Occlusion in fpd seminar

1. Occlusion In
Fixed Partial Dentures
Department of Prosthodontics Including Crown & Bridge, Maxillofacial
Prosthodontics & Oral Implantology. 1
Presenter- Dr. Nikita Aggarwal
Preceptor- Dr. Siddhi Tripathi
6th of May 2020

2. CONTENTS
Introduction
Evolution of Occlusion
Theories of Occlusion
Classification
Concepts of Occlusion
- bilateral balanced
-unilateral balanced
- mutually protected
2

3. Curves of occlusion
Determinants of occlusion
-vertical
-horizontal
Occlusal relation btw centric cusps and opposing
teeth
Interferences
Pathologic occlusion
Selective grinding for occlusal equilibration
Conclusion
References
3

4. INTRODUCTION
4
Chief Aim - maintain an occlusion that
will function in harmony with the other
components of masticatory mechanism,
thereby preserving their health at the
same time providing optimum, if not
maximum masticatory function.
Stomatognathic system is designed to
dissipate the forces of mastication to
the supporting structures.

5. DEFINITIONS1
Occlude - to bring together / to shut.
Occlusion - the static relation between the incising or masticating
surfaces of maxillary and mandibular teeth or tooth analogues
Articulation - in dentistry, the static and dynamic contact relationship
between the occlusal surfaces of the teeth during function
Maximal intercuspal position - the complete intercuspation of the
opposing teeth independent of condylar position, sometimes referred to
as the best fit of the teeth regardless of the condylar position
Centric occlusion - the occlusion of opposing teeth when the mandible
is in centric relation; this may or may not coincide with the maximal
intercuspal position
eccentric occlusion - an occlusion other than maximal intercuspal
position
Disclusion - the separation of opposing teeth during eccentric
movements of the mandible
5
1.Glossary of Prosthodontic Terms, Edition Nine, J Prosthet Dent 2017;117 (5S):e1-e105

6. IDEAL OCCLUSION 2:
Guichet(1970)
Criteria I-
Incorporate into the
occlusion those
factors which have
to do with the
reduction of vertical
forces.
Criteria II- provide
a maximum
intercuspation of
teeth with the
condyles in
centric relation
position.
Criteria III- Provide
for horizontal
movement of the
mandible from
the centric
position
6
2. Guichet NF, Gourion G, Gauthier G.Rev Fr Odontostomatol. Gnathology--why and how? The occlusion
syndrome. Dec;17(10):1375-84.

7. EVOLUTION OF
OCCLUSION3
7
3. KARNATI, PRAVEEN KUMAR & Reddy, Vivek & Chaitanya, Nellore. Functional occlusion and temperomandibular joint.
Annals and Essences of Dentistry 2014;6(2):51-55

8. DEVELOPMEN
T OF THE
CONCEPT OF
THE
OCCLUSION
IS DIVIDED
INTO THREE
PERIODS AS
8
1. THE
FICTIONAL
PERIOD ( PRIOR
TO 1900 )
1900
2. THE
HYPOTHETICAL
PERIOD
1900–
1930
3. THE FACTUAL
PERIOD ( 1930
TO PRESENT DAY
)
1930 TO
PRESENT

9. 1. THE FICTIONAL PERIOD
Pioneers like Fuller, Clark and Imric talked of
antagonism, meeting or gliding of teeth.
Kingsley wrote in 1880 about peculiarities of
the permanent teeth
Eugene Talbot’s text “Irregularities of the
teeth and their treatment”
9

10. 2. THE HYPOTHETICAL
PERIOD
EDWARD HEARTLY ANGLE (1899) - “KEY TO OCCLUSION”.
MATHEW CRYER AND CALVIN CASE -terms ‘protrude’ and ‘retrude’ should always refer to the
relation they bear to the normal dentofacial position and not to the normal occlusal position.
Case (1908)- the static empiric nature of the concept of occlusion
Bennet (1908) function analysis or a dynamic approach to occlusion
Lischer and Simon - forming the basis of science of gnathostatics
10

