GNATHOLOGICAL CONCEPT OF

OCCLUSION
PRESENTED BY-
DR. ANKITA TRIKHA
J.R.-3
DEPARTMNET OF
PROSTHODONTICS, CROWN AND
BRIDGE.
CHANDRA DENTAL COLLEGE AND
HOSPITAL
 CONTENTS
1. INTRODUCTION 8. MUTUALLY PROTECTED 9. AIMS AND OBJECTIVES OF GNATHOLOGY
OCCLUSION 10. PROCEDURE
2. DEFINTION
 PRE-REQUISITE OF MUTUALLY 11. GNATHOLOGY VERSUS PMS TECHNIQUE
3. GNATHOLOGICAL SOCIETY PROTECTED OCCLUSION 12. GNATHOLOGY VERSUS HOBO AND

4. McCOLLUM’S KEY  CANINE PROTECTED OCCLUSION TAKAYAMA CONCEPT

 WHY CANINE IS BEST SUITED 13. GNATHOLOGY VERSUS NEUROMUSCULAR
5. HISTORY OF GNATHOLOGY
 BIOMECHANICS OF CANINE APPROACH
6. EARLY GNATHOLOGICAL PROTECTED OCCLUSION 14. LIMITATIONS OF GNATHOLOGY
THEORY 9. FUNDAMENTALS OF 15. SUMMARY

7. FINAL GIST OF GNATHOLOGY 16. REFERENCES

GNATHOLOGICAL PRINCIPLES  CENTRIC RELATION

 ANTERIOR GUIDANCE
 OCCLUSAL VERTICAL DIMENSION
 INTERCUSPAL POSITION
 INTRODUCTION
• Though the primary function of teeth is mastication, teeth are not chewing organs by
themselves. They are capable of performing their function only when it is used
collectively with the other components of the stomatognathic system which include the
maxilla, mandible, the TMJ’s , the teeth with their investing periodontal membranes,
and the neuromuscular mechanism.

• These are collectively known as the masticatory apparatus and should be treated as
one unit which is the goal of Gnathology
 DEFINITION

• Gnathos", meaning jaw and "ology", meaning study of, or knowledge of

• Gnathology- A general term for the study of the biology of the masticatory
mechanism and the kinetic recording of mandibular position. Gpt-9

• Gnathology is more than a technique, it is the science and study of mandibular

movement, jaw relationships, tooth morphology and their functional requirements for
a harmonious, self maintaining occlusion.

• It encompasses biology, physiology, as well as mechanics.

 GNATHOLOGICAL SOCIETY

• The Gnathological concept was formulated under the direction of-

Dr. Beverly B. McCollum, of Los Angeles, California;

Dr. Harvey Stallard of San Diego, California; and

Dr. Charles E. Stuart, of Ventura, California.

 MC COLLUM’S KEY

• Beverly McCollum - the father of Gnathology has said that the function of the
mouth is the key to biological dentistry & keeping the physiological integrity of the
oral organ as intact as possible is the basic aim of all our preventive work & no other
professional group should earnestly desire to practice prevention than dentists.
 HISTORY OF GNATHOLOGY
• Stallard first coined the term “gnathology” in 1924
• McCollum formed the Gnathological Society in 1926

• An early concept of comprehensive dentistry originated from the Gnathologic Society

• The Gnathological Society grew from a few to 15 and finally 24 dentists, converging
as a “clinic club” attempting to explore and record their observations of occlusion
and eccentric movements in a scientific manner over a 13-year period between 1924
and 1937.
• McCollum along with Harlan, is credited with the discovery of the first positive method of
locating the transverse horizontal axis and transferring the recording to an articulator.

• It was concluded by Gnathologists that, if the rotational centers in the condyles could be located, and
if the border movements of these rotational centers were recorded and reproduced on a
sophisticated three-dimensional articulator, then all functional motions for the patient could also be
reproduced by that instrument.

