Occlusion

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Occlusion

  1. 1. Temporomandibular Joint and related structures • Claver O. Acero Jr. DMD, PhD
  2. 2. (Functional Occlusion system) N ervous system N eurom uscular TM J D entition
  3. 3. The Temporomandibular Joint
  4. 4. PHYSIOLOGIC CHARACTERISTICS OF THE TEETH1. Growth a. Initiation (6th wk. of intrauterine life) b. proliferation c. histodifferentiation & morphodifferentiation d. apposition or critical calcification2. Calcification Nollas stages of calcification
  5. 5. Nolla’s Stages of toothcalcification
  6. 6. 3.Eruption Active eruption Passive eruption- attrition, lost of opposing Parameters of eruption Assignment-time of eruption-sequence of eruption4. Resorption & exfoliation of primary teeth primary teeth only,5. Attrition
  7. 7. Favorable sequence of eruption for permanent dentition
  8. 8. Dentitional Period & Occlusal DevelopmentI.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 monthsGeneral Characteristics1. Crown proportion2. Molar relationship. Flush terminal plane3. Anterior interdental spaces & primate spaces4. Overbite & overjet
  9. 9. Sequence of eruption of Primary teeth A B D C EA B D C E
  10. 10. Dentitional Period & Occlusal DevelopmentI.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 monthsGeneral Characteristics1. Crown proportion2. Molar relationship. Flush terminal plane3. Anterior interdental spaces & primate spaces4. Overbite & overjet
  11. 11. Dentitional Period & Occlusal DevelopmentI.Primary dentitional period (fr. 6 mos. to 5 years) start from 6 mos. Completed at 24 to 30 monthsGeneral Characteristics1. Crown proportion2. Molar relationship. Flush terminal plane3. Anterior interdental spaces & primate spaces4. Overbite & overjet
  12. 12. Significance of primary dentition
  13. 13. II. Mixed Dentitional Period (transitional period)-from 6 years to 13 yearsCharacteristics: a.Early Mixed• Distal flaring of upper anteriors• End to end molar relationship• Transient anterior crowding of lower anterior teethb. Late mixed dentition*space closed because of erupting canine*crossbite/negative overbite*zero overbite*posterior overbite
  14. 14. II. Mixed Dentitional Period (transitional period)-from 6 years to 13 yearsCharacteristics: a.Early Mixed• Distal flaring of upper anteriors• End to end molar relationship• Transient anterior crowding of lower anterior teethb. Late mixed dentition*space closed because of erupting canine*crossbite/negative overbite*zero overbite*posterior overbite
  15. 15. II. Mixed Dentitional Period (transitional period)-from 6 years to 13 yearsCharacteristics: a.Early Mixed• Distal flaring of upper anteriors• End to end molar relationship• Transient anterior crowding of lower anterior teeth Late mixed dentition*space closed because of erupting canine*crossbite/negative overbite*zero overbite*posterior overbite
  16. 16. II. Mixed Dentitional Period (transitional period)-from 6 years to 13 yearsCharacteristics: a.Early Mixed• Distal flaring of upper anteriors• End to end molar relationship• Transient anterior crowding of lower anterior teeth Late mixed dentition*space closed because of erupting canine*crossbite/negative overbite*zero overbite*posterior overbite
  17. 17. Incisor liability ( 8 -9 year old) 1.6 mm in the mandible
  18. 18. How we overcome incisor liability1. Slight increase in arch width2. Labial positioning of permanent incisor relative to primary incisor3. Repositioning of canines in the mandibular arch4. Continued development of the arches improves spacing.
  19. 19. Nance leeway space
  20. 20. Favorable sequence of eruption for permanent dentition
  21. 21. III. Permanent Dentitional PeriodGeneral characteristics3. Normal surface contact4. Normal cuspid to fossa relationship5. Normal triangular ridge to embrassure or groove contactTOOTH CONTACTS-stamp cuspids-shear cuspids
  22. 22. Six Keys to occlusion by Lawrence Andrew
  23. 23. Key I. Molar Relationship
  24. 24. Key II. Crown Angulation ( Tip )
  25. 25. Key III. Crown Inclination( labiolingual or buccolingual inclination, torque)
  26. 26. Key IV. Rotations
  27. 27. Key V. Tight contacts.
  28. 28. Key VI. Occlusal plane.