11. 3. THE FACTUAL PERIOD
HOLLY BROADBENT (1930) - accurate technique of
Roentgenographic Cephalometry.
PLANER - told when bites should be opened and when
they should not, depending on the amount of space
between two positions.
In the past 40yrs or since 1930, a third element of
occlusion, “Time” has received more attention.
11

12. AS RELATED TO THE DESIGNS OF ARTICULATORS-
1. BONWILL’S THEORY OF OCCLUSION
2. CONICAL THEORY OF OCCLUSION
3. SPHERICAL THEORY OF OCCLUSION
THEORIES
OF OCCLUSION
12

13. BONWILLS THEORY OF
OCCLUSION
In 1858- triangular theory-
distance from the incisal edges
of the lower incisors to each
condyle is 4 inches, and the
distance between the condyles
is 4 inches 4.
Proposed concept of bilateral
balanced occlusion
Developed articulator that
applied his 4-inch triangular
theory.
13
4”
4”
BONWILL 1858
4. Christensen, F. T. (1959). The effect of Bonwill’s triangle on complete dentures. The Journal of Prosthetic Dentistry, 9(5), 791–796

14. CONICAL THEORY OF
OCCLUSION
 Lower teeth move
over the surface of the
upper teeth as over the
surface of a cone with
a generating angle of
45º and with a central
axis of the cone tipped
at a 15º angle to the
occlusal plane
Hall automatic
articulator by
R.E.Hall www.asiandentalacademy.org

15. THE
SPHERICAL
THEORY OF
OCCLUSION
Before 1916 Monson formulated a
three-dimensional occlusal
philosophy by combining the
concepts of Bonwill's 4-inch
triangle and bilateral balanced
occlusion, Von Spee's
compensating curve, and the
observations of Balkwill and
Christensen on condylar
movement.
This occlusal model was named
the Spherical Theory.
15

16. THE SPHERICAL THEORY OF OCCLUSION
16
 Lower teeth moving over the surface of upper teeth as a surface of a
sphere of a diameter of 8 inches with centre in the region of Glabella.
 Monson then developed an articulator for the

17. DAWSON’S
CLASSIFICATIO
N OF
OCCLUSION5
Type 1- Maximal
intercuspation is in
harmony with
centric relation.
Type IA: Maximal
intercuspation
occurs in harmony
with adapted centric
posture.
The A signifies
adapted condition.
17 5. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St. L
Elsevier;2009. p. 107-109

18. Type II: Condyles must
displace from a verifiable
centric relation for maximum
intercuspation to occur.
Type IIA: Condyles must
displace from an adapted
centric posture for maximum
intercuspation to occur.
18

19. Type III: Centric
relation cannot be
verified.
Type IV: The
occlusal relationship
is in an active stage
of progressive
disorder because of
pathologically
unstable TMJs.
19

20. 20
6
6.

21. BILATERAL BALANCED
OCCLUSION
 In 1935 ,Schuyler developed the first detailed
technique for occlusal adjustment. By 1953 he
began to observe failure of natural dentition
restored with balance .His observations and
suggestions effectively signaled the end of
BALANCE as a acceptable treatment approach
for the dentulous patient
 Stuart and Stallard (1960) noted that
balanced occlusion in reconstructed natural
dentitions
1.Often required injudicious increase in occlusal
vertical dimension to achieve balance.
2. Often led to instability of occlusion.
3. Frequently showed increased wear of teeth and
restorations
21
The Demise of Balanced Occlusion in restoring natural dentition

