Fundamentals of occlusion/ cosmetic dentistry training

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Fundamentals of occlusion/ cosmetic dentistry training

  1. 1. FUNDAMENTALS OFFUNDAMENTALS OF OCCLUSIONOCCLUSION INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com
  2. 2. CONTENTSCONTENTS  INTRODUCTIONINTRODUCTION  DEFINITIONDEFINITION  TMJTMJ  CENTRIC RELATIONCENTRIC RELATION  MANDIBULAR MOVEMENTSMANDIBULAR MOVEMENTS  DETERMINENTS OF OCCLUSIONDETERMINENTS OF OCCLUSION  OCCLUSAL INTERFERENCESOCCLUSAL INTERFERENCES  NORMAL V/S PATHOLOGIC OCCLUSIONNORMAL V/S PATHOLOGIC OCCLUSION  VARIOUS OCCLUSAL CONCEPTSVARIOUS OCCLUSAL CONCEPTS  CONCLUSIONCONCLUSION  BIBLIOGRAPHYBIBLIOGRAPHY www.indiandentalacademy.comwww.indiandentalacademy.com
  3. 3. INTRODUCTIONINTRODUCTION  Unfortunately the occlusion of teeth isUnfortunately the occlusion of teeth is frequently overlooked or taken for granted infrequently overlooked or taken for granted in providing restorative dental treatment forproviding restorative dental treatment for patients. This may be due in part to the factpatients. This may be due in part to the fact that the symptoms of occlusal disease are oftenthat the symptoms of occlusal disease are often hidden from the practitioner not trained tohidden from the practitioner not trained to recognize them or to appreciate theirrecognize them or to appreciate their significance..significance.. www.indiandentalacademy.comwww.indiandentalacademy.com
  4. 4.  The long term successful restorations areThe long term successful restorations are dependent upon the maintenance of occlusaldependent upon the maintenance of occlusal harmony. The minimal expectation of theharmony. The minimal expectation of the competent practitioner is the ability tocompetent practitioner is the ability to diagnose and treat simple occlusaldiagnose and treat simple occlusal disharmonies. Practitioners must be able todisharmonies. Practitioners must be able to produce restorations that will avoid theproduce restorations that will avoid the creation of iatrogenic occlusal diseasecreation of iatrogenic occlusal disease www.indiandentalacademy.comwww.indiandentalacademy.com
  5. 5. DEFINITION:DEFINITION:  The static relationship between the incising orThe static relationship between the incising or masticating surfaces of maxillary ormasticating surfaces of maxillary or mandibular teeth or tooth (GPT-7)mandibular teeth or tooth (GPT-7) www.indiandentalacademy.comwww.indiandentalacademy.com
  6. 6. ANATOMY OFANATOMY OF TEMPOROMANDIBULARTEMPOROMANDIBULAR JOINTJOINT www.indiandentalacademy.comwww.indiandentalacademy.com
  7. 7. www.indiandentalacademy.comwww.indiandentalacademy.com
  8. 8. www.indiandentalacademy.comwww.indiandentalacademy.com
  9. 9. www.indiandentalacademy.comwww.indiandentalacademy.com
  10. 10. www.indiandentalacademy.comwww.indiandentalacademy.com
  11. 11. Collateral ligamentCollateral ligament www.indiandentalacademy.comwww.indiandentalacademy.com
  12. 12. Capsular ligamentCapsular ligament www.indiandentalacademy.comwww.indiandentalacademy.com
  13. 13. Temporomandibular ligamentTemporomandibular ligament www.indiandentalacademy.comwww.indiandentalacademy.com
  14. 14. Accessory ligamentsAccessory ligaments www.indiandentalacademy.comwww.indiandentalacademy.com
  15. 15. CENTRIC RELATIONCENTRIC RELATION The maxillomandibular relationship in which theThe maxillomandibular relationship in which the condyles articulate with the thinnest avascular portioncondyles articulate with the thinnest avascular portion of their respective discs with the complex in theof their respective discs with the complex in the anterior-superior position against the shapes of theanterior-superior position against the shapes of the articular eminences. This position is independent ofarticular eminences. This position is independent of tooth contact. This position is clinically discernibletooth contact. This position is clinically discernible when the mandible is directed superiorly andwhen the mandible is directed superiorly and anteriorly. It is restricted to a purely rotary movementanteriorly. It is restricted to a purely rotary movement about the transverse horizontal axis. (GPT-5)about the transverse horizontal axis. (GPT-5) www.indiandentalacademy.comwww.indiandentalacademy.com