• McCollum and Stuart developed the first instrument capable of exactly recording mandibular
movement. This jaw recording device was labeled a "Gnathograph," meaning "jaw writer.“

• With McCollum’s original device, C.E. Stuart created the first fully adjustable articulator, the "Stuart
Instrument” and developed a practical method for determination of the hinge axis and mandibular
recordings.
• The latest instrument is Dr. Niles Guichet's Denar D4-A articulator.
 EARLY GNATHOLOGIC THEORY
• Cnathologic theory at the early time included:
1) CR as the most posterior relation of mandible to maxilla. Further investigations led them to believe
that CR is the rearmost, uppermost, and middlemost position of condyles in the glenoid fossa

2) establishing via a hinge axis location the rotational centers of the condyles;

3) recording the three dimensional envelope of motion of the condyles via the pantographic tracing;

4) maximum intercuspation of the teeth when the condyles are in their hinge position; and

5) bilateral balance with eccentric jaw movements…

• Stallard and Stuart, felt that the basic theory of mandibular movement was
fundamentally correct, but the application of this knowledge was misdirected.

• They proposed eliminating the balancing contacts in eccentric jaw movements by

having the canines on the working side disclude the posterior teeth; they named it the
Cuspid Protection Theory. This also became known as the Mutually Protected System.

• The concept of canine guidance was suggested by D’Amico as a part of mutually

protected occlusion where anterior teeth protect the posterior teeth in excursions, and
posterior teeth protect the anterior teeth in maximum intercuspation.

• In canine guidance concept, maxillary canine serve to guide for the mandible during
eccentric movements, thus preventing off axis forces on other teeth.
• Thus, their observations led to the development of the principles of-
mandibular movements,
transverse horizontal axis,
maxillomandibular relationships, and
an arcon articulator that was designed to accept the transfer of these records.

• The goal was to truly capture maxillomandibular relationships that accurately

reproduced border jaw movements and which would prescribe the best occlusal
interface.

• The registration of the horizontal and sagittal displacements of patients was

believed to allow the maximum cusp height-fossae depth with proper placement of
ridges and grooves
 FINAL GIST OF GNATHOLOGICAL CONCEPT OF
OCCLUSION
1. C. R. 0. and C. 0. shall be made to coincide.

2. All the posterior teeth shall contact evenly and exactly at the same time, at the
established vertical dimension, when the jaws are closed in their terminal hinge position or
centric relation.

3. This shall be a three point contact between the cusp slopes (ridges) with the fossa slopes
(ridges forming the fossa perimeter); the cusp tip, per se, never contacts anything, anytime,
anywhere. This type of tooth contact is referred to as "tripodism".
4. The cuspid tooth whenever possible shall disclude or separate the posterior teeth in all lateral eccentric
movements. ( P.M.S. TECHNIQUE… encouraged multiple occlusal contacts during lateral movements -
group function or wide centre)

5. The anterior teeth shall similarly disclude the posterior teeth in protrusive movements. (P.M.S.
TECHNIQUE… during protrusive movements… an essential feature of this technique is long centric)

6. Therefore, no posterior tooth shall contact except in C. R. 0. ; this type of occlusion is known as
"disclusion". (P.M.S. TECHNIQUE… The concept of posterior disclusion has made the use of FGP
technique)

7. This disclusion must be in harmony with the temporomandibular joint and mandibular movement.

8. Elimination of all possible fremitus.

9. Neither the teeth nor the joint is permitted to become the dictator one over the other.
 MUTUALLY PROTECTED OCCLUSION

• Mutually protected occlusion is also known as canine-protected occlusion or organic

occlusion.

• It had its origin in the work of D’Amico, Stallard, Stuart, and Lucia and the members
of the Gnathological Society.

• They observed that in many mouths with a healthy periodontium and minimum wear,
the teeth were arranged so that the overlap of the anterior teeth prevented the
posterior teeth from making any contact on either the working or the nonworking side
during mandibular excursions. This separation from occlusion was termed disocclusion
• According to this concept of occlusion, the anterior teeth bear the entire load, and the posterior
teeth are disoccluded in any excursive position of the mandible. The desired result is an absence of
frictional wear.

• The position of maximal intercuspation coincides with the optimal condylar position of the mandible.

• All posterior teeth are in contact with the forces being directed along their long axes.

• The anterior teeth either contact lightly or are very slightly out of contact (approximately 25
microns), relieving them of the obliquely directed forces that would be the result of anterior tooth
contact.