22. THUS THE
CONCEPT OF A
UNILATERALLY
BALANCED
OCCLUSION
(GROUP
FUNCTION)
EVOLVED
22

23. Group Function Occlusion
(Unilateral balanced occlusion)
Schuyler (1929)
Multiple contact relations
be- tween the maxillary
and mandibular teeth in
lateral movements on the
working-side whereby
simultaneous contact of
several teeth acts as a
group to distribute occlusal
forces 1
GPT-9
23
1. Glossary of Prosthodontic Terms, Edition Nine, J Prosthet Dent 2017;117 (5S):e1

24. Here excursive contact occurs between all opposing
posterior teeth on the laterotrusive(working) side only. On
the mediotrusive(non-working) side, no contact occurs until
the mandible has reached centric relation.
24
6
6

25. • ADVANTAGES:
• Group function of the teeth on the
working side distributes the occlusal load
• The absence of contact on the
nonworking side prevents those from
getting subjected to destructive ,obliquely
directed forces found in nonworking
interferences.
25

26. • It also saves centric holding cusps that is mandibular bucca
cusps and maxillary palatal cusps from excessive wear.
• In the presence of anterior bone loss or missing
canines, mouth should be restored to group function
Due to these factors, this concept has had broad support
from PANKEY , MANN and SCHYLUER (1960)
RAMJFORD,ASH(1966),POSSELT(1968),and
LAURITZEN(1974).
It has been adapted by PANKEY and MANN for complete
mouth rehabilitation
26

27. LONG CENTRIC(FREEDOM
FROM CENTRIC)7
freedom to close the mandible
either into centric relation or
slightly anterior to it without
varying the vertical dimension at
the anterior teeth.
Concern- restrictive effect that
can result from the lingual
inclines of upper anterior teeth
27
7. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St.
Louis: Elsevier;2009. p. 189-198

28. 28
According to Dawson in the absence of any CR interferences difference
between centric closure and light closure from rest rarely exceeds 0.5mm,the
usual long centric would be close to 0.2mm,and there are patients who do
not require “long centric” at all because their light closure from rest is
identical to their firm closure into CR.

29. Controversy ?????
SCHUYLER Vs GUICHET
29
Schuyler felt all working side
teeth should contact during
lateral movement by
eliminating non — working
contacts; he did not discuss
pressure differences on
molars compared to anterior
teeth.
Guichet (1970) questioned
Schuyler’s theory and stated
the lateral pressure on
canines is approximately 1/8
than on second molars.
When sharing the load on the
working side, the molar
bears a greater burden and
not all teeth share the same
amount of load.

30. Disadvantages:-
Group Function Occlusion doesn’t fulfill
criteria for ideal occlusion.
Guichet(1970) described standards for
ideal occlusion and said that there was no
one ideal occlusion pattern for all
individuals but an appropriate pattern can
be found based on these criteria.
30

31. Mutually Protected Occlusion
(Organic occlusion)
31
6
6

32. Stallard found that anterior teeth protect posterior teeth and
that the posterior teeth protect the anterior teeth.
32

33. 33

34. 34
6
6

35. 35

36. D’Amico (1958) performed a study on canines in animals
and human beings and advocated a canine guided
occlusion.
This theory suggests that
the only tooth contact in all
positions of the mandible
except CR should be between
maxillary cuspids and
mandibular cuspids.
Thus he called canine as NATURE’S STRESS BREAKER
Canine guided occlusion
36

37. WHY CANINE??
Long roots
 Good crown to root ratio
 Surrounded by dense compact bone which
tolerates forces better.
 Location is far from the TMJ thus receiving less
stress .
 It has many receptors in the periodontal ligament
so it controls lateral pressure by directing vertical
masticatory movements.
37

38. PLANE OF OCCLUSION :7
It refers to an imaginary surface that theoretically
touches the incisal edges of the incisors and tips of
the occluding surfaces of the posterior teeth.
38
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;

39. The curvatures of anterior teeth are determined by:
Establishment of an esthetically correct smile line on
the maxillary; and
The relationship of the mandibular incisal edges to the
anterior guidance & phonetics.
39
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;
2007:200-6

40. 40
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;
The curvatures of posterior plane of occlusion
are divided into:
an Anteroposterior curve  Curve of Spee
Mediolateral curve  Curve of Wilson
Together, the composite of the curve of Spee, the
curve of Wilson, and the curve of the incisal edges
is properly referred to as the curve of occlusion.

