FUNCTIONAL

OCCLUSION
AND THE MOUNTING
OF THE CASTS
In recent years, orthodontists have voiced
more and more interest in occlusion and
functional occlusion.
The answer to the stability of a treated case
rests partially in the functional dynamics of
occlusion,
Developing a sound ,functional masticatory
systemis the primary goal of all orthodontic
therapy
“According to Roth --------------------------
the treatment goal in orthodontics
should be the centrically related
occlusion in which the intercusping
of teeth takes place with the
mandible in the centric relation”
it is unrealistic to think that equilibration
alone will solve all the problems in
orthodontics
“For a case to be equilibratable
to a stable centric requires a
case that has most of the
proper tooth positions to begin
with, and one that is reasonably
close to centric.”
The case that is poorly treated
and inadequately detailed, or is
grossly out of centric, cannot be
equilibrated to a stable centric
In some instances, it cannot
even be restored, but must be
retreated orthodontically.
The musculoskeletally
stable position is the most
orthopedically stable position
for the joint and can be
identified by observing the
directional forces applied by
the stabilizing muscles.
 Masseters: anterosuperior
Medial pterygiod : superoanterior
. Temporal muscles : straight superior
direction
Inferior lateral pterygoids:position the
condyles anteriorly against the posterior
slopes of the articular eminences
When heavy contraction of the elevator
muscles occurs, joint stability is
maintained this position is therefore
considered to be the most
musculoskekeletally stable position of
the mandible
in this position the articular surfaces are
so aligned that forces applied by the
musculature do not create any damage
The musculoskeletally stable joint
position is also influenced occlusal
contact pattern
When closure of the mandible in the
M.S stable position creates an
unstable occlusal condition,the
neuromuscular system quickley feeds
back appropriate muscle action to
locate a mandibular position that
results in a more stable occlusal
condition
The term centric relation refers to
the position of the mandible when the
condyles are in there uppermost’
midmost position in the mandibular
fossae and related anteriorly to the
distal slope of the articular eminence
As the mandible appears to rotate
around a transverse axis through the
condyle in the centric relation
movement’ guidance of the jaw by the
clinician in opening and closing
movements that do not have
translation us referred to as a hinge
axis movement
In this position condyles are
considered to be in the terminal hinge
position
Hence the complete definition of
optimum joint position is that
the condyles are in there most
supero anterior position in the
articular fossae, resting against
the posterior slopes the
articular eminences with the
articular discs properly interposed
There is an ideal position for the condyles
in the glenoid fossae and the mandible
should be able to move in any possible
direction without the teeth getting in the
way of the joint-dictated movement pattern

The mandible should also be able to close

into maximum intercuspation without
deflecting the condyles from their most
"ideal" relationship in the fossae.
Recognizing Occlusal Disharmony

Signs or symptoms from occlusal

interferences:

1. Occlusal wear.
2. Excessive tooth mobility.
3. Temporomandibular joint sounds.
4. Limitation of opening or
movement.
5. .Myofascial pain.
6. .Contracture of mandibular
musculature, making manipulation
difficult or impossible.
7. Some types of tongue-thrust
swallow.
If a patient has any of these signs or
symptoms and the mandible is
difficult to manipulate, use of a splint
is indicated to see if the symptoms
can be eliminated or alleviated and
what changes occur in mandibular
position, before placing orthodontic
appliances.
The neuromuscular positioning
of the mandible to
accommodate to occlusal
discrepancies hides the true
discrepancies from us.
.
To select treatment plans that will
allow us to treat to or very near to
centric relation occlusion we must
be aware of what the
maxillomandibular relationship is
in centric relation position of the
mandible and diagnose the case
from this position,
> Records must be obtained as close
as possible to centric relation.

> Standard orthodontic models and

cephalometric headfilms have been
traditionally taken in habitual centric
occlusion.
For instance,----

we may have a case in which there

appears to be unilateral Class II molar
relationship, but in centric relation of the
mandible there is really a bilateral Class
II molar relationship end-on.
If we base our mechanics upon a
unilateral Class II relationship and
treat accordingly, we will wind up
with a case treated out of centric
that is bilateral Class I in habitual
centric closure and unilateral end-on
Class II on the side opposite the
original habitual centric Class II in
centric relation.
If it is bilateral end-on Class II then
our mechanics must deal with a
bilateral Class II situation, in order
to be able to finish the case in
bilateral Class I and in centric
relation occlusion .
When we look at the case intraorally ,
while it is propped open on the first
centric contacts, we will see an
overjet of the incisors.
It is not possible to know by looking
at this overjet how much of it is due to
the hinging open of the mandible and
how much is a true anteroposterior
discrepancy.
The only way to find out is to mount
models on an articulator transferred
from an accurately located hinge-axis,
and then remove the interferences on
the models until the vertical overlap of
the incisors is the same as the habitual
centric overlap.
The difference in overjet between the
habitual centric closure and the hinge-
axis centric closure on the
equilibrated models can be measured
and the discrepancy can be divided
into its vertical and horizontal
components.
The difference at the incisal guide pin
gives us the vertical discrepancy, and
the horizontal difference can be
measured with a Boley gauge or
dividers
Achieving a good
functional occlusion has
been a goal that has been
talked about in orthodontics
for years.
One factor that we must a/ways keep
in mind is that----- we simply cannot
believe what we see in the mouth.

