritional wear and moved of dentistry are interrelated and the specialists have to
teeth. This is occlusal disease left undiagnosed and work in harmony. The main aim of any treatment should
untreated until the late stage of progressive damage be to make sure that the teeth are positioned in centric
has occurred. relation and all our final restorations have to be in this
6. Anterior guidance attrition: This occurs when anterior position too.[33,34]
teeth that interfere either with centric relation closure
or with functional jaw movement patterns develop Treatment planning
early signs of attritional wear of the lingual enamel
Step 1: To confirm if there is a discreprency between
on upper anterior teeth.
centric relation and MIP.
7. Sore teeth: Compression of periodontal ligaments
can be combined with pulpal hyperemia to cause Step 2: Deprogramming of the patient if the discreprency
considerable soreness or pain on biting. If empty mouth is seen with anterior bite plane, Lucia jig, and Pankey jig.
clenching causes any discomfort in a tooth, it is an
indication that the sore tooth is in occlusal interference. Step 3: Once the muscles are deprogramming, recording
8. Hypermobility: An early sign of occlusal disease the centric relation with face bow transfer is done.
is tooth hypermobility. It can result in widened
periodontal space and greater susceptibility to Step 4: Finding out the occlusal discr epancy in
periodontal disease. semi‑adjustable articulators.
9. Painful musculature: A common symptom of
occlusal disease results from disharmony between Step 5: Correction of the discrepancy in the mouth.
the occlusion and the TMJs. Deflective occlusal
interferences that require the jaw joints to displace The periodontal treatment can be initiated at this phase.
to achieve maximum intercuspation are a potent After completing the periodontal treatment, once again
cause for painful masticatory musculature. Occlusal the steps 3‑5 have to be carried out to make sure that
overload can cause excessive wear, hypermobility, there are no occlusal discreprencies. This is because
fractured cusps, and hypersensitivity. during periodontal treatment, the teeth may change their
positions. It is well known that occlusal discreprencies
CLINICAL CONSIDERATIONS could be the primary etiology for periodontitis, but
the reason for failure of properly done periodontal
By now, it is very clear that the science behind a rehabilitation is nothing, but not taking care of the
beautiful smile is not as simple as what we think. The above‑mentioned factors.[35]
dentist of today must become a physician of the total
masticatory system.[30] this is not surprising because The restorative and the prosthetic work will start after
knowledge about occlusion‑related issues is essential to stage 5. It is needless to say that periodontal treatment
good clinical practice in all disciplines. The loss of tooth precedes all rehabilitation work.
structure is the first sign that any clinician should keep
a watch to control the occlusal disease. We all know Step 6: Temporization of patient with prototype
that signs precede symptoms, hence if the patient is restorations.
symptomatic; it simply means that a lot of destruction
Prototype restorations are nothing, but the exact replica
has already happened.[31]
of the final restorations.
Loss of enamel resulting in attrition, both in anteriors Step 7: Follow‑up of the patient with temporaries.
and posteriors, is not a minor issue to be neglected. As Correcting occlusal discreprencies of temporaries in both
discussed earlier, the occlusal diseases are a result of centric and eccentric position.
improper positioning of teeth. When unattended, this will
result in periodontal destruction and ultimate loss of tooth Step 8: If the patient is comfortable and temporaries are
structure. The reasons for failure of restorations, prosthesis, stable, then proceed to permanent restorations.

Figure 8: Improperly done fixed dental prosthesis Figure 9: Another case of improperly done fixed dental prosthesis
Figure 10: Severe attrition of anterior and posterior teeth Figure 11: Prototype restorations done on the lower posterior teeth
Figure 12: Occlusal view of the prototype restoration Figure 13: Severe attrition of lower posteriors
Figure 14: Table top restorations Figure 15: Cemented table top restorations

Step 9: Make replica of the temporaries (prototype) 2. McNamara JA, Seligman DA, Okeson JP. Occlusion, orthodontic
and communicate to the lab to make per manent treatment, and temperomandibular disorders. A review. J Orofacial
Pain 1995;9:73‑90.
restoration exactly resembling the temporaries. These
3. Greene CS. Orthodontics and temperomandibular disorders. Dent
final restorations, strictly speaking, should not have any Clin North Am 1988;32:529‑38.
changes in the mouth. 4. Lytle JD. The clinician`s index of occlusal disease; definition, recognition,
and management. Int J Periodont Rest Dent 1990;10:102‑23.
All these stages have to be followed for multiple 5. Williamson EH, Lundquist DO. Anterior guidance: Its effects on
restorative work, prosthetic reconstruction, and full mouth electromyographic activity of the temporal and masseter muscles.
J Prosthet Dent 1983;49:816‑23.
rehabilitation when an occlusal problem is diagnosed.
6. Graf H, Zander HA. Tooth contact patterns in mastication. J Prosthet
If not, all restorative and prosthetic procedures have to Dent 1963;13:1055‑66.
incorporate steps 6‑9 to make sure that we do not induce 7. Gilboe D. centric relation as the treatment position. J Prosthet Dent
an occlusal problem. 1983;50:685‑9.

