Occlusion Textbook
Occlusion Textbook
Occlusion Textbook
com
OCCLUSION
Occlusion may be defined as:” The contact of the opposing surfaces
of teeth of the two jaws”.
T M J:
Anatomy
1 -Condyle
2-Glenoid Fossa
3- Articular Disc
Description
− Muscles of Mastication:
Masseter
Temporalis
Lateral Pterygoid
Medial Pterygoid
− TMJ Capsule
− Associated Ligaments
Tempromandibular
Sphenomandibular
Stylomandibular
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Definitions:
Centric Relation:
Centric Occlusion:
This is a relation between the lower and the upper teeth, that is,
it is a tooth-to-tooth relation.
Fig.2:
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Maximum Intercuspation:
Condylar Movements
1-Rotation
Fig.4:
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2-Translation
In mandibular translation,
there is a change in the relationship Fig.5:
of the condyle and its articular disc
with the articular fossa.
Mandibular Movements
1-Opening
2-Protrusive
3-Lateral Excursions: right and left
A-Opening Movement
B-Protrusive Movement
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.
Fig.8:
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 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
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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.
From the horizontal view, the effect of the posterior wall of the
fossa can be seen.
On the non-working
side, the condyle moves medially,
downwards and forwards, on the
medial wall of the glenoid fossa.
The stamp buccal cusps of the
lower molars move downwards,
anteriorly and medially, passing
through the oblique lingual non-
working grooves of the upper
molars without contact. The upper
palatal stamp cusps should pass
through the lower oblique non-
working grooves, also without Fig.12:
contact.(fig 12)
Side Shift
Fig.13:
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D-Inter-Condylar Distance
These are the factors found within the dentition that are capable
of affecting the mandibular movements.
1-Occlusal Plane
Fig.15:
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2-Curve of Spee
Incisal Guidance:
Occlusal Contacts:
-Types of 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.
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A stamp cusp constitutes about
60% of the bucco-lingual dimension
of a molar, while the shear cusp
constitutes the remaining 40%.(fig 20)
-A , B , C Contacts
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.
The B contacts are the most difficult to obtain and the most
difficult to maintain and without them we have malocclusion.
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Static Occlusion
Types of Occlusion Relationship:
Dynamic Occlusion
Concepts of Occlusion:
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.
To summarize:
-All teeth contact each other during centric and all eccentric
movement.
-Complete dentures are made with this type of occlusion for the
purpose of stability.
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.
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
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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.
Long Centric:
1-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.
-When teeth are in the way if the patients close normally, but are
fine when the mandible is pushed to the back.
-When teeth are fine when laying down, but are in the way
while sitting upright.
If a patient needs long centric and does not get it, the lower
incisors will strike the lingual inclines of the upper incisors causing
instability, followed by bruxism and clenching.
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.
To summarize:
Organic Occlusion:
1- Cusp-Fossa relation
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2- Simultaneous contact of posterior teeth in centric.
Occlusal Adjustments
Occlusal adjustment refers to selective recontouring and grinding
of teeth in order to remove prematurities.
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Indications:
1-Evidence of trauma from occlusion, by changes in the periodontium
2-Symptoms of TMJ dysfunction and habit neurosis (Bruxism)
3-Excessive tooth mobility
4-Excessive tooth wear
5-Need for extensive restorative work
6-Prerestorative treatment
Aim of Adjustment:
Our aim is to develop maximal intercuspation of teeth in the centric
relation. The post canine teeth should only contact in centric, while the
anterior teeth carry all eccentric contacts. This procedure follows the
criteria set forth in “Organic Occlusion”.
Articulators
In Fixed Prosthodontics
Introduction:
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Ever since man was able to make impressions of teeth and pour them into
positive molds, he has been seeking ways to instrumentate these casts.
With the understanding of the complexities of the masticatory system and the
impracticality of performing prosthetics directly on the patient, the profession has
sought instrumentation and recording devices to simulate the system and therefore
fabricate the prosthesis outside the mouth. This transferring vehicle seems to be the
essence of articulation and the development of recording devices and articulators.