What we see in the mouth is the

patient's neuromuscular adaptation of
closure and movement to the existing
occlusal arrangement.

Patients will bite where their teeth fit,

and not where they don't fit.
> Patients will move the mandible so
as to avoid noxious contact of teeth,
rather than allow them to collide.
> Muscles will contract to avoid
inflicting self-injury to joints, teeth, and
supporting structures.
> All of these neuromuscular
responses to the patient's existing
occlusion limit our ability to see what
we need to see in order to establish a
good functioning occlusion.
Therefore, we need instrumentation to
get the patient's neuromuscular
mechanism out of the way, so that we
can see how the patient would close and
move if there were no teeth interfering
with the movement pattern that his
temporomandibular joints can execute.
The purpose of an articulator is --
to eliminate the patients neuromuscular
response to his existing occlusion, so
that we may see how his teeth relate
when the jaw joints are properly related
to the fossae
This is the basis of the occlusal therapy
and TMJ treatment and a
cornerstone of the functional occlusion
concepts
Gnathological Objectives

The gnathological objectives are

aimed at harmonizing the occlusal
morphology or natural tooth positions
with closure of the mandible in centric
relation, and with border excursions of
the mandible.
The first objective of a gnathological
occlusion is to obtain a stable centric
relation of the mandible and have the
teeth intercusp maximally at this
mandibular position.
All centric stops should hit equally and
simultaneously and the stress of closure
should be directed, down the long axes of
the posterior teeth.
There should be no actual contact of the
anterior teeth in centric closure (.0005"
clearance).
The second objective is to have a
harmonious glide path of anterior teeth
working against each other to separate
or disclude the posterior teeth
immediately, but gently, as soon as the
mandible moves out of centric closure.

The glide path provided by the anterior

teeth must be in harmony with the way
in which the mandible moves through
border excursions.
There should be sufficient overbite and
overjet at the maxillary incisor tips to
allow for a gentle glide path

The cuspids should be the main gliding

inclines on lateral excursion and the six
maxillary anterior teeth should articulate
with the six mandibular anterior teeth
and the mandibular bicuspids so that
the protrusive load is spread over 14
teeth.
Hence a "mutually protective" occlusal
scheme is established where the
anterior teeth protect the posterior
teeth from lateral stress during
movement and
the posterior teeth protect the anterior
teeth from lateral stress during closure
into centric relation occlusion.
The anterior teeth are subjected to a
minimum of stress during
movements, only if a gentle glide
path is provided that is in harmony
with the manner in which the
mandible moves.
Thus, in a mutually protective occlusal
scheme, the mandible can execute its
total range or envelope of motion
without interference from the teeth
 Centric (A) protrusive (B) working (C) arid idling
(D) excursions on a mounted posttreatment
orthodontic case demonstrating a mutually protected
occlusion.
In order to find centric the patient
must be placed on a repositioning
splint, until the mandibular position
has remained stable for quite some
time.
Final seating and finishing of the
occlusion is the last opportunity that
the orthodontist has to take a well-
treated case and do the "fine tuning" of
the occlusion.
For this, the use of a finishing
appliance called the Gnatho-
Positioner is desired.
Traditionally, It has been used in
orthodontics to gain an intercuspation
of the teeth at the end of treatment.
 The positioner is used to guide the
case closer to centric during the
settling process and to control the
manner in which the case settles in
terms of minor tooth positions that
may affect centric relation closure or
excursive tooth relationships.
The positioner is then used to
maintain centric during most of the
retention period.
A gnathological tooth positioner should be
made on an anatomical articulator.

THE MOUNTING

>Capture the true centric relation of

the mandible.