• As a result of the anterior teeth protecting the posterior teeth in all mandibular excursions and the
posterior teeth protecting the anterior teeth at the intercuspal position, this type of occlusion came
to be known as a mutually protected occlusion. Mutually protected occlusion… probably the most
widely accepted …because of its ease of fabrication and greater tolerance by patients.
 PRE-REQUISITE FOR A MUTUALLY PROTECTED
OCCLUSAL SCHEME
1. Periodontally sound anterior teeth
2. In presence of anterior bone loss or missing canine restore to
group function
3. Angle class II/III malocclusion- mutually protected occlusion not feasible
4. Reverse occlusion/ crossbite mutually protected not feasible
 CANINE PROTECTED OCCLUSION

• A form of mutually protected occlusion in which the vertical and horizontal overlap of
the canine teeth disclude the posterior teethin the excursive movements of the
mandible.
•
• Also known as canine guidance, canine disclusion or canine rise.

• The theory of canine-protected occlusion is attributed to – Nagao, Shaw and D’Amico

and is based on the fact that the canines are the most appropriate teeth to guide
mandibular excursions.
WHY CANINE IS THOUGHT TO BE THE MOST
APPROPRIATE???
1. Good crown root ratio… capable pf tolerating high occlusal forces

2. Canine provide high proprioception

3. Shape of palatal surface of canine is concave and is suitable for guiding lateral
movements

4. Posterior teeth and better suited to accept vertical versus lateral forces. Lateral
forces should be directed toward the anterior teeth especially canines due to its
root length and position of these being at a distance from TMJ.
 BIOMECHANICS OF CANINE-PROTECTED
OCCLUSION
Thus, canine due to their-
size,
steeper inclines,
structure, made it best suited for mutually protected occlusion
root-length
strategic position from fulcrum,
stress-breaking capabilities,
keen proprioception capabilities
LEVER SYSTEM OF THE MANDIBLE AS APPLIED ON
CANINE-PROTECTED OCCLUSION
 FUNDAMENTALS OF GNATHOLOGY

• The fundamentals of gnathology include the concepts of-

1) centric relation,
2) anterior guidance,
3) occlusal vertical dimension,
4) the intercuspal design, and
5) the relationship of the determinants of mandibular movements recorded using
complex instrumentation to the occlusion in fixed prosthodontics
 1. CENTRIC RELATION
• The early gnathologists believed that the retrusion is the movement toward the
posterior, and it is the most retruded physiologic relation of the mandible to the maxilla
to and from which the individual can make lateral movements that defines centric
relation (CR) to the gnathologist.

• Later gnathologists believed that mandibular (condylar) movements are governed by

the 3 axes of rotation. The concept of centric relation evolved as a 3-dimensional
characterization, resulting in its description of centric relation as the rearmost,
uppermost, and midmost (RUM) position of the condyle in the glenoid fossa…. However,
in the GPT-8, CR is defined as the maxillomandibular 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.
• A central gnathological theme was to have maximal tooth intercuspation coinciding with centric relation.
Often this situation or goal was historically referred to as centric relation occlusion (CRO). However, GPT-9,
describes CRO as centric occlusion, which may or may not coincide with maximal intercuspation.

• In many gnathological circles, the FMR begins with the reconstruction with transitional restorations (cast-
metal occlusal surfaces). The occlusion would be subsequently adjusted to a centric relation-centric occlusion
position with a mutually protected articulation until the physiological adaptation of the patient was
achieved.

• The gnathological treatment concept typically required that both the maxillary and mandibular teeth be
prepared so as to eliminate any deflective tooth contacts, deprogram the musculature, and stabilize the
temporomandibular joints to a reproducible position.

• Following this adjustment or tooth preparation, a pantographic recording would be made prior to definitive
rehabilitation to achieve an “organic occlusion.”

• Cast-metal transitional crowns have limitations related to cost, inability to increase the occlusal vertical
dimension, and changes in mandibular position that cannot be equilibrated easily to a new maximum
intercuspal relationship.
 2. ANTERIOR GUIDANCE
• Disocclusion refers to separation of opposing teeth during eccentric movements of the
mandible, as reported by Christensen.

• D’Amico, suggested the concept of canine guidance.

• Stuart and Stallard also observed this phenomenon and therefore developed anterior
guidance as part of their gnathological concept in mutually protected articulation.

• According to the philosophy of gnathology, the anterior teeth protect the posterior teeth
in eccentric movements and conversely have the posterior teeth protect the anterior teeth
in maximal intercuspation (mutually protected articulation) without any deflective occlusal
contacts or interferences in speech.
 3. OCCLUSAL VERTICAL DIMENSION
• The development of occlusal vertical dimension (OVD) is a function of maxillary and
mandibular growth along with the eruption of the dentition and accompanying alveolar
bone formation.