Definition
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.
Uses of An Articulator:
Diagnostic
Occlusal Equilibration
Working
Types of Articulators
1-Non-Adjustable Articulators:
Simple Hinge: (Fig. 1)
Also known as the plain line or the straight line articulator. These types of
articulators possess the ability to produce opening and closing movements. The
centric occlusion and/or maximum intercuspation can be accurately recorded and
maintained, however no information regarding the eccentric movements of protrusive,
working and nonworking positions is available. These positions and movements can
not be duplicated on these instruments.
These articulators can permit some eccentric movements. They are limited in
the direction and form and can not be altered to accommodate individual patient
Fig. 2
Fixed condylar guidance
control articulators
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variations.
At the same time, because the intercondylar distance is by far smaller than that
in the skull, a finished restoration fabricated on such an articulator would have a non
working side interference.
2-Semi-Adjustable Articulators:
These articulators are anatomically nearly normal in size and design. They can
be adjusted to individually different mandibular movements.
Fig. 4. Semi-adjustable articulators record the starting and ending points of the movement, while the
actual character is duplicated with an average path.
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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. (Fig. 4)
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.
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. (Fig. 5a, b)
Fig. 5 a & b
Both the distance from
the cast to the rotational
axis of the articulator
and the inter condylar
distance are close to
those in the skull.
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.
Non-Arcon Articulators:
(Example: Hanau H2 Articulator)
(Fig. 6)
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.
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.
Arcon Articulators:
(Example: Whip Mix Articulator)
(Fig. 7)
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
midsagittal plane of the skull. The intercondylar distance is adjustable to three different
sizes: small (96mm), medium (110mm), and large (124mm).
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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.
This is used both to locate the actual hinge axis of a patient, using a mandibular
clutch fixed to the lower arch of the patient (referred to then, as a mandibular
facebow), and in relating the upper arch to the actual hinge axis of the skull, previously
located by the mandibular facebow. Upon mounting the upper casts with this record,
the actual relation between the maxilla and the terminal hinge axis is transferred
accurately to the articulator.
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b-The Average-Axis Facebow: (Fig. 9)
This face bow utilizes two posterior points as being the average points of the
hinge axis. The average points differ from one brand of articulator to another, so does
the third point of reference (the anterior point of reference).
In the case of the Hanau articulator the posterior reference points are points that are
13 mm away from the Tragus of the ear along the Tragus-Eye line, while the third,
anterior point of reference coincides with the lowermost point on the bony rim of the
orbit. While in the case of the Whip Mix articulator, the two posterior reference points
are the two external auditory meatuses, while the anterior reference point is the
Nasion.
In addition, this record may be made using a variety of materials, among which
are Wax, Polyvinyl Siloxane impression materials, Zinc Oxide and Eugenol registration
materials, and Auto-Polymerizing resin. For taking this record, the patient is instructed
to hold his teeth tightly in contact while the registration material sets.
On the other hand for mounting in centric relation position (Fig. 11), a recording
material is be placed between the teeth and the mandible guided in the closing
movement until the teeth contact the material without coming in contact with their
opposing teeth. By this, the centric record can be made away from the influence of
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centric prematurities that would deflect the mandible and slide it to close in the
maximum intercuspal position.
a-Protrusive Record:
This record can be made using wax, by guiding the mandible forward until the
lower anterior teeth are even with or just beyond the incisal edges of the maxillary
incisors. (Fig. 13) The mandible is then guided to close till the teeth indent the wax. It
is imperative that teeth should not penetrate the wax to the extent that upper and
lower teeth would get into contact. Such a contact would cause rocking of the
mandible and this record would be faulty.
This record is needed for an articulator such as the Arcon Whip-Mix Semi-
adjustable articulator, and is used to adjust the condylar control angle and the side
shift on the opposite side of the movement. A right excursion record would be used to
adjust the left control, while a left record would be used in adjusting the right control.