  16. 16. www.indiandentalacademy.comwww.indiandentalacademy.com
  17. 17. MANDIBULAR MOVEMENTSMANDIBULAR MOVEMENTS www.indiandentalacademy.comwww.indiandentalacademy.com
  18. 18. SAGITTAL PLANESAGITTAL PLANE www.indiandentalacademy.comwww.indiandentalacademy.com
  19. 19. www.indiandentalacademy.comwww.indiandentalacademy.com
  20. 20. HORIZONTAL PLANEHORIZONTAL PLANE:: www.indiandentalacademy.comwww.indiandentalacademy.com
  21. 21. www.indiandentalacademy.comwww.indiandentalacademy.com
  22. 22. FRONTAL PLANEFRONTAL PLANE:: www.indiandentalacademy.comwww.indiandentalacademy.com
  23. 23. www.indiandentalacademy.comwww.indiandentalacademy.com
  24. 24. Transverse hinge axisTransverse hinge axis www.indiandentalacademy.comwww.indiandentalacademy.com
  25. 25. BENNETT MOVEMENTBENNETT MOVEMENT www.indiandentalacademy.comwww.indiandentalacademy.com
  26. 26. BENNETT ANGLEBENNETT ANGLE www.indiandentalacademy.comwww.indiandentalacademy.com
  27. 27.  86% of condyle had immediate or early lateral86% of condyle had immediate or early lateral translation.translation.  Lundeen and Wirth used mechanicalLundeen and Wirth used mechanical apparatus, showed a median dimension to beapparatus, showed a median dimension to be approximately 1.0mm to max of 3mm.approximately 1.0mm to max of 3mm.  Hobo and Mochizuki used electronicHobo and Mochizuki used electronic measuring device found 0.4mm to 2.6mm ofmeasuring device found 0.4mm to 2.6mm of immediate lateral translation.immediate lateral translation. www.indiandentalacademy.comwww.indiandentalacademy.com
  28. 28.  Progressive side shift or bennett side shift.Progressive side shift or bennett side shift.  Lundeen and Wirth found slight variation inLundeen and Wirth found slight variation in the direction of progressive lateral translationthe direction of progressive lateral translation or bennett angle with a mean value of 7.5or bennett angle with a mean value of 7.5 degree.degree.  Hobo and Mochizuki foung a much greaterHobo and Mochizuki foung a much greater variation ranging from1.5 to 36 degree with avariation ranging from1.5 to 36 degree with a mean value of 12.8degree.mean value of 12.8degree. www.indiandentalacademy.comwww.indiandentalacademy.com
  29. 29. DETERMINENTS OFDETERMINENTS OF OCCLUSIONOCCLUSION  Posterior determinentsPosterior determinents  Anterior determinentsAnterior determinents  Neuromuscular systemNeuromuscular system www.indiandentalacademy.comwww.indiandentalacademy.com
  30. 30. Posterior determinentsPosterior determinents  Rt and lt temporomandibular joints.Rt and lt temporomandibular joints.  No control over it.No control over it.  Condylar path is the basis for the use ofCondylar path is the basis for the use of articulator.articulator. www.indiandentalacademy.comwww.indiandentalacademy.com
  31. 31. Anterior determinantsAnterior determinants  Teeth.Teeth.  Posterior teeth – vertical stops for closure.Posterior teeth – vertical stops for closure. Also guide the mandible to maximumAlso guide the mandible to maximum inercuspationinercuspation  Anterior teeth – guide the mandible in lateralAnterior teeth – guide the mandible in lateral excursive and in protrusive movements.excursive and in protrusive movements. www.indiandentalacademy.comwww.indiandentalacademy.com
  32. 32.  Anterior teeth are suited for guidance 1)caninesAnterior teeth are suited for guidance 1)canines having longest, strongest roots.having longest, strongest roots. 2)the load being reduced by distance from the2)the load being reduced by distance from the fulcrum.fulcrum. 3)the proprioceptive threshold and concomitant3)the proprioceptive threshold and concomitant reflexes reducing the load.reflexes reducing the load.  Dentist have direct control over the toothDentist have direct control over the tooth determinants by orthodontic movement, restoration ofdeterminants by orthodontic movement, restoration of anterior lingual or posterior occlusal surfaces,anterior lingual or posterior occlusal surfaces, selective grinding.selective grinding. www.indiandentalacademy.comwww.indiandentalacademy.com
  33. 33. www.indiandentalacademy.comwww.indiandentalacademy.com