• Growth variations and acquired processes can alter the OVD.

• This spatial relationship is often measured by the evaluation of phonetics, the interocclusal
distance from rest position to mandibular incisal contact into the lingual cingulum area of
the maxillary incisors, and facial-tooth esthetic profiling.

• The mandibular-maxillary incisal relationship assists in establishing the anterior reference

of occlusal vertical dimension (OVD).
• However, many researchers (Thompson and Brodie) believe that occlusal vertical
dimension is constant and does not vary though life. While others found that the vertical
dimension of rest varies with speech, emotion, jaw relationship, resorption, body position,
and after natural tooth contacts are lost. As such, these variations may impact
determinations of the OVD.

• If the anterior teeth are to be restored, then from the articulated diagnostic casts, a
diagnostic arrangement can be designed to optimize the mutually protected articulation,
and this relationship can then be transferred to the provisional restorations.

• In gnathology, this technique should be performed first so that the OVD and anterior
guidance are established and then harmonized with the posterior determinants.

• The posterior tooth morphology is then designed so as to incorporate the maximum

development of a mutually protected articulation, without infringement upon phonetics
and/or esthetics
 4. INTERCUSPAL POSITION
• Once a functional and reproducible centric relation is established that is without TMJ pathology, and a functional
mutually protected anterior guidance is developed, then the posterior occlusal morphology may be designed.

• The goal of gnathology is to establish an occlusion that is interference free and entails the concept of an organic
occlusion.
Organic (organized) occlusion encompasses :
disocclusion,
cusp to fossae relationship,
centric (relation) occlusion,
uniform centric contact,
forces directed in line with the long axes of the teeth,
 tripodism,
twin centric contact for cross tooth stability,
narrow occlusal table,
maximum cusp height, and
fossae depth with supplemental anatomy
 AIMS AND OBJECTIVES
Optimum oral health
Anatomic harmony
Functional harmony
Occlusal stability

• Thus Gnathology has two goals;

1. to help the gnathic organ get well and stay that way - and
2. to help the gnathic organ function smoothly so as not to be self-destructive.

The concept of Gnathology says that above all else, therapy must rest on evaluation
diagnosis and treatment planning and this provides a solid foundation for the
general practitioner.
 PROCEDURE FOR GNATHOLOGICAL CONCEPT

• The Gnathological Society developed parameters that must be recognized,

captured, and understood. These parameters are dictated by several factors present
in every patient,

some variable and alterable by the restorative dentist,

some fixed and constant for each individual and unalterable in oral
rehabilitation
 THE CONSTANTS AND VARIABLE FACTORS

• Constant factors that must be accounted • Variable factors that can be dictated
for are: the intercondylar distance, the by the needs of restorative dentistry
hinge axis position, the condylar path and esthetics include tooth shape and
as it moves in the glenoid fossa, and the position (which incorporates
relationship of the maxilla to the compensating curves), vertical interarch
mandible. These represent individual dimension, anterior guidance, and the
characteristics that must be considered occlusal scheme.
as they occur in the patient when
planning an oral rehabilitation and
completing treatment.
 CONSTANTS

• Unchangeable by the restorative dentist.

• These constants include intercondylar distance, hinge axis position, the relationship of
the maxilla to the mandible in centric relation, and the path of the condyle-disk
assembly in the glenoid fossae.

• The constants factors must be evaluated, recorded, and transferred to a patient

simulation device accurately enough to permit diagnostic planning prior to treatment
and the fabrication of dental restorations during treatment.
 THE CONSTANT FACTORS
 INTERCONYLAR DISTANCE
TERMINAL HINGE AIXS POSITION- FACEBOW
INTERARCH RECORDS- TERMINAL HINGE AXIS, CONDYLAR PATHWAYS
LATERAL AND PROTRUSION CHECKBITES
TRANSFERRING CONSTANTS TO THE ARTICULATOR

• The constants when applied to the articulator make possible the thorough evaluation of the mounted
casts. This process permits the visualization of potential changes of the existing variable determinants
that may be required to accomplish stable rehabilitation of the occlusion .

• After the articulator is set to mimic the constants dictated by the patient, the restorative dentist is
prepared to create variables on the instrument that may be transferred to the provisionals and
ultimately to the final restorations.
 VARIABLES
• It’s fortunate that the restorative dentist is not forced to deal only with the constants that
the patient presents with in planning and completing oral rehabilitation.