41. CURVE
OF SPEE
Purpose- To align each
tooth for maximum
resistance to functional
loading, the long axis of
each lower tooth is
aligned nearly parallel
to its individual arc of
closure around the
condylar axis.
41
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;

42. 42
7. Dawson PE. Evaluation, diagnosis and treatment of occlusal problems; p.190
If the curve of Spee is too
high in posterior
Deleterious to supporting
tissues of posterior teeth
because it forces the most post
teeth to carry the full stress
imposed on them by the
musculature when the mandible
is protruded
If the curve of
Spee is too high or
low in front
Poor esthetic result
Can cause excessive
stress on maxillary
posteriors

43. CURVE OF WILSON
43
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;
2007:200-6

44. Mediolateral curve
Contacts the buccal and
lingual cusp tips on each
side of the arch.
Results from inward
inclination of the lower
posterior teeth, making the
lingual cusps lower than the
buccal cusps on the
mandibular arch;
The buccal cusps are higher
than the lingual cusps on
the maxillary arch because
of the outward inclination of
the upper posterior teeth.
44
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;

45. There are two reasons for this inclination of posterior
teeth:
1) resistance to loading - Axial alignment of all posterior
teeth is nearly parallel with the strong inward pull of
the internal pterygoid muscles.
2) masticatory function - easy access for the food to get
to the occlusal table.(inward inclination of the lower
occlusal table)(upper teeth positions the buccal cusps
higher for easier access from the buccal corridor)
45
7. Dawson PE. Functional occlusion from TMJ to smile design. Mosby;

46. When the curve of Wilson is
made too flat
ease of masticatory function
may be impaired because of
increased activity required to
get the food onto the occlusal
table
46

47. When the curve of Wilson is
made too steep
It may eliminate the use of
upper lingual cusps as
holding contacts since they
would interfere with lateral
movements of the mandible.
47

48. Determinants
of occlusion8
48
Posterior controlling factor (CONDYLAR GUIDANCE)
Anterior controlling factor (ANTERIOR GUIDANCE)
8. Okeson - Management of Temporomandibular Disorders and Occlusion, 7th

49. POSTERIOR
CONTROLLIN
G FACTOR
(CONDYLAR
GUIDANCE)
49

50.  As the condyle moves out of centric relation it descends along
the articular eminence.
 If the articular eminence is steep, the condyle describes a
steep vertically inclined path and if flatter, the path is less
vertically inclined.
The angle at which the condyle moves
away from a horizontal reference plane
is referred to as the CONDYLAR
GUIDANCE ANGLE.
50

51. 51
The CGA is steeper for the orbiting condyle in
a latero-trusive movement of the mandible as
the medial wall of the mandibular fossa is
steeper than the articular eminence in front.
The two TMJ’s are the posterior controlling
factor.
CONDYLAR GUIDANCE is a fixed factor.

52. ANTERIOR
CONTROLLING
FACTOR
(ANTERIOR
GUIDANCE)
52

53.  The anterior teeth guide the movement of the anterior portion of
the mandible.
 As the mandible protrudes, the incisal edge of the mandibular
anterior teeth occlude with the lingual surfaces of the maxillary
anterior teeth.
The steepness of the lingual surface determines the amount of
vertical movement of the mandible.
 It is a variable factor.
53

54. VERTICAL DETERMINANTS
1. Effect of condylar guidance on cusp height
2. Effect of anterior guidance on cusp height
3. Effect of plane of occlusion on cusp height
4. Effect of curve of Spee on cusp height
54
Influence the height of
the cusp & the depth of
the fossae

55. Effect of condylar guidance on cusp height
55
STEEPER the articular eminence, more is
the descent of the condyle, resulting in
greater vertical movement. Thus allowing
for STEEPER posterior cusps.