8. Dawson PE. Optimum TMJ condyle position in clinical practice. Int J
Figures 8 and 9 shows improperly done fixed prosthesis, Periodontics Restorative Dent 1985;3:11‑31.
which had resulted in severe TMD and periodontal 9. Dawson PE. New definition for relating occlusion to varying conditions
of the temperomandibular joint. J Prosthet Dent 1995;75:619‑27.
destruction. Figure 10 shows severe occlusal disturbance
10. Hellsing G. functional adaptation to changes in vertical dimension.
with all anterior and posterior destruction. Figures 11 J Prosthet Dent 1984;52:867‑70.
and 12 show the picture of a patient undergoing 11. Prombonas A, Vlessides D, Molyvdas P. the effect of altering the
rehabilitation with prototype restoration. Figure 13 vertical dimension on biting force. J Prosthet Dent 1994;71:139‑43.
shows severe attrition of lower posterior teeth due to 12. Crothers A, Sandham A. Vertical height differences in subjects with
severe mismatch of centric relation and MIP. It is general severe dental wear. Euro J Orthod 1993;15:519‑25.
tendency to perform root canal therapy and restore them 13. Gibbs CH, Mahan PE. Occlusal forces during chewing: Influences of
biting strength and food consistency. J Prosthet Dent 1981;46:561‑7.
with ceramic crowns. Since root canal treatment and
14. Reigh JD. Vertical dimension: A study of clinical rest position and
crowns will not solve patient’s primary problem, root jaw muscle activity. J Prosthet Dent 1981;45:670
canal therapy in such cases is not at all warranted and is 15. Silverman MM. determination of vertical dimension by phonetics.
considered as improper diagnosis and treatment planning. J Prosthet Dent 1956;6:463.
Figure 14 shows the replica of prototype with press and 16. Pound E. the vertical dimension of speech: The pilot of occlusion.
stain ceramic restorations. Figure 15 shows individual J Calif Dent Assoc 1978;6:42‑7.
17. Stallard H. the anterior component of force of mastication and
table top restorations cemented in all the lower posteriors.
its significance to the dental apparatus. Dent Cosmos 1923;
Patient is now completely rehabilitated in accordance with 65:457‑74.
centric relation. The reasons for success and failure are very 18. Boucher DO. Current status of prosthodontics. J Prosthet Dent
vivid now. The failure, not necessary to be a catastrophic 1960;10:418.
one, might range from a fracture of single composite 19. Craddock HL, Lynch CD, Fraulsin P. A study of the proximity of the
restoration, chipping of the ceramic crowns, debonding Broodrick ideal occlusal curve to the existing occlusal curve in dental
patients. J Oral Rehabil 2005;32:895‑900.
of the fixed prosthesis to the complete instability of partial
20. Monson GS. Applied mechanics to the theory of mandibular
and full dentures and also unscrewing of implants.[36] movements. Dent Cosmos 1932;74:1039.
21. Dawson PE. Centric relation: Its effect on occluso‑muscle harmony.
Dent Clin North Am 1979;23:169‑180.
CONCLUSION 22. Dawson PE. A classification system for occlusion that relates
maximal intercuspation to the position and condition of the
temperomandibular joints. J Prosthet Dent 1996;75:60‑6.
The subject of occlusion has to be given much more
23. Seligman DA, Pullinger AG. The role of functional occlusal
importance in our day‑to‑day practice. Instead of finding relationships in temperomandibular disorders. J Craniomandib Disord
out the reasons for the failure of our procedures, it is better 1991;5:265‑79.
to understand and respect the dentofacial system to avoid 24. Roth RH. Functional occlusion for the orthodontist. J Clin Orthod
such failures. Within the limitation of this article, we have 1981;5:32‑51.
discussed the basics of occlusion and its role in day‑to‑day 25. Grippo Jo, Simring M, schreiner S. Attrition, abrasion, corrosion and
abfraction revisited: A new perspective on tooth surface lesions.
practice. Also, the importance of interdisciplinary approach
J Am Dent Assoc 2004;135:1109‑18.
to this problem and treatment protocol has been briefly 26. Abrahamsen TC. The worn dention‑pathognomnic patterns of
explained. When all these concepts are followed, success abrasion and erosion. Int Dent J 2005;4:268‑76.
is sure to come. 27. Miller WD. Experiments and observations on the wasting of tooth
tissue variously designated as erosion, abrasion, chemical abrasion,
and denudation. Dental Cosmos 1907;XLIX:1‑23.
REFERENCES 28. Coleman TA, Grippo Jo, Kinderknecht KE. Cervical dentin
hypersensitivity. Quintessence Int 2003;34:427‑4.
1. Goodman P, Greene CD, laskin DM. Response of patients with 29. Dawson PE. Functional occlusion. Missouri: Mosby‑ 2007.
pain‑dysfunction syndrome to mock equilibration. J Am Dent Assoc 30. Dawson PE. Want a thriving practice? Concentrate on clinical
1976;92:755‑8. excellence. Dent Econ 1992;82:78‑9.

