Occlusion-

 Today we hope to learn;

 To study mandibular movements
 To understand ‘occlusal’ definitions
 What makes the ‘Ideal occlusion’
 Symptoms of the ‘Deranged’ occlusion
Occlusion

 What is occlusion ?
 The position of the jaws:
 when teeth are in still----static occlusion
 When the teeth are moving--dynamic occlusion
 The maxilla does NOT move
 The mandible DOES
 So many occlusal positions are possible
The Determinants of
Occlusion
 Anterior Determinants
 The Teeth
 Their shape & position

 Posterior Determinants
 The Tempero-mandibular joint
 With the condyles, ligaments and muscles
 The Muscles of mastication
 And the controlling central nervous system
 Mandibular Movements
 The mandible can:

 Hinge
 Translate (slide)
 Lateral Rotation
 Side-shift
 Any combination of these
Mandibular Movements -
Hinge
The mandible can open aprox. 20mm about the
imaginary terminal hinge axis, running
through the two condyles
 Both condyles remain rear-most, upper-most
This is a reproducible position
 If there is no disease
Mandibular Movements - Hinge

axis
g e
Articular Hin
surface

condyle
Mandibular Movements
Translation or Slide
 Both condyles
Articular
move (slide) surface
down the
articular
eminence of the
temporal bone, condyle

without rotation
Mandibular Movements
Translation or Slide
 Mandibular Movements
Lateral Rotation
A combination movement, One condyle rotates
While the other condyle translates
 Mandibular Movements
Immediate Side-shift

The mandible can

make small lateral
movements,
Without rotation
or translation
Occlusion - A Few ‘Key’
Definitions
 Centric Relation
 Centric Occlusion
 Premature Contact
 Slide
 Lateral Excursion
 Protrusive Excursion
‘Key’ Definitions – CR or RCP
 Centric Relation, CR, also known as maxillomandibular
relationship, independent of tooth contact, in which the condyles
articulate in the anterior-superior position against the posterior
slopes of the articular eminences; in this position, the mandible is
restricted to a purely rotary movement; from this unstrained,
physiologic, maxillomandibular relationship, the patient can make
vertical, lateral or protrusive movements; it is a clinically useful,
repeatable reference position

 Deflective Occlusal Contact

a contact that displaces a tooth, diverts the mandible
from its intended movement or displaces a removable
denture from its basal sea
‘Key’ Definitions - CO or MIP
Centric Occlusion, CO, the occlusion of opposing teeth
when the mandible is in centric relation; this may or may
not be coincide with the maximal intercuspal position;

Retruded Contact , contact of a tooth or teeth along the

retruded path of closure; initial contact of a tooth or
teeth during closure around a transverse horizontal axis

Maximal Intercuspal Position

 the complete intercuspation of the opposing teeth
independent of condylar position, sometimes referred to
as the best fit of the teeth regardless of the condylar
position
Occlusion - A Few ‘Key’
Definitions
 Do you remember:
 The posterior determinants
 TMJ, ligaments, muscles
 The anterior determinants
 The teeth

 CR is determined by posteriors
 CO is determined by both
‘Key’ Definitions - Slide

 Slide is the movement from CR to CO

 A premature contact may occur in CR, and

the mandible then ‘slides’ into CO

 When the anterior determinants take over

from the posterior determinants
‘Key’ Definitions - Slide

 If a cusp tip occludes onto an

inclined plane, the mandible is
usually displaced anteriorly
 There may also be some lateral
displacement

 A classical example is the Class 3

patient with edge to edge bite, in
CR the patient contacts the
incisors, then postures into CO in
cross bite
 ‘Key’ Definitions - Excursion

 Lateral Excursion is the mandibular

movement where one condyle rotates and
the other translates

So in RIGHT lateral
excursion the R condyle
rotates and the L
condyle translates

Is this anterior or posterior determinants ?

 ‘Key’ Definitions - Excursion

 Protrusive Excursion
 is the mandibular movement where both condyles
translate together, without rotation

Also called ‘Posturing’

of the mandible

Is this anterior or posterior determinants ?

Occlusion – Guidance &
Contacts
 A few more commonly used terms:
 Working Side, WS
 Non Working Side, NWS
 Working Side Contact, WSC
 Non Working Side Contact, NWSC
 Balancing Contact
 Protrusive Contact
 Anterior Guidance
 Canine Guidance & Group Function
Occlusion – Guidance &
Contacts
 Working Side, WS
 Describes the side to which the mandible is
moving in lateral excursion

 Non Working Side, NWS

 Describes the opposite side to which the
mandible is moving in lateral excursion
Occlusion –Contacts

 Balancing Contact,
 Bilateral tooth contact on mandibular exc.
 Desirable in full denture cases

 Protrusive Contact,
 Tooth contact on the
 anterior teeth when
 the mandible is protruded
 Occlusion – Anterior
Guidance

Protrusive
Lateral Protrusive

Canine
Crossover
Mandibular Movements Posselt’s
diagram
 This diagram showsor the ‘envelope of
C F
movement’
position of the tip of a lower
central incisor in all extreme
B
G
mandibular movements, as
seen in the saggital plane D E

 A-B hinge axis A

 A-H open wide
 B-C slide CR to CO
 C-F anterior teeth
 F-G protrusion

H
 Occlusion – Guidance
 Canine Guidance

 Working side movement is guided ONLY by the

canine, ALL other teeth are discluded
 Considered the best form of guidance
Canine Guidance
 Occlusion – Guidance
 Group Function