56. 5
6
Effect of anterior
guidance on cusp
height
INCREASED HORIZONTAL
OVERLAP decreases the
anterior guidance angle. There
is less vertical movement of
the mandible leading to
FLATTER POSTERIOR CUSPS.

57. 57
INCREASED VERTICAL OVERLAP increases the anterior
guidance angle. There is more vertical movement of the mandible
leading to STEEPER POSTERIOR CUSPS.

58. Effect of plane of occlusion on cusp
height
Plane of
occlusion is an
imaginary line
touching the
incisal edges of
the maxillary
anterior teeth
and the cusps
of the maxillary
posterior teeth.
58

59. • The more parallel the
plane of occlusion is to the
condylar guide angle, the
shorter the posterior
cusps must be
• The more divergent the
plane of occlusion is to the
condylar guide angle, the
taller the posterior cusps
can be
59

60. Its degree of curvature
influences the height of the
posterior cusps.
FLATTER the curve of Spee,
greater is the angle away from
the maxillary posteriors –
TALLER cusp.
More acute curve of Spee,
smaller the angle of
mandibular posterior tooth
movement – flatter cusps.
Effect of curve of spee on cusp height
60

61. EFFECT OF MANDIBULAR LATERAL
TRANSLATION MOVEMENT ON CUSP
HEIGHT
61
The greater the movement
The shorter the posterior
cusps
The more superior the
movement of the rotating
condyle
The shorter the posterior
cusps
The greater the immediate
side shift
The shorter the posterior
cusps

62. HORIZONTAL DETERMINANTS
1. Effect of distance from the rotating condyle
2. Effect of distance from midsagittal plane
3. Effect of distance from rotating condyle and fossa
from midsagittal plane
4. Effect of mandibular lateral translation movement
5. Effect of intercondylar distance
62

63. Effect of distance from the rotating condyle
INCREASED distance – wider angle between laterotrusive and
mediotrusive pathways, FLATTER centric cusps.
63

64. EFFECT OF
DISTANCE FROM
MIDSAGITTAL
PLANE
INCREASED
DISTANCE – WIDER
ANGLE BETWEEN
LATEROTRUSIVE
AND MEDIOTRUSIVE
PATHWAYS,
FLATTER CENTRIC
CUSPS
64

65. Effect of mandibular lateral translation
movement
Increased lateral movement, increases the angle between laterotrusive
and mediotrusive pathways
The direction of rotation of the rotating condyle also plays a role
Lateral and anterior direction – Increased angle (flatter cusp)
Lateral and posterior direction – decreased angle (sharper cusp)
65

66. EFFECT OF
INTERCONDYLAR
DISTANCE
INCREASE IN
DISTANCE,
REDUCES THE
ANGLE BETWEEN
LATEROTRUSIVE
AND MEDIOTRUSIVE
PATHWAYS
66

67. Occlusal relationship
between centric cusps
and opposing teeth
67

68. Tooth – to tooth occlusion
•Cusp tip to fossa
•Cusp to fossa
Tooth – to – two teeth
occlusion
Cusp marginal ridge/ cusp
embrasure occlusion
68

69. CUSP TO
FOSSA
OCCLUS
ION
69
Also called TOOTH TO TOOTH
OCCLUSION/ THREE POINT CONTACT/
TRIPODISM:
Rare in the Natural Dentition
It is a principle recommended by Peter
Thomas in 1967.
Biomechanical Advantages:
•Most stable tooth contact in the position of maximum
intercuspation can be obtained
•Occlusal forces can be axially directed
•“Wedging Effect” of a cusp articulated over the
occlusal embrasure is avoided

70. 70
4 upper centric cusps - mesiolingual cusp of molars & palatal of
the premolars
2 lower centric cusps – distobuccal cusps of the molars

71. 71
CUSP TO EMBRASURE
OCCLUSION
Also called CUSP MARGINAL RIDGE
OCCLUSION/ TOOTH TO TWO TOOTH
OCCLUSION/ TWO POINT CONTACT:
One tooth occludes with two opposing teeth
Found in 95% of all adults with natural dentition.
The centric cusp occludes in opposing embrasures
contacting the marginal ridges of opposing pair of
teeth.