31. Alex G. Adhesive dentistry: Where are we today. Compend Contin complex aesthetic restorative cases. Pract Proced Aesthet Dent
Educ Dent 2005;26:152‑5. 2006;18:217‑24
32. Spear FM. The business of occlusion. J AM Dent Assoc 36. Terry DA, Moreno C, Geller W, Roberts M. The importance of
2006;137:666‑7. laboratory communication in modern dental practice: Stone
33. Tarantola GJ, Becker IM, Gremillion H, Pink F. The effectiveness models without faces. Pract Periodontics Aesthet Dent 1999;
of equilibration in the improvement of signs and symptoms in 11:1125‑32.
the stomatognathic system. Int J Periodontics Restorative Dent
1998;18:594‑603.
34. Spear FM, Kokich VG. Interdisciplinary management of anterior How to cite this article: Mohan B, Sihivahanan D. Occlusion: The gateway
dental esthetics. J Am Dent Assoc 2006;137:160‑9. to success. J Interdiscip Dentistry 2012;2:68-77.
35. Fondriest JF. Using provisional restorations to improve results in Source of Support: Nil, Conflict of Interest: None declared.
Announcement
“QUICK RESPONSE CODE” LINK FOR FULL TEXT ARTICLES

The journal issue has a unique new feature for reaching to the journal’s website without typing a single letter. Each article
on its first page has a “Quick Response Code”. Using any mobile or other hand-held device with camera and GPRS/other
internet source, one can reach to the full text of that particular article on the journal’s website. Start a QR-code reading
software (see list of free applications from http://tinyurl.com/yzlh2tc) and point the camera to the QR-code printed in the
journal. It will automatically take you to the HTML full text of that article. One can also use a desktop or laptop with web
camera for similar functionality. See http://tinyurl.com/2bw7fn3 or http://tinyurl.com/3ysr3me for the free applications.

Occlusion The Gateway To Success.2

Uploaded by

Copyright:

Available Formats

Occlusion The Gateway To Success.2

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Occlusion The Gateway To Success.2

Uploaded by

Copyright:

Available Formats

Invited Review Occlusion: The gateway to success

Bhuvaneswaran Mohan, Dhanasekaran Sihivahanan

Address for correspondence: Dr. Bhuvaneswaran Mohan, E‑mail: [email protected]

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

Key words: Comprehensive dentistry, occlusal discrepancies, occlusion, temperomandibular joint

INTRODUCTION examination, treatment, and problem solving takes

A t every level of general practice, a dentist

The objective of this article is to explore the role of occlusion

Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 69

Figure 1: Occlusal wear facet

70 Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2

When a muscle is neither hypotonic nor hypertonic, it is

Neutral zone Curve of monson

Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 71

certain that the occlusal plane is correctly evaluated as a

of Wilson results from inward inclination of the lower

The form of the occlusal plane is directly related to specific

Type I: Maximal intercuspation is in harmony with centric

Type IA: Maximal intercuspation occurs in harmony with

72 Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2

not necessarily precipitated by bruxism or parafunction.

between the TMJs, the masticatory musculature, and

Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 73

74 Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2

Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 75

an occlusal problem. 1983;50:685‑9.

76 Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2

“QUICK RESPONSE CODE” LINK FOR FULL TEXT ARTICLES

Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2 77

You might also like