 Working side movement is guided by a number of

teeth, usually canine & premolars, may even
include the molars
 Acceptable where the canine is non functional
Group function
 Occlusion – Guidance
 Functioning
 Inclines

Canine Guidance Group Function

The Ideal Occlusion
 Andrew’s Six Keys described the
 ‘Ideal Occlusion’ AJO 72;63:296
 Class1 Molars, no rotations, crowding or
spacing, with correct axial inclinations

 CR should be at, or very close to, CO

 Canine guidance with no NWSC
 Even protrusive contacts with complete
posterior disclusion
The Ideal
Occlusion
16
 Occlusal Contacts
 are Cusp to Fossa

 Provides Axial loading

46
The Non -Ideal
Occlusion

16
 Premature or NWS
contacts are detrimental
to posterior teeth
 as they produce non
axial, tilting forces 46
The Ideal Occlusion –from
Dawson
 In Centric Relation:

 — The bicuspids and molars touch simultaneously.

 — The forces are directed along the long axes of the teeth.
 —-The condyles are seated on the disc and are in their most
superior, unstrained positions and there are no deflective
contacts along that arc of closure.
— The anterior teeth are in light, passive contact.
 — When the jaw is clenched, the teeth do not deflect
The Ideal Occlusion –from
Dawson
 In Lateral Excursions:

 — The cuspids are the guiding teeth.

 -- If group function is appropriate, it is carried
by the cuspids and bicuspids.
 -- There are no balancing or non working side
contacts.
 — The most extreme position (crossover) is
borne by anterior teeth, with no
posterior contacts.
The Ideal Occlusion –from
Dawson
 In Lateral Protrusive contacts:
 --The maxillary lateral is not subjected to deflective forces.

 Straight Protrusive contacts:

 are borne equally by the two maxillary centrals.

 In Edge to Edge Positions:

 --The maxillary central incisors contact simultaneously.
 --The maxillary lateral incisor cannot be in exclusive contact.

 In the ‘Alert Feeding Position’ (head tilted 30 o forward):

 --There are no deflective contacts on the maxillary anterior teeth,
as the mandible closes in its acquired position.
 The Deranged Occlusion
 Caused by many factors;
 Misaligned teeth due to:
 Crowding / spacing
 Rotations
 Cross bite
 Malocclusions
 Poor Ortho treatment
 Perio disease with mobility
 Poorly fitting denture
 Partially erupted teeth
The Deranged Occlusion

 Caused by many factors;

 Misaligned teeth
 Loss of Tooth Shape due to:
 Caries
 Attrition /Abrasion / Erosion
 Fractures
 Poorly contoured restorations
 Poorly contoured crowns or bridges
The Deranged Occlusion

 Caused by many factors;

 Misaligned teeth
 Loss of Tooth Shape
 Missing Teeth due to:
 Impaction
 Failure to develop or erupt
 Extraction
Signs of a Deranged
Occlusion
 Many patients will tolerate small defects in their
occlusion (including a slide) for many years
without any problems
 It is within their adaptive capacity

 However there may come a time

 when they exceed their adaptive
 capacity, and some of the following
 symptoms are seen:
 Signs of a Deranged
Occlusion
 Repeated fracture of cusps or restorations
 Repeated decementation of crowns
 Severe loss of tooth structure, often with loss of
correct guidance
 Muscle tenderness and fatigue
 Trismus
 Headaches
 TMJ problems such as clicking or pain
Treatment of a Deranged
Occlusion
 Short -Medium Term Options
 Sympathy, Reassurance, Counseling, Therapy
 Occlusal Analysis
 Fitting a full coverage hard occlusal splint with built in correct
occlusion
 Selective occlusal grinding
 Recontouring of restorations
 Long Term Options
 Ortho tooth movement
 Full mouth reconstruction
Testing the Occlusion

 Testing for tooth to tooth contact

 is needed to establish the true nature of the
patients occlusion,
 both in mandibular closure,
and all excursive movements

How do we do it?
Testing the Occlusion

 Ask the patient while they are sitting up

 Don't rely on this, they may be numb or tired
 Observe, you may see WSC, not NWSC
 Use thin articulating paper
 Blue for centric, red for excursions
 Test grip with mylar strip or foil
 Use a finger to test for fremitus
So before our Tx. is
complete
 Have we fulfilled our aesthetic goals,
 and Andrews Six Keys

1. Class1 Molar relationship,

2. Crowns have correct angulation (tip)
3. Crowns have the correct inclination (torque)
4. There are no rotations,
5. Tight proximal contacts,
6. Flat or slight curve of Spee
 So before our Tx. is
 complete
Have we fulfilled Dawson’s functional guidelines?
 In Centric Relation:
 The pre/molars touch together.
 The forces are directed along the long axes of the teeth.
 The anterior teeth are in light, passive contact.
 When the jaw is clenched, the teeth do not deflect

 In Lateral Excursions:
 There is ideally canine guidance.
 Group function is OK if shared between canine and premolars
 There are no balancing or non working side contacts.

 In Protrusive and Edge to Edge contacts:

 --The upper laterals are not subjected to deflective forces.
 --The upper central incisors contact simultaneously
Occlusion- Conform or
Reorganise
 Before we start restorative work we need to
decide whether we wish to either:

 Conform to the existing occlusal situation

 or
 Reorganize the occlusion completely
 Occlusion-
 Today we have learned;
 To study mandibular movements
 To understand ‘occlusal’ definitions
 What makes the ‘Ideal occlusion’
 Symptoms of the ‘Deranged’ occlusion