72. 2 upper centric cusps - disto-lingual cusp of the molars
72

73. 4 lower centric cusps- buccal cusps of the premolars and mesiobuccal of the
molars
73

74. 74
9
9

75. 75
Four types of interferences
- Centric Interference
- Working Interference
- Non Working Interference
- Protrusive Interference

76. 76

77. 77

78. 78
6

79. SELECTIVE GRINDING FOR OCCLUSAL
EQUILIBRATION7
79
7. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St. Louis:
Elsevier;2009. p. 189-198

80. Equilibration procedures
80
Reduction of
interferences
in Centric
Relation
Elimination of
all posterior
interferences
during
protrusive
excursions
Harmonizati
on of
anterior
guidance
Selective
reduction of
interferences
in lateral
excursions

81. CENTRIC
RELATION
INTERFERE
NCES CAN
BE
DIFFERENTI
ATED INTO
TWO TYPES:
81
1. Interference to
the arc of closure
2. Interference to
the line of
closure

82. Interference to the arc of closure
82
As the condyles rotate on their
centric relation axis, each lower
tooth follows an arc of closure
Any interference  condyles
displaced downward and forward
 anterior slide

83. Basic grinding rule to correct anterior slide
83
Mesial inclines of maxillary teeth OR
distal inclines of mandibular teeth
MUDL

84. Interference to the line of closure
84
Primary interferences that cause the
mandible to deviate to left or right from
first point of contact in CR to most
closed position

85. Basic grinding rules
85
1. If the interfering incline causes the
mandible to deviate off the line of
closure toward the cheek, grind the
buccal incline of maxillary or lingual
incline of mandibular or both
BUL
L

86. 86
2. If the interfering incline causes the
mandible to deviate off the line of
closure toward the tongue, grind the
lingual incline of maxillary or buccal
incline of mandibular or both
LUB
L

87. GRINDING RULES
RULE 1: NARROW STAMP CUSPS BEFORE RESHAPING
FOSSAE
87
Stamp cusp is the cusp that fits inside the fossa-
1. Lower buccal
2. Upper lingual cusp

88. RULE 2: DON’T
SHORTEN A
STAMP CUSP
The cusps should be
narrowed on the side
that marks when the
jaw closes to centric
relation contact
If interferences that
deviate the mandible
forward are
eliminated, a “long
centric” will be
provided
automatically
88

89. RULE 3:
ADJUST
CENTRIC
INTERFERE
NCES FIRST
89
By adjusting centric
interferences first, you have the
option of improving cusp-tip
position.
occlusal grinding is more evenly
distributed to both arches.
eccentric interferences can be
eliminated with speed and
simplicity.

90. RULE 4:
ELIMINATE
ALL
POSTERIOR
INCLINE
CONTACTS.
PRESERVE
CUSP TIPS
ONLY.
90
if all eccentric contacts on
posterior teeth are to be
elimiinated, any posterior
incline that marks in any
excursion can be reduced.
Centric stops must be
preserved, but all other
contacts can be shaped so that
they are discluded by the
anterior guidance.

91. LATERAL EXCURSION
INTERFERENCES
91
dictated by two
determinants:
1. The border
movements of the
condyles
2. The anterior
guidance
When lateral
excursions are being
equilibrated, the
mandible must be
guided with firm
upward pressure
through the condyles
to ensure that all
interferences are
recorded and
eliminated through
the uppermost ranges
of motion that can
occur at true border
paths for both the
condyles and the an-
terior guidance.