• The ability to change specific aspects of tooth form and position as well as the interarch
dimension at tooth contact (vertical dimension of occlusion) permits the establishment of
anterior guidance and an occlusal scheme appropriate to each individual patient.

• Coordinating these variables with the patient’s intercondylar distance, terminal hinge axis,
centric relation arc of closure, and envelope of function permits re-creation of the form
present prior to tooth breakdown and the creation or re-creation of appropriate function.

• It may also permit creation of new tooth positions and/or an altered vertical dimension of
occlusion from that presented at initial evaluation
• A pre-determination of the variables will be completed on the articulator as a mock-up
and then tested in the patient through the use of provisional restorations.

• Accuracy of diagnostic wax-up depends on- 1. accurate transfer of the constants to the articulator
2. diagnosis and treatment planning

• Ability to capture and use the constants makes it possible to mock-up anticipated changes to the variables.

• Ability to alter the variables makes it possible to restore a patient

• However, alteration of any variable is only possible within the functional possibilities of the constants for each patient
 PROCEDURE

• The Gnathological rehabilitation techniques

employ the use of a diagnostic work-up to
apply any changes to the variables
determined necessary through the study of
the mounted casts.
• The changes may be accomplished through:
1. Removal (Equilibration)
…SAME WITH THE P.M.S. TECHNIQUE *
2. Addition (Restoration)
3. Repositioning (Orthodontics)
4. Repositioning (Orthognathics)
• The work-up represents the three dimensional application of the changes to the
variables as determined by the constants previously set on the articulator.

• Having completed the case on the articulator the restorative dentist is prepared to move
to the mouth.

• Whether Gnathology or the Pankey-Mann Schuyler techniques are employed this first
completion of the case provides the blue-print for all subsequent actions.

• Gnathological techniques dictate setting up the articulator and duplicating these settings
in the mouth, the Pankey-Mann-Schuyler techniques involve working with the provisionals
to provide on on-going blue print for variables.
 GNATHOLOGY VERSUS PANKEY-MANN-SCHULER CONCEPT

GNATHOLOGICAL CONCEPT PANKEY-MANN-SCHULER CONCEPT

• Gnathological technique mandates • Acrylic provisionals are adjusted
remounting on the articulator so that intraorally.
original settings as determined by the
pantograph are adhered to.
• In the PMS technique these adjustments of
the provisional restorations become
• The extraoral adjustment protocol for the integral to the determination of the
Gnathological technique is utilized variables.
whenever needed.

• Introral adjustment of acrylic provisionals is

not part of the rehabilitation process with
the Gnathological technique
GNATHOLOGICAL CONCEPT PANKEY-MANN-SCHULER CONCEPT
• Gnathologically restored anterior teeth are • PMS technique involves a segmental
completed simultaneously with posterior approach.
teeth and based on the settings created
from the recordings of the pantograph.
• Lower anterior, upper anterior, lower
posterior, and upper posterior teeth are
• Condylar inclination and anterior guidance evaluated, planned out with a wax-up, and
are matched to create an identical anterior restored in sequence.
and posterior guidance angle.

• As adjustment of the provisional restorations is

completed to function harmoniously with the
patient’s envelope of function the tooth form
and position, the vertical dimension of
occlusion, and the anterior guidance are
created in the acrylic.
 GNATHOLOGICAL CONCEPT PANKEY-MANN-SCHULER CONCEPT
• The final impressions are completed for all teeth to • Once stable, these variables are captured
be restored. and transferred to the articulator via an
impression and cast of the provisional
restorations.
• The final die casts are mounted using a new facebow
and articulated with an interocclusal record at the
vertical dimension determined in the planning stage. • The anterior restorations completed with the
PMS technique are based directly on the
guidelines established in the provisional
• Wax ups of the final castings are completed within restorations
the guidelines determined by the intercondylar
distance, terminal hinge axis position, interocclusal
relationship, vertical dimension, condylar pathways,
and anterior guidance as set on the articulator.