>Centric relation wax records are

taken.
> Three thicknesses of wax anteriorly
and one thickness of wax posteriorly are
used ,
so that the resistance offered by the
anterior portion of the wax will allow the
patient and the patient's musculature to
seat his own condyles.
With an accurately mounted set of casts, if
we allow the articulator to go into centric
relation, this usually shows a discrepancy
between centric relation and centric
occlusion, and the first premature contacts
are usually found on the second molars.
If one sees a case mounted immediately out
of orthodontic appliances and all the teeth fit
together on the mounting, it can be safely
concluded that the operator has missed his
centric registration.
A three-dimensional mounting of the
three-dimensional relationship of the
upper and lower teeth must be
captured in relation to the patient's
hinge-axis.
It is not sufficient to utilize a two-
dimensional medium, such as a
cephalometric headfilm, to construct a
"true gnathological appliance"
THE SET UP
a centrally located mutually protected
occlusal scheme must be achieved.
This requires that as many centric
stops as possible be secured
and that the upper anterior teeth be
arranged to provide the gentlest
anterior guidance possible to
immediately disclude the posterior
teeth,
And that the upper cuspids ride on
the lower bicuspids in a protrusive
movement while the posterior teeth
gently disclude.
The three-dimensional relationship
between the occlusal plane and the
axis-orbital plane must be maintained
during the setup
Upper and lower occlusal planes must
remain parallel to each other and in
their original relationship in all three
planes of space to the axis-orbital
registration of the mounting.
CONSTRUCTION TECHNIQUE

A facebow transfered to an anatomic

articulator which is done with a
bitefork registration

The upper model is secured to the

articulator with a mounting plate and
plaster
After the upper model has been
mounted, the articulator is inverted, the
centrix wax registration is placed on the
upper model, and the lower model is
placed into the wax.
A mounting plate is fastened to the lower
member of the articulator, and the lower
model is secured into place, using
mounting plaster or stone. At this point
the mounting is completed.
At the laboratory, a set of duplicate
models is required in addition to the
mounted models.
An upper and lower Bioplast mold of
the duplicate models is made on the
Biostar machine
The teeth are sectioned and wedged,
and placed into the Bioplast molds
Then a layer of wax is poured over
the teeth, and a stone base poured
over the wax base that the teeth are
set into
We now have a duplicate set of
upper and lower models with the
teeth in the same positions that they
were in originally.
However, they are now set in wax.
These models are then transferred to
the articulator by utilizing the centric
registration that the original models
were mounted from.

First, the lower model is mounted to

the centric registration with the upper
solid model still in place on the
articulator .
After the lower wax-up model has
been mounted, the upper model with
the teeth set in wax is mounted to the
centric registration, and we have a
duplicate set of models with the teeth
set in wax mounted to the articulator
This mounting looks exactly like the
original mounting,
and the original models can be kept
for a permanent record of where the
case was at the time of debanding.
After the models, with the teeth set in
wax have been transferred to the
articulator at the laboratory,
the centric pin discrepancy between
centric relation and centric occlusion
is calculated and the pin is raised half
the amount of the centric relation-
centric occlusion vertical discrepancy.
The lower model is placed under a
heat lamp until the wax is uniformly
softened
and then it is placed back on the
articulator and the articulator closed.
Now the lower cuspid teeth are
removed from the arch and a
preformed occlusal guide plane, that
has an ideal curve of Spee and curve
of Wilson built in to it, is placed on the
lower arch
. This plane is placed so as to contact
as many of the lower teeth as possible.
It is then sticky-waxed in place, and
this is mounted to the upper member of
the articulator with mounting plaster or
mounting stone.
More recently a mechanical occlusal
guide plane has been developed that
mounts on the articulator like a
mounting plate and can be adjusted
mechanically for the best fit against
the lower occlusal plane (with the
cuspids removed from the arch or
intruded).
The lower teeth are then brought into
contact with the occlusal guide plane
while the rotations are corrected and
the lower posterior teeth are moved
forward into the band space and the
lower anterior teeth are moved back
into the band space.
Any width discrepancy can be
corrected at this time.
For instance, if there is a
discrepancy between upper and
lower molar widths of one
millimeter in centric relation, the
lower molars can be set buccally
one-half millimeter.
When the upper teeth are set to the
lowers they will automatically be
brought lingually one-half millimeter.

The lower teeth are set against the

guide plane, until all the cusps touch
the occlusal guide plane in the molar
area and until the marginal ridge
heights are equal.
Once this has been done, the arch
form can be finalized and the lower
cast can be waxed in.

It is very rare that one has to come

back and move lower teeth, if this
process is done carefully.
Once the lower arch setup has been
completed, the upper arch is heated
under the heat lamp until the wax
has been softened uniformly .
The upper cast is then placed back
on the articulator, and the upper
teeth are brought down into
occlusion with the lower teeth .
After the upper teeth have been set
into centric relation occlusion with
the lower teeth, the articulator is
moved into excursions, and the
anterior teeth are adjusted so as to
produce an ideal anterior guidance
so that we have a mutually
protected occlusal scheme.
The occlusion is set into a Class I
buccal segment relationship in
centric relation.
On excursions, the posterior teeth
will exhibit clearance, while the
anterior teeth will provide gentle
guiding inclines that will gently
disclude the posterior teeth on any
excursive movement.
The cuspids will provide the main
guidance upon lateral movement.
In the protrusive excursion
the six upper anterior teeth contact
the six lower anterior teeth equally
and evenly in a gentle disclusive path
while the upper cuspids ride against
the lower first bicuspids during
protrusive movement.
On the balancing side , there is a
close approximation of the teeth.
However there is immediate and
complete disclusion.
After the completion of the setup, the
incisal guide pin is raised an appropriate
amount to provide the thickness of
material between the upper and lower
teeth required for the positioner.

Wax sheet is rolled up into thirds and

softened thoroughly in the 140-degree
water bath, and a centric registration of
the setup is made
Then, impressions are taken of the
upper and lower models of the setup.
These are poured in stone, to create
a duplicate set of models, which are
trimmed with the bases tapered to
leave no undercut areas so that after
processing of the positioner these
can be easily removed from the
Centric Correlator.
The Centric Correlator, is the only
known instrument by which the
positioner can be processed to the
exact centric arc of opening and
closing that is exhibited by the patient,
and on an accurate articulator
mounting.
Next, the lower model is arbitrarily
mounted to the lower member of the
Centric Correlator
The wax bite is then set on the lower
model, the upper model is placed into
the wax bite, mounting plaster is
placed on the upper model
and the Correlator is bolted closed
before the mounting plaster reaches
its initial set.
This will capture the centric wedge of
opening between the upper and lower
casts, as it exists on the articulator
and as it exists in the patient's mouth.

After the plaster has set, the wax is

removed and the Oralastic II material
is ready to be packed.
 The material is placed between the
upper and lower teeth on the
Correlator, and
the Correlator is closed and bolted
shut, the Correlator will index
exactly back into centric relation,
because of the construction of its
metal parts.
After the material is compressed
between the upper and lower teeth, a
polyethylene strip can be used to press
the labial surface of the material
against the teeth
This is then trimmed, using an ordinary
table knife, and the packing process is
completed in approximately five
minutes.
Once the packing has been completed,
the entire Correlator with the packed
material is placed into a pot of boiling
water for 45 minutes, and the material
is cured.
The Correlator is then opened and the
upper and lower models can be
removed from the mounting plaster,
and the positioner removed from the
duplicate models .
The positioner can then be finished

The base plate wax centric relation

record, that was used to mount the
duplicate models to the Correlator and
captured the wedge of opening
between the teeth, is the exact
"wedge" of material that the positioner
has had processed into it.
The teeth of the setup fit securely and
positively into the centric wax
registration on the articulator, with the
incisal guide pin touching the incisal
guide table
The finished Gnatho-Positioner can be
placed onto the setup on the
articulator and, with the teeth fitting
into the sockets of the articulator and
the articulator locked in centric, the
incisal guide pin will rest on the incisal
guide table at the same setting as with
the wax registration .
This verifies that the same three-
dimensional relationship was captured
and processed into the positioner.
This intrudes the teeth on the
lower arch that are responsible
for the centric vertical
discrepancy, but this intrudes
them only half the distance of
the discrepancy.
The pin is then set at the centric
occlusion reading and the upper
model is heated under the heat lamp,
placed back on the articulator, and the
other half of the centric vertical
discrepancy is eliminated by hinging
the articulator closed until the incisal
guide pin comes back down to the
incisal guide table.
This intrudes the upper posterior
teeth.
Thus, we have eliminated the
vertical discrepancy between centric
relation and centric occlusion, and
have still maintained the occlusal
plane in the same exact position it
was in originally.
Gnatho-Positioner on skull showing teeth
seated in sockets and condyles seated in
fossae.
 SUMMARY

Treating to a gnathological result in

orthodontics the following points
should be emphasized:

1. To treat to centric the case must be

diagnosed from centric.
2. The case must be constantly
monitored in centric throughout
treatment.
3. The operator must know how and
when to use a repositioning splint to
find centric.
4. Treatment mechanics should be
employed that will not tend to create a
centric "fulcrum”
5. The operator should have an "End of
Mechanotherapy Goal" from which teeth
will tend to settle most favorably.
6. The orthodontist must be able to
apply the excursive border movements
clinically, to determine proper
mandibular position and individual tooth
position.
7. The use of a carefully and properly
constructed gnathological positioner will
aid in achieving the most ideal
functional occlusion on a case that is
basically treated close to centric relation
occlusion with orthodontic appliances.