92. NEXT STEP:
ELIMINATING
EXCURSIVE
INTERFERENCES
protrusive interferences,
interferences of the
working side
interferences of the
balancing side
Can be marked and
adjusted without concern
for whether the
interference is in
protrusive, lateral
working side, or
balancing side.
92
The ideal pattern of centric relation contacts.

93. PERFECTED
OCCLUSION
DOTS IN BACK . . .
LINES IN FRONT.
This is the ideal
result of marking
with a red ribbon
while the patient
grinds the teeth
together in all
excursions.
All teeth touch in
centric relation.
Only the anterior
teeth contact in
excursion.
93

94. A TYPICAL PATTERN OF
MARKINGS WHEN A RED
RIBBON IS PLACED AND THE
PATIENT IS INSTRUCTED TO
GRIND THE TEETH TOGETHER.
note the posterior
interferences
prevent any
excursive contact on
the anterior teeth
Grind all red marks
on posterior teeth.
Do not touch any
black marks.
94
armamentarium : A small diamond
wheel stone, 12-sided football-
shaped finishing bur work well for
precise reduction and reshaping.
Red and black marking ribbons are
held in Miller ribbon holders.

95. 95
Marks that might look insignificant can be
potent triggers for activating muscle
hyperactivity and can prevent the turning off
of the elevator muscles that occurs when
posterior disclusion is complete.
Such interferences can easily be eliminated,
and must be, for a predictably successful
result.

96. ADJUSTING THE ANTERIOR
GUIDANCE
Step 1. guided closure.
Step 2. light tapping from a postural position. Use a red
marking ribbon for light postural closure. Then use a black
ribbon for centric (guided) closure. If red marks extend onto a
fairly steep incline, reduce the incline just enough to permit
unguided closure without wedging into the incline before fully
closed.
Step 3. Equalize contact in the protrusive path. If a single tooth
is carrying 100 percent of the forces when the mandible slides
forward, reduce the incline as needed to bring more incisors
into contact in protrusive.
Step 4. Adjust the lateral anterior guidance as needed to permit
smooth, comfortable excursions.
96

97. 97

98. PROTRUSIVE INTERFERENCES
DUML: GRIND THE DISTAL INCLINES OF THE UPPER OR,
UPPER OR, IN SOME INSTANCES, THE MESIAL INCLINE
INCLINE OF THE LOWER TEETH.
“slide forward and back, forward and back.” from
centric
The patient should do the sliding, but the dentist
should maintain a firm hold on the mandible to
make sure the condyles are staying up against the
eminentiae during the movement.
98
DUML

99. VERIFICA
TION OF
COMPLET
ION
99
Clench Test - Ask the
patient to clench the
teeth together and
squeeze firmly
(empty mouth). If the
patient can feel any
discomfort in any
tooth, the
equilibration is not
complete.
Anterior Deprogramming
Splint - to confirm whether
the problem is or is not
related to occluso-muscle
pain. If the anterior splint
completely separates all the
posterior teeth,
all discomfort will dissipate
if the cause of
the discomfort is totally
related to occlusion.

100. OCCLUSI
ON
INDICATO
RS –
TYPES10
100
Qualitative indicators
• Articulating paper
• Articulating silk
• Articulating film
• Metallic shim stock fi lm
• High spot indicator
Quantitative indicators
• T-Scan occlusal analysis system
• Virtual dental patient
10. Ramakrishna Rajan Babu, Sanjna Vibhu Nayar. Occlusion indicators: A review. J
Soc. 2007;7(4):170-174