As noted, the condylar control angle is adjusted using two records: the
protrusive and the lateral excursive records. In the event that the two records would
give two different readings for the same condyle, the lower reading should be used for
that condyle. Another way of dealing with this situation is to adjust the control for each
movement separately by changing the angle each time upon performing that
movement on the articulator.
This advantage is practically seen when mounting a lower cast to the maxillary
cast using a centric relation record, where the registration material must have
sufficient thickness so that the teeth would not come in contact. The cast is in such a
case mounted in a raised vertical dimension than the working vertical dimension. After
removal of the centric relation record and closing the articulator, the angle between
the condylar pathway and the occlusal plane remains the same with an Arcon
articulator.
On the other hand, this is not the case with the Non-Arcon articulators, where
this angle is altered. A loss of about 8 degrees would be expected. This decreased
angle in the inclination of the condylar control would affect the cusp height, fossa
depth and angle of the cusp in the finished restoration.
It should be noted however that in registering the jaw relation for the
construction of complete dentures, the centric relation record is taken at the working
vertical dimension. This will in return lead to the stability of the angle between the
Fig.19 Fully
Adjustable Articulators
Description:
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.
For making the centric relation record, an anterior resin jig is used to hold the
teeth slightly out of contact .It is formed around the maxillary central incisors and
shaped so that it would form a ramp with an upward lingual slope.
By the use of malleable metal, shaped to conform to the arch, the centric
relation is registered with Zinc Oxide-Eugenol registration paste. Other materials may
also be used for that record, however the choice of the paste is for accuracy reasons.
(Fig. 21)
c-Pantographic tracings:
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The pantograph (Fig. 22) consists of two facebows, one affixed to the maxilla
while the other to the mandible, with the use of clutches that are attached to the teeth.
The tracings are made by styli attached to one member and small tables upon
which the tracings are drawn attached to the other member, opposite the styli. There
are posterior vertical and horizontal tables on both right and left sides, along with two
anterior tables, one on each side. The patient is instructed to move his mandible
through protrusive, right and left lateral excursion movements, while the styli scribe on
their opposing tables the paths followed by the condyles in those movements.
Fig. 23 a,
b
by the styli on their tables, that is following the paths of the condyles in their
movements.
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Computerized systems have also been developed. A print out is obtained and used to
program the articulator. The computerized systems closely resembles the manual
pantograph and are much more economical as regards time, as the transfer stage is
eliminated.
For programming the articulator, the clutches are transferred to it, and it is
moved to follow along the paths formed by the cut out areas. The condyles of the
articulator are made to mold auto-polymerizing resin, previously placed in the
articulator fossae. This enables the original jaw movements to be reproduced when
the clutches are removed.
Requirements of an Articulator:
The requirements as stated by Winkler were described as the minimal
requirements necessary for fabricating complete dentures to the patient s centric
position and to a balanced occlusion. These were:
A more recent list for requirements of an articulator were listed by Hobo and
(11)
Takayama , and were related to the purpose needed from an articulator.
According to both Hobo and Takayama, the purpose of an articulator is to establish
centric relation and to reproduce mandibular eccentric movements.
In order to establish proper centric relation, an articulator must be equipped
with a reliable centric latch.
Effectiveness of an Articulator
It can be concluded that the effectiveness of any articulator depends on:
1. How well the operator understands its purpose and its construction.
2. How enthusiastic he is for that particular instrument.
3. How well he understands the anatomy of the joints, their movements and the
neuromuscular system.
4. How much precision and accuracy are used in registering jaw relations.
5. How sensitive the instrument is to these records.
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There has always been that controversy as to which articulator would be
considered the best. It must be clear that the person using the articulator is more
important than the instrument itself. If a dentist does understand the instrument and its
deficiencies, he can compensate for its inherent inadequacies.
It was Dawson s understanding that the simpler the articulating device, the
more compensations must be made for its shortcomings, but if compensations can be
made easily and accurately, there is practical value in keeping the instrumentation as
simple as possible.