  34. 34. Neuromuscular systemNeuromuscular system  The neuromuscular system, throughThe neuromuscular system, through proprioceptive nerve endings in theproprioceptive nerve endings in the periodontium, muscles and joints monitor theperiodontium, muscles and joints monitor the position of the mandible and its path ofposition of the mandible and its path of movement.movement.  Indirect control over it.Indirect control over it. www.indiandentalacademy.comwww.indiandentalacademy.com
  35. 35. Effects of anatomic determinantsEffects of anatomic determinants www.indiandentalacademy.comwww.indiandentalacademy.com
  36. 36. Molar disocclusionMolar disocclusion  Normal occlusions perform repeated lateralNormal occlusions perform repeated lateral mandibular movements, they will not trace themandibular movements, they will not trace the same path on electronic recordings due tosame path on electronic recordings due to flexible nature of articular disc.flexible nature of articular disc.  The measurement deviation averages 0.2mmThe measurement deviation averages 0.2mm in centric relation, 0.3mm in working, andin centric relation, 0.3mm in working, and 0.8mm in both protrusive and nonworking0.8mm in both protrusive and nonworking movementsmovements www.indiandentalacademy.comwww.indiandentalacademy.com
  37. 37.  Healthy natural occlusions exhibit clearancesHealthy natural occlusions exhibit clearances that will accommodate these aberrations.that will accommodate these aberrations.  Measurement of disocclusions from theMeasurement of disocclusions from the mesiobuccal cusp tips of the mandibular firstmesiobuccal cusp tips of the mandibular first molar in asymptomatic test subjects with goodmolar in asymptomatic test subjects with good occlusions showed separations averagingocclusions showed separations averaging 0.5mm in working , 1.0mm in nonworking and0.5mm in working , 1.0mm in nonworking and 1.1mm in protrusive movement.1.1mm in protrusive movement. www.indiandentalacademy.comwww.indiandentalacademy.com
  38. 38.  Therefore one of the treatment goals in placingTherefore one of the treatment goals in placing occlusal restorations should be to produce aocclusal restorations should be to produce a posterior occlusion with buffer space thatposterior occlusion with buffer space that equals or surpasses the deviations resultingequals or surpasses the deviations resulting from natural variations found in thefrom natural variations found in the temporomandibular joint.temporomandibular joint. www.indiandentalacademy.comwww.indiandentalacademy.com
  39. 39. Condylar guidanceCondylar guidance *Protrusive condylar inclination – average 30.4*Protrusive condylar inclination – average 30.4 degree.degree. - steep- steep - shallow- shallow *mandibular lateral translation*mandibular lateral translation www.indiandentalacademy.comwww.indiandentalacademy.com
  40. 40. www.indiandentalacademy.comwww.indiandentalacademy.com
  41. 41. Immediate lateral translationImmediate lateral translation www.indiandentalacademy.comwww.indiandentalacademy.com
  42. 42.  Ridge and groove directions are affected byRidge and groove directions are affected by the condylar path, particularly lateralthe condylar path, particularly lateral translation. The effect was observed on thetranslation. The effect was observed on the occlusal surface of a mandibular molar andocclusal surface of a mandibular molar and premolar.premolar.  The working path is traced on the mandibularThe working path is traced on the mandibular tooth in lingual direction and nonworking pathtooth in lingual direction and nonworking path is in a distobuccal direction.is in a distobuccal direction. www.indiandentalacademy.comwww.indiandentalacademy.com
  43. 43.  Nearer the tooth is to the working side condyleNearer the tooth is to the working side condyle anteroposteriorly, the smaller the angleanteroposteriorly, the smaller the angle between the working and nonworking pathsbetween the working and nonworking paths www.indiandentalacademy.comwww.indiandentalacademy.com
  44. 44. www.indiandentalacademy.comwww.indiandentalacademy.com
  45. 45. Anterior guidanceAnterior guidance  Protrusive incisal path inclination – 50 to 70Protrusive incisal path inclination – 50 to 70 degrees.degrees. www.indiandentalacademy.comwww.indiandentalacademy.com
  46. 46. www.indiandentalacademy.comwww.indiandentalacademy.com
  47. 47. www.indiandentalacademy.comwww.indiandentalacademy.com
  48. 48. www.indiandentalacademy.comwww.indiandentalacademy.com
  49. 49. www.indiandentalacademy.comwww.indiandentalacademy.com
