This document discusses concepts and techniques related to occlusal rehabilitation. It covers topics such as centric relation, anterior guidance, restoring anterior and posterior teeth, and solving various occlusion problems. The Pankey-Mann-Schuyler philosophy advocates establishing stable centric stops, proper anterior guidance in harmony with jaw movements, disclusion of posterior teeth in protrusion, and non-interference of teeth during lateral excursions. The document provides guidelines for determining tooth contours and positions to achieve optimal function, stability, and aesthetics.

1. PANKEY MANN
SCHUYLER
TECHNIQUE
ANISH AMIN

2. Occlusal Rehabilitation Is A Labor Of Love.
If It Serves The Purpose Intended For It,
It Will Be Well Worth All The Effort
That Has Gone Into It 2

3. Contents
 The concept of complete dentistry
 Determinants of occlusion
 Centric relation
 vertical dimension
 The neutral zone
 The occlusal plane
 Yuodelis Scheme for Advanced Periodontitis Cases
 Nyman and Lindhe Scheme for Extremely Advanced Periodontitis Cases
 Pankey –Mann- Schuyler philosophy
 Long centric
 Anterior guidance
 Restoring anterior teeth
 Methods for determining the plane of occlusion

4.  Restoring posterior teeth
 Solving occlusal wear problems
 Solving deep overbite problems
 Solving anterior over jet problems
 Solving anterior open bite problems
 Treating end to end occlusions
 Treating the cross bite
 Post operative care
 References

5. The concept of complete dentistry
4 comprehensive goals
Optimal oral health
Anatomic harmony
Functional harmony
Occlusal stability

6. Requirements of successful occlusal therapy
 Comfortable Condyles –starting point ?
 Anterior teeth in harmony with the envelop of motion.
 Non interfering posterior teeth

7. Start with………a socket in a fixed base
Then,Add lever arm with a fulcrum so the
mandible can hinge open & close
But spinal cord has to move forward
So can walk upright. If we stay on this fixed
hinge. On opening , it compress our
airways & our alimentary canal.
That’s why, need for a movable
socket so that it can slide
forward while hinging

8. Now last thing…….
align the teeth
After all mechanical parts
in place……muscles required
to make jaw function
Now ,surrounds & encloses the
TMJ within capsule
By attaching ligaments with disk ………
….limit movement of the jaw

9. Hence, Occlusal morphology determinants are………

10. Centric relation
If one were asked to select the one arch to arch relationship that is most
important to comfort ,function and health of the stomatognathic system ,one
would have to say ,without reservation ,centric relation
Engrams
The muscle changes jaw position in the presence of the interferences as to
protect the interfering tooth or teeth from absorbing the entire force of the
closing musculature ,they become patterned to the devious closure .such
memorized patterns of the muscle activity are called as the ENGRAMS

11. 2 most important criteria for centric relation are
1.The complete release of the inferior lateral pterygoid muscle
2.Proper alignment of the disk on the condyle

12. If the condyle axis move forward then it is no longer in the centric relation

13. Methods of manipulation for centric relation:
1. One handed technique by Anderson and Tanner
2.Anterior stop technique
a) Lucia jig technique
b) Leaf gauge technique advocated by Long
c)A directly fabricated anterior deprogramming device
d)The pankey jig
e)The best bite appliance
3. Central bearing point method
4.Bilateral manipulative technique (Dawson technique )

14. Directly
fabricated
NTI device
Pankey jig
The Lucia jig Thebest bite
appliance

15. Methods for taking centric bite records
l. Wax bite procedures
2. Anterior stop techniques
3. Use of preadapted bases
4. Central bearing point technique.

17. Reasons for error in almost all of the centric relation
1.Improper manipulation
2.No guidance or verification of the centric relation
3.Flimsy bite recording materials
4. Too deep indentations in the bite materials
5.Use of the soft waxes that easily distorts when casts seated in the records
6. Too shallow or non existent in dentations
7.Unstable bite recording materials that warp or distorts.

18. 5 criteria for accuracy in making an inter occlusal record bite
1.The bite record must not cause any moment of teeth or displacement of the soft
tissue .
2. It must possible to verify the accuracy of the inter occlusal record in the mouth
3. The bite record must fit the cast as accurately as it fits in the mouth
4.It must be possible to verify the accuracy of the bite record on the cast
5. The bite record must not distort during storage .

19. Some of the invalid reasons for which vertical dimension change are :
1.To relieve a TMD
2.To “unload”the TMJ s .
3. To restore lost vertical dimension in a severely worn occlusion
4. To get rid of facial wrinkles
Vertical dimension

20. Fallacy of bite rising
Increased vertical height Creation of vaccum??

21. Rotation of the mandible
backwards to maintain
pivot 1st contact on last
molar
Increased bite force and
stepped occlusion

22. The neutral zone
Considerations
1.The teeth and their alveolar process are the most adaptive part of the
masticatory system .They can be moved horizontally or vertically by light
forces
2.There is neutral zone within which muscular pressure against the dentition is
equalized from the opposite directions
3. If irregularities of the tooth position, allignment or contour can be corrected
within the neutral zone ,the prognosis for the long term stability is good

23. 4. A problem occurs when the neutral zone is not where we want the teeth to be
5.A treatment decision then must allow determination of if and how we can
change the neutral zone to orient it where we want the teeth to be

24. Methods for altering the neutral zone
1.Orthodontics –by re aligning the teeth .
2. Elimination of the noxious habits
3.Myofunctional therapy
4.Reduction of the tongue size (surgical)
5.Surgical lengthening of the buccinator band .
6.Vestibuloplasty

25. …An ideal curve of Spee is aligned so
that a continuation of this arc would
extend through the condyles.
Plane of occlusion……

26. Curve of spee too low posteriorly:
It presents no problems, since it cannot interfere with basic requirements of
protrusive and balancing side disclusion…. If grossly overdone:
1. Create poor esthetic result
2. Excessive stress on upper teeth.
3. Reduce function by causing too much posterior teeth separation in
protrusion
Curve of spee too high or low in front:
If The lower premolars are higher than the cuspids, they can interfere
with the anterior protrusive guidance by bumping into the upper cuspids.

27. Curve of wilson……
…… Mediolateral curve that contacts
the buccal and lingual cusp tips of
each side of the arch.
…….It results from the inward
inclination of the lower posterior
teeth, making the lingual cusps lower
than the buccal cups 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.

28. Purposes of
curve of wilson…
1) Resistance to loading…………Axial alignment of all posterior teeth
nearly parallel with of strong inward pull internal pterygoid muscle……..this
alignment…..produces great resistance to masticatory muscles & creates
inclination that forms curve of wilson
Plane of occlusion……

29. One of the functions of our tongue……Dump food
into our mouth.
--
2) Impact on mastication….
How????????

30. Yuodelis Scheme for Advanced Periodontitis Cases:
The foundation of a healthy periodontium is emphasized.
The aim is for simultaneous interocclusal contact of posterior teeth in
CRCP (usually coincident with IP) with forces directed axially.
Anterior disclusion is provided for protrusive excursions and canine
disclusion for lateral excursions.
Cuspal anatomy is so arranged that if the canine disclusion is lost through
wear or tooth movement, the posterior teeth ‘drop into’ group function.

31. Diagnostic temporary restorations are important in providing information
essential to this scheme.
Both fully and semi-adjustable articulators
Emphasis is placed on margin placement and crown contour.
Comments:
This is a sensible combination of available techniques.
Primarily suitable for large vertical: horizontal ratio cases.

32. Nyman and Lindhe Scheme for Extremely Advanced
Periodontitis Cases:
This applies to bridgework supported by a healthy, though greatly reduced,
periodontium.
Even contact should be provided in the IP, although no great emphasis is
placed upon the type of contacts.
When distal support is present, anterior disclusion should be provided.

33. When there are long tooth-borne cantilevered restorations, balanced
occlusion is provided, that is, there are simultaneous working and non-
working side contacts on the cantilever.
All restorations should be fabricated on semi-adjustable articulators with
average settings and there is an emphasis on supragingival margin
placement of restorations.

34. Pankey-Mann-Schuyler Concept:
Practical philosophies for occlusal rehabilitation is the rationale or
treatment that was originally organized into a workable concept by
Dr. L.D. Pankey.
Utilizing the "Principles of occlusion" espoused by Dr. Clyde Schuyler,
Dr.Pankey integrated different aspects of several treatment approaches
into an orderly plan for achieving an optimum occlusal result.

35. Pankey –Mann- Schuyler philosophy
The goals of full mouth rehab are fulfilled by the following these principles :
1.A static coordinated occlusal contact of the maximum number of the teeth
when the mandible is in the centric relation
2. An anterior guidance that is in harmony with the function in lateral eccentric
positions on the working sides
3.Disclusion by the anterior guidance of all posterior teeth in protrusion
4. Disclusions of the non –working side inclines in lateral excursions
5.Group function of the working side inclines in lateral excursions .

36. Sequence advocated by the PMS philosophy
Part 1. Examination , diagnosis ,treatment planning ,prognosis
part2. Harmonization of the anterior guidance for the best possible
1.Esthetics
2.Function
3.Comfort
Part3. Selection of an acceptable occlusal plane and restoration of the lower
posterior occlusion in harmony with the anterior guidance in a manner that