  29. 29. Significance of ABC contacts• Concept of TripodizationFunction of tooth contactsc. Prevent horizontal or lateral drift of the teeth buccolinguallyd. Prevent mesial & distal drifting
  30. 30. 下顎窩,下顎頭および関節円板の 相対的位置関係
  31. 31. 開口初期に関節円板に生じる くさび効果
  32. 32. 開口時の下顎頭と関節円板の挙動
  33. 33. Concepts of occlusion• Balanced occlusion• Mutual protection• Canine protected occlusion• Multiple group function occlusal contacts
  34. 34. Chewing pattern• Chopping type chewing• Crushing type chewing
  35. 35. Normal buccolingual arch relationship
  36. 36. 両側性平衡咬合
  37. 37. 片側性平衡咬合
  38. 38. 臼歯離開咬合
  39. 39. Basic mandibular positions• Centric relation• Maximum Intercuspation• Centric occlusion• Centric relation of occlusion• Physiologic rest position PRP- VDO =FWS
  40. 40. Directional movement of the Mandible• Bilateral movement – condyle move at same direction and dimension• Unilateral movements- working and nonworking side
  41. 41. Bilateral Directional movement of the mandible Rotation TranslationElevation upward backward & upwardDepression downward forward & downwardProtrusion downward forwardRetrusion
  42. 42. Salivary glands• Parotid gland – Stensens duct• Submandibular gland – Wartons duct• Sublingual gland – Bartolins duct• Minor: – Mucous glands: glossopalatine glands, palatin glands, anterior 2/3 of tongue, posterior 1/3 of tongue – Mixed: retromolar, labial, buccal mucosa. – Serous: salivary protein and amylase – Von Ebner gland: beside circumvalate papilla to clean the papilla.
  43. 43. Salivary glands• Parotid gland – Stensens duct• Submandibular gland – Wartons duct• Sublingual gland – Bartolins duct• Minor: – Buccal and Labial glands – Palatoglossal glands – pharyngeal isthmus – Palatal glands- soft and hard palate – Anterior lingual glands- embedded w/in muscle in ventral surface of tongue – Posterior gland - root of the tongue – Von Ebner gland: empty- trench of circumvalate papilla to clean the papilla. serous
  44. 44. Properties• 99 percent water 1 percent inorganic and organic• 5.6 to 7.6 pH• 1.002 to 1.008 specific. Gravity• Frothy, colorless or slightly opalescent, odorless• 1 t 1.5 liters a day Types of Saliva – Pure or active – stimulated saliva, clear and colorless – Resting or mixed saliva- frothy Serous cells – has zymogen granules Mucous cells – mucous cells
  45. 45. Functions of saliva Effect ComponentProtection Lubrication Glycoprotein, mucin Water proofing Lavage Pellicle formationBuffering Maintains pH unsuitable Phosphate, bicarbonate for microbial colonization Sialin Neutralizes acidDigestion Bolus formation water Neutralizes esophageal Phosphate, carbonate contents protease, lipase, ribonuclease Digest starch Amylase
  46. 46. Functions of saliva Effect ComponentTaste Solution of molecules Water Taste bud growth and Gustin maturationAntimicrobial Barrier Glycoprotein Antibodies Immunoglubulin A Hostile environment Lysozyme, LactoferrinTooth integrity Enamel maturation Calcium, Phosphate
  47. 47. • Masticatory salivary reflex• Gustatory salivary reflex• Symphathetic – Noradrinalin – constric salivary gland duct – decrease secretion• Parasymphathetic – acetylcholine – dilates salivary duct – increase secretion• Calcium binding proteins – Statherin – prevents formation of calcified masses – Proline rich proteins – acidic, inhibit Ca PO4 nucleation – prevents calcular deposits
  48. 48. • Salivary proteins with antimicrobial action – Immunoglobulin - aggregation – Mucin – agglutination – Lysosyme – autolysis – Lactoferrin – Peroxidase – block essential metabolic process Growth factors in saliva – Epidermal growth factors – wound healing – NGF – stimulates ganglionic factor – Transforming GF – differentiation and growth – Fibroblast growth factor – woung healing
  49. 49. • Diagnostic tests – Calorimeter test – caries susceptivility test a. Hyd ion test - indicate pH – pink, brown, blue b. Methyl red test – acts as disclosinh solution c. Snyder test - chew food- inoculate test 24, 48, 72 hrs. if turns yellow – acidic 2. Microbial test a. Bacteriologic test 3. Chemical test - flouride
  50. 50. Growth Factors in SALIVA• a. Epidermal Growth Factor- wound healing effect; mucosal defense barrier• b. Nerve Growth Factor- stimulating effect on ganglionic factor.• c. Transforming Growth Factor- causes cell differentiation & growth• d. Fibroblast Growth Factor- regulator of wound healing
  51. 51. Mouth and Clinical Examination• 1. soft tissue • Posterior • Superior • Lateral • Anterior• 2. individual tooth examination (DMFT)
  52. 52. MasticationControl of mastication• Voluntary Movements- result of deliberate effort and will.• Reflex Movements- programmed in CPG -fine-ture voluntary movements
  53. 53. Reflex Movements• Stretch reflex from muscle spindles- maintain the posture of the jaw in its rest position• Periodontal Reflex- give sensation about pressure on the teeth (pacinian corpuscles) - guide teeth into occlusion during the grinding phase as teeth slide across each other towards occlusal position
  54. 54. 3. Tendon organ reflexes- monitor the force exerted by a number of different motor units during weak contractions.4. Joint Reflexes- signal extremes of movement (e.g opening, protrusion, or lateral excursion) that oppose movement beyond safe limit.