  50. 50. FactorFactor ConditionCondition EffectEffect CondylarCondylar guidanceguidance SteeperSteeper TallerTaller AnteriorAnterior guidanceguidance More overbiteMore overbite More OverjetMore Overjet TallerTaller ShorterShorter Plane ofPlane of occlusionocclusion More parallelMore parallel ShorterShorter Curve ofCurve of SpeeSpee More acuteMore acute ShorterShorter LateralLateral translationtranslation Greater movementGreater movement ShorterShorter www.indiandentalacademy.comwww.indiandentalacademy.com
  51. 51. FactorFactor ConditionCondition EffectEffect Distance fromDistance from rotating condylerotating condyle GreaterGreater Wider the angleWider the angle Distance fromDistance from midsagittal planemidsagittal plane GreaterGreater Wider the angleWider the angle Lateral translationLateral translation GreaterGreater Wider the angleWider the angle IntercondylarIntercondylar distancedistance GreaterGreater Smaller the angleSmaller the angle www.indiandentalacademy.comwww.indiandentalacademy.com
  52. 52. Occlusal interferencesOcclusal interferences  CentricCentric  WorkingWorking  NonworkingNonworking  protrusiveprotrusive www.indiandentalacademy.comwww.indiandentalacademy.com
  53. 53. Centric interferenceCentric interference www.indiandentalacademy.comwww.indiandentalacademy.com
  54. 54. Working interferenceWorking interference www.indiandentalacademy.comwww.indiandentalacademy.com
  55. 55. Nonworking interferenceNonworking interference www.indiandentalacademy.comwww.indiandentalacademy.com
  56. 56. Protrusive interferenceProtrusive interference www.indiandentalacademy.comwww.indiandentalacademy.com
  57. 57. NORMAL V/S PATHOLOGICNORMAL V/S PATHOLOGIC OCCLUSIONOCCLUSION  10% population with complete hormony according to10% population with complete hormony according to old conceptold concept  In majority of population, the maximumIn majority of population, the maximum intercuspation causes the mandible to be deflectedintercuspation causes the mandible to be deflected away from its optimum position.away from its optimum position.  In the absence of symptoms, this is consideredIn the absence of symptoms, this is considered physiologic or normal .physiologic or normal .  So in physiologic occlusion teeth will be in theSo in physiologic occlusion teeth will be in the maximum intercuspation and condyle in the lessmaximum intercuspation and condyle in the less optimal position.optimal position. www.indiandentalacademy.comwww.indiandentalacademy.com
  58. 58.  Patient ability to adapt may be influenced byPatient ability to adapt may be influenced by the effects of psychic stress and emotionalthe effects of psychic stress and emotional tensions on CNS.tensions on CNS.  Lowering the threshold, leads toLowering the threshold, leads to parafunctional activity.parafunctional activity.  Normal occlusion becomes the pathologic one.Normal occlusion becomes the pathologic one. www.indiandentalacademy.comwww.indiandentalacademy.com
  59. 59. www.indiandentalacademy.comwww.indiandentalacademy.com
  60. 60. Okesons criteria for optimal occlusion;Okesons criteria for optimal occlusion; 1.1. In closure, the condyles are in the mostIn closure, the condyles are in the most superoanterior position against the discs onsuperoanterior position against the discs on the posterior slopes of the eminences of thethe posterior slopes of the eminences of the glenoid fossae. The posterior teeth are inglenoid fossae. The posterior teeth are in solid and even contact and the anterior teethsolid and even contact and the anterior teeth are in slightly lighter contact.are in slightly lighter contact. 2.2. Occlusal forces are in the long axes of theOcclusal forces are in the long axes of the teethteeth www.indiandentalacademy.comwww.indiandentalacademy.com
  61. 61. 3. In lateral excursions of the mandible, working3. In lateral excursions of the mandible, working side contacts disocclude or separate theside contacts disocclude or separate the nonworking teeth instantly.nonworking teeth instantly. 4. In protrusive excursions, anterior tooth4. In protrusive excursions, anterior tooth contacts will disocclude the posterior teeth.contacts will disocclude the posterior teeth. 5. In an upright posture, posterior teeth contact5. In an upright posture, posterior teeth contact more heavily than do anterior teeth.more heavily than do anterior teeth. www.indiandentalacademy.comwww.indiandentalacademy.com