101. 101
Articulating paper:
Hydrophobic
Their basic constituents are a coloring agent and a bonding
agent (e.g., Transculase-Bausch Articulating paper)
In practice, there is a tendency to
use cost-effective materials such
as carbon papers. These are made
up of hydrophobic waxes that tend
to smudge the tooth surface and
fail to mark the contact spots
clearly.
Metallic shim stock film: The shim stock fil
a metallic surface on one side and the othe
colour coded. It is mainly indicated for use
occlusal splint therapy in order to accurate
the contacts on the soft splint in the labora
Articulating film: The Artifol
articulating film(Bausch Inc.) has
only a thickness of 8 μ, It is made
up of a emulsion with a thickness
of 6 μ, which is hydrophobic and
contained inside a polyester film. It
must be used with special holders
in a dry environment. It is

102. 102
Bausch pdf
Based on thickness
-Ultra-thick- 200 micron plus- mostly not used
-Thick -41-100 microns- removable prosthodontics,
/metal surfaces
-Thin -19-40 microns- natural dentition, bisque trial
-Ultra-thin -8-12 microns- foils- shimstock, artifoil- imp
( as not pdl), check presense or tightness of prox
contacts, friction on intaglio surface of crowns
Dr. Moez Khakiani, youtube

103. 103

104. First -1987
consists of a thin
flexible sensor inserted
into an autoclavable
sensor handle that is
plugged into the USB port
of a personal computer.
The sensors are 85
microns thick, it encloses
a double layer of Mylar, a
special ink.
A force applied to each
of these cells modifies
the electric conductivity
of the Mylar. The
program records and
analyzes the differentials
of applied voltage, and
gives relative values of
the force and duration of
occlusal contacts, with a
time precision of 10 ms.
Developed by Maness, 1987
T- Scan 10
10. Ramakrishna Rajan Babu, Sanjna Vibhu Nayar. Occlusion indicators: A
review. J Indian Prosthodont

105. - accurate way to
determine and evaluate
the time sequence and
force of occlusal
contacts by converting
the qualitative data into
quantitative and
displaying them
digitally
- analyzing tooth
contacts in order to
improve TMD and
removing the causes of
disorders.
105
Digital force data 2D and 3D

106. CONCLUSI
ON
There is no one answer to occlusal
problems, the dentist should use the
philosophy that works best in his
own hands and at the same time do
the most good, or better yet, the
least harm to the patient.”
106

107. REFERENCES
107

108. 1.Glossary of Prosthodontic Terms, Edition Nine, J Prosthet Dent 2017;117 (5S):e1-
e105
2. Guichet NF, Gourion G, Gauthier G.Rev Fr Odontostomatol. Gnathology--why and how?
The occlusion syndrome. Dec;17(10):1375-84.
3. KARNATI, PRAVEEN KUMAR & Reddy, Vivek & Chaitanya, Nellore. Functional
occlusion and temperomandibular joint. Annals and Essences of Dentistry
2014;6(2):51-55
4. Christensen, F. T. (1959). The effect of Bonwill’s triangle on complete dentures. The
Journal of Prosthetic Dentistry, 9(5), 791–796
5. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St. Louis:
Elsevier;2009. p. 107-109
6. Rosensteil SF, Land MF, FujimotoJ. Contemporary Fixed Prosthodontics. 3RD ed.
St. Louis:Elsevier;2000.p.110-144
7. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St. Louis:
Elsevier;2009. p. 189-198
8. Okeson - Management of Temporomandibular Disorders and Occlusion, 7th
Edition PG:86-99
9. Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brakett SE. Shillinburg's
Fundamentals Of Fixed Prosthodontics.4th ed. Chicago: quintessence;2012
108

109. TILTED TEETH
if the mark on the upper tooth is
lingual to the central fossa and if
stability can be improved, the lower
cusp tip is moved toward the buccal,
and the lower cusp is reshaped by
grinding its lingual inclines to move
the contact buccally.
This should not be done if it will
require shortening of the cusp out of
centric contact .
To grind the up- per tooth only may
mutilate its lingual cusp unnecessarily
without improving the direction of
forces.
109