• The wax ups are cast, adjusted on the articulator,

and seated in the patient or remount.
GNATHOLOGICAL CONCEPT PANKEY-MANN-SCHULER CONCEPT
• After being fitted to the teeth a pick-up stent is • The PMS technique differs in its approach to completion
created and impressions are completed to pick up of the rehabilitation.
the castings for creation of a metal model
incorporating the castings for adjustment on the • The precisely adjusted provisional restorations are
articulator. utilized in completion of the mandibular anteriors,
followed by the maxillary anteriors and the mandibular
posteriors.
• The models with incorporated castings are mounted
on the articulator with a new facebow. • The maxillary posterior teeth are restored with a
functionally generated path model that incorporates all
movements of the mandiblur teeth against the maxillary
• The castings are then adjusted to precisely function teeth within the patient’s constants (intercondylar
distance, terminal hinge axis, interocclusal relationship,
within all of the guidelines established on the and condylar pathways) and the variables (tooth form
articulator. and position, vertical dimension of occlusion, and
anterior guidance) determined and captured in the
provisionals and subsequently transferred to the
completed restorations in the anterior and mandibular
• The meticulous gathering of data and the precise posterior.
transfer of information to the articulator is the
control which determines the final creation of the
restorations • Because the functionally generated path corrects for
any discrepancies, remounts are not necessary
 THE GNATHOLOGICAL APPROACH VERSUS THE
HOBO- TAKAYAMA CONCEPT
• Early gnathological concepts focused primarily on the condylar path and it was believed that
anterior guidance was independent of the condylar path.
• However, Hobo and Takayama in their study revealed that anterior guidance influenced the
working condylar path and concluded that they were dependent factors.

• Gnathology utilized complicated instruments such as the pantograph and fully adjustable
articulators, whereas in Twin Stage procedure (Hobo), these are not required. This procedure
is much simpler than the standard gnathological procedure, yet it follows gnathological
principles.
 THE GNATHOLOGICAL APPROACH VERSUS THE
NEUROMUSCULAR APPROACH
GNATHOLOGY NEUROMUSCULAR APPROACH
• Gnathology which is based on a belief that • Neuromuscular, based on the understanding that
the TMJ’s hinge on an axis of rotation in the the TMJ’s are in a physiologic resting position
glenoid fossa of the skull. All occlusion is based on the guidance of muscles and stabilized
guided and determined by the axis of jaw by the occlusion of both the upper and lower
joint rotation. The emphasis is on occlusion teeth.
and joint position which is fundamentally • Emphasis is on a physiologic position of the jaw/
called “centric relation”. mandible position to the skull (neuromuscular rest
position), the physiology of rested muscles to
support a physiologic occlusion for stability of all
three entities: the TM joints, the muscle and the
teeth.
 LIMITATIONS OF GNATHOLOGIC CONCEPT
Although, the concept of gnathology provides stable long-term results due to mutually protected
occlusion and tripod contacts, in some patients, freedom in occlusion may be required.

To reconstruct a mouth with a mutually protected occlusion, it is necessary to have anterior teeth
that are periodontally healthy. In the presence of anterior bone loss or missing canines, the
mouth should probably be restored to group function (unilateral balance)

 The use of a mutually protected occlusion is also dependent on the orthodontic relationship of
the opposing arches. In either a Class II or a Class III malocclusion (Angle), the mandible cannot
be guided by the anterior teeth. A mutually protected occlusion cannot be used in a situation of
reverse occlusion, or crossbite, in which the maxillary and mandibular facial cusps interfere with
each other in a working-side excursion
Point centric and cusp-to-fossa tripodization complicate the need to obtain precise
gnathologic restorations

Need for a fully adjustable articulator

Cast metal transitional restorations had limitations related to cost,

inability to increase occlusal vertical dimension, and

changes in mandibular position that cannot be equilibrated easily to a new

maximum intercuspal relation.
 CONCLUSION
• Gnathological concepts offer a structured methodology for prosthodontic treatment
in the presence of a disorganized or dysfunctional occlusion requiring fixed
prosthodontics.

• Gnathology will historically be judged as a significant stimulus to relate the

physiology of occlusion to biomedical concepts in complex restorative treatment.
 REFERENCES
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14(4):344–351
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6. An Appraisal on Occlusal Philosophies in Full-mouth Rehabilitation: A Literature Review. International
Journal of Prosthodontics and Restorative Dentistry, October-December 2016;6(4):89-92
7. Occlusal concepts in full mouth rehabilitation: An overview. J. Ind. Prosthet Soc. (2014);14(4):344-351
8. Gnathology and Pankey-Mann-Schuyler : fulfilling the requirements of occlusion in oral rehabilitation .
Master of science scholarly project. Medical college of Ohio.
9. Comparative accuracy of the gnathological and neuromuscular concepts. JADA (1978); 96, 559-565