  62. 62. Occlusal conceptsOcclusal concepts  Bilateral balanced occlusionBilateral balanced occlusion  Unilateral balanced occlusionUnilateral balanced occlusion  Mutually protected occlusionMutually protected occlusion www.indiandentalacademy.comwww.indiandentalacademy.com
  63. 63. Bilateral balanced occlusionBilateral balanced occlusion  Von spee and MonsonVon spee and Monson  Very difficult to achieve.Very difficult to achieve.  High rate of failure.High rate of failure.  Excessive frictional wear.Excessive frictional wear.  Increased periodontal breakdown andIncreased periodontal breakdown and neuromuscular disturbance.neuromuscular disturbance. www.indiandentalacademy.comwww.indiandentalacademy.com
  64. 64. Unilateral balanced occlusionUnilateral balanced occlusion  SchuylerSchuyler  Distributes the occlusal load on working sideDistributes the occlusal load on working side  Prevents the teeth from oblique directed forcesPrevents the teeth from oblique directed forces on non-working side.on non-working side.  Saves centric holding cusps from excessiveSaves centric holding cusps from excessive wear.wear.  Maintainance of occlusion.Maintainance of occlusion. www.indiandentalacademy.comwww.indiandentalacademy.com
  65. 65. Group function occlusion www.indiandentalacademy.comwww.indiandentalacademy.com
  66. 66. Mutually protected occlusionMutually protected occlusion  D’Amico, stuart and stallard.D’Amico, stuart and stallard.  Maximum intercuspation coincides with theMaximum intercuspation coincides with the optimal condylar positionoptimal condylar position  All posterior teeth are in contact and forcesAll posterior teeth are in contact and forces directed along the long axes.directed along the long axes.  Anterior teeth either lightly contact of veryAnterior teeth either lightly contact of very slight out of contact (25microns)slight out of contact (25microns) www.indiandentalacademy.comwww.indiandentalacademy.com
  67. 67. Canine guided occlusion www.indiandentalacademy.comwww.indiandentalacademy.com
  68. 68.  Easy of fabrication and greater tolerance byEasy of fabrication and greater tolerance by the patients.the patients.  Anterior teeth should be periodontally healthyAnterior teeth should be periodontally healthy  Depends on the orthodontic relation of theDepends on the orthodontic relation of the opposing arches.opposing arches.  Cannot be used in reverse occlusion or crossCannot be used in reverse occlusion or cross bite.bite. www.indiandentalacademy.comwww.indiandentalacademy.com
  69. 69. conclusionconclusion  Occlusion is the integrated relationship of the toothOcclusion is the integrated relationship of the tooth periodontium, TMJ and neuromusculature, and notperiodontium, TMJ and neuromusculature, and not merely the interdigitation of the tooth. There is amerely the interdigitation of the tooth. There is a complex interaction of many components ofcomplex interaction of many components of masticatory system. Changes in one component affectmasticatory system. Changes in one component affect the entire system. The dentist who practice restorativethe entire system. The dentist who practice restorative dentistry should appreciate their significance for thedentistry should appreciate their significance for the long term successful restorations by maintaining thelong term successful restorations by maintaining the occlusal integrity.occlusal integrity. www.indiandentalacademy.comwww.indiandentalacademy.com
  70. 70. BibliographyBibliography  Okeson JP. Management ofOkeson JP. Management of Temporomandibular Disorders andTemporomandibular Disorders and Occlusion, ed. 4th, 1998; Mosby .Occlusion, ed. 4th, 1998; Mosby .  Shillingburg HT. Fundamentals of FixedShillingburg HT. Fundamentals of Fixed Prosthodontics, ed.3rd.Prosthodontics, ed.3rd.  Rosenstiel S.F. Contemorary FixedRosenstiel S.F. Contemorary Fixed Prosthodontics, 3rd edition.Prosthodontics, 3rd edition.  Glossary of prosthodontics terms – 7thGlossary of prosthodontics terms – 7th edition, 1999.edition, 1999. www.indiandentalacademy.comwww.indiandentalacademy.com
  71. 71. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.comwww.indiandentalacademy.com

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