Fundamentals of Dental Occlusion

Fundamentals of dental occlusion
Sydney C. Butts, MD ; Sherard A. Tatum III, MD
Acc urate assess me nt of occlusio n is an imp ort ant clini cal

skill for eve ry practicing oto laryngo log ist. It is an essen-
tial part of the examinatio n of pati ent s with fac ial trauma
or acq uired or con genit al malocclu sion , as we ll as those
seeking fac ial ae sthetic surgery. For examp le, patien ts
seeking ment oplasty should be assessed for micrognath ia
as well as microgenia. Me nto pla sty performed on patients
with unrecognized micrognathi a ca n result in an un natural Mesiobuccal
cusp - - - - - -
postsurgical appe ara nce marked by pro mine nce of the Distobuccal • -
labi om en tal sulcus . Pat ient s with microgn ath ia ca n ofte n cusp ~
be better se rve d by or thog nathic surge ry. I

Occlusion is described in thre e dim en sion s: antero pos -
teri or, verti cal , and tran sverse. Occlusion ma y be normal
in one of these dim ension s and abn orm al in ano ther.
Th e term s used to describe tooth surfaces in the den tal
arches differ from the more fami liar anato mic de scrip-
tors. The occl usal surface of the tooth is opposite the end
where the root is located (apical end). Th e mesial side of
the tooth faces the den tal midli ne, and the distal surface is
away fro m the dent al midlin e (figure I). Region all y, tooth
surfaces are referred to by the struc tures they face . Th e
anterior teeth , whi ch include the inci sors and canines, have
labial outer surfaces .Th e prem olars and molars have buccal
Figure J. Illustration shows the max illary (top ) and mandib ular
out er surfaces. Th e occl ud ing surface s of the ant erior and
(bottomidental arches. Reprinted with permission from Elsevier:
posterior den tition differ sig nifica ntly. Cusps (co nvex ities)
Bran d RW, Isselh ard DE. Anatomy of Orofacial Str uctur es, 4th
and grooves (concavities) charac ter ize the occlusal surfaces ed . SI. Louis: CV Mosby, [990: 222.
of the canines, prem olars, and molars. Incisors lack the se
features; instea d they have sharp inci sa l edges. '
Th e anteropos te rior relatio nships of the posterior teet h but not abso lute way s. Normally, the maxill ar y incisors
are describe d by the Ang le clas sifica tio n. Th is sys tem are anterior to the mandibular inci sors. This is the norm al
defines the relationship of the molar teeth ." In class I oc - overjet relation ship, w hic h ranges from I to 3 mm .' Ab-
clu sion , the mesiobu ccal cusp of the ma xill ary first molar normal anterior rel at ion ships include an excess ove rjet,
intercusp ates with the buc cal groove ofthe mand ibul ar first edge -to-edge cont act , and an anterior crossbite in which
mola r (figure 2) . Cl ass II malocclusion occ urs when the the maxillary inc isor s are pos terior to the mandibular
buccal groove of the mandibular first molar is posterior inci sors (figure 3). Usua lly, patien ts with a class I occl u-
to the mesiobuccal cusp of the maxillary first molar. In sion also have a normal overjet while those with a class
cl ass III malocclusion, the mandibular teeth are anterior or II malocclusio n have an excessive overjet . Th ere are two
mesial to the ma xillary teeth .I:' T hese mol ar rel ationships subdiv isions of the cla ss II rel ationship that app ly to the
ca n affect the occlusion of the ante rior teeth in pred ictab le position s of the inci so r teeth. In cla ss II, divi sion I, there is
Fro m the Division of Facia l Plastic Surger y. Departm ent of Otolaryngology and Co mmunica tion Disorders. SUNY Upstate College of Medici ne,
Syracuse, N.Y.
31 2 ENT-Ear, Nose & Throat Journal· May 2006

FACIAL PLASTIC SUR GER Y CLINI C
Figure 2. The Angle classification is based 0 11 molar occlusion. Adap ted with perm ission fro m Kellman RM, Tatum SA. Com plex
facia l trauma with plating. In: Bailey B1, ed. Head and Neck Surgery-Otolaryngo logy, 2nd ed. Philadelph ia: Lippincott-R aven
Publishers, 1998; 1051.
an increased ove rjet, In division II, the central incisors are • An overbite or deep bite describes an increased vertical
palatall y tilted to compensate for the skeletal abnormality, overlap of the incisor teeth. Normally, the maxillary incisors
resulting in a norm al or near-normal anterior relationship. overlap the mandibular incisors by I to 3 mm.' When this
The class III malocclu sion is typicall y associated with an distance increases, the maxillary incisor teeth obscure the
anterior cross bite. mandibul ar incisors. In the transverse dimension, the molar
In the vertical dimension, two clinical situations may teeth intercus pate in such a way that the buccal cusps of
be encountered: the maxillary teeth are lateral or buccal to the buccal cusps
of their mandibul ar counterparts. Th is norm al situation is
• An open-bite deformit y is seen when the occlusal or altered when there is a posterior cross bite.'
incisal surfaces of the teeth do not meet in the same plane
durin g jaw movem ent. If there is unilateral premature con- Malocclusion can have a profound effect on both func-
tact between the posterior teeth, a posterior open bite will tion and appeara nce. It contributes to several conditions
occur contralatera lly. Thi s is commo nly see n in unilateral for which patient s seek evaluation, including sleep apnea,
subco ndylar frac tures. co ngenital cra niofac ial anomalies, and aesthetic concerns.
The documentation of occlusion is an essenti al part of the
diagnosis of these dent al-skeletal anomal ies.
~ References
~ I. Zide BM, Pfeifer TM, Longa ker MT. Chin surgery: I. Augmenta -
tion-The allures and the alerts. Plast Recons tr Surg 1999; I 04:
1843-53.
2. Brand RW, Isselh ard DE . Anatomy of Orofacial Structures. 4th ed.
'"
~
SI. Louis: Mosby ; 1990:213-80.
3. Tatum SA. Correction of post-traumatic max illofacial defor mities
f Edge to involving occlusion. Facia l Plast Surg Clin North Am 1998;6:
edge bite 535-56 .
Figure 3. Illustrations show abnormal incisor relationships.

Ada pted with permission from Kellman RM,Tatum SA. Compl ex
facial trauma with plating. In: Bailey B1, ed. Head and Neck
Surgery-Otolaryngology, 2nded. Philadelphi a: Lippincott-R aven
Publishers, 1998; 105 1.
314 ENT-Ear, Nose & Throat Journal > May 2006

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Fundamentals of dental occlusion

Sydney C. Butts, MD ; Sherard A. Tatum III, MD

Acc urate assess me nt of occlusio n is an imp ort ant clini cal

be better se rve d by or thog nathic surge ry. I

31 2 ENT-Ear, Nose & Throat Journal· May 2006

Figure 3. Illustrations show abnormal incisor relationships.

314 ENT-Ear, Nose & Throat Journal > May 2006

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