  55. 55. Cyclical Movements -rhythmic and well-controlled functional mandibular movements due to proprioceptors and nociceptors that receive stimuli.
  56. 56. Chewing stroke -basic unit of mastication -represents each cycle of opening and closing movements of the mandible. 1. opening phase- downward with slight lateral movement of the mandible. 2. closing phase a. crushing phase- initial upward movement of mandible b. grinding phase c. chopping type
  57. 57. Tooth Contacts during masticationSingle tooth contact -tooth contact B -occurs in the maximum intercuspal positionGliding tooth contact -occurs as the cuspal inclines of the stamp cusp pass by each other during the opening (56%) and grinding phase ( 60%) of mastication
  58. 58. Stages of Mastication• Incision stage- performed by incisors to cut food into smaller pieces• Direct crushing stage- buccal inclines of maxillary stamp cusps pass over lingual inclines of mandibular stamp cusps to tear food into morsels.• Trituration stage- performed by molars to grind food ready for swallowing
  59. 59. Factors that affect Forces of Mastication1. Gender female- 35.8 - 44.4 kg male- 53.6 - 64.4 kg2. Tooth incisor- 13.2 - 23.1 kg molar- 41.3 – 89.8 kg4. Type of food5.Age and Diet6. Dentition (dentulous, edentulous, partial edentulous)7. Craniofacial morphology - brachycephalic, dolichocephalic8. Masticatory muscle size - masseter
  60. 60. Factors that affect Chewing stroke1. quality & quantity of tooth contacts -more tooth contacts , smaller chewing strokes2. occlusal condition of teeth -flat occlusal table- broader chewing stroke -tall cusps with deep fossa- predominantly vertical chewing stroke.3. TMJ -normal TMJ- well rounded strokes with definite borders and less repeated -painful TMJ- repeated pattern & shorter strokes, slower & irregular pattern
  61. 61. SwallowingTypes1. Infantile or Visceral swallowing a. mandible is stabilized by placing the tongue forward & between the gumpads b. c. occurs until posterior primary teeth errupt to assume somatic or mature swallow -approximately before 2 years old
  62. 62. 2. Mature or Somatic swallowing -requires maximum intercuspation a. mandible is stabilized by maximum intercuspation of teeth. most important tooth contact: single tooth contact (tooth contact B) b. normal oral seal
  63. 63. Types of Swallowing1. Bucco-pharyngeal phase -voluntary movement from oral cavity to pharynx (oropharynx) Space of Donder- where the bolus is placed - space between tongue & palate (when tongue is elevated) -ends when tongue goes down.
  64. 64. 2. Pharyngo-esophageal phase -involuntary movement from pharynx to esophagus epiglottis- most important structure to prevent choking - closes the oropharynx - closes the airway during swallowing “during choking, food enters the larynx therefore bolus blocks larynx.”
  65. 65. 3. Esophagus to Stomach -peristaltic movement of esophagus -involuntary regurgitation-movement of bolus from esophagus to oral cavity vomiting-movement of chyme from stomach to esophagus to oral cavity -pressure is in stomach GERD (Gastro-esophageal Reflux Disease) oral significance: increase susceptibility to caries (acid reflux)
  66. 66. Frequency of Swallowing- approximately 590 times a day a. 146- while eating b. 394- between meals while awake c. 50-while sleepingUnique Features:6. Occurs as early as intrauterine life.7. Occurs at the end of respiratory phase.8. Occurs even in the absence of food.9. Most frequently repeated activity of the masticatory system.
  67. 67. SpeechProcesses involved• respiration- major physiology for speech• resonance- paranasal sinuses• articulation a. lips- come together and touch to produce M, B, P sounds b. teeth- incisal edges of anterior teeth approximate each other to produce “Sh” sound c. tongue & palate- tip of tongue touches palate behind incisors to produce D sound
  68. 68. d. tongue and teeth- tongue touches upper incisors to produce Th and S sound. e. lip & teeth- lower lip touches incisal edges of upper incisors to make F & V sound. f. tongue & soft palate- posterior portion of tongue touches soft palate to make K & G sound.4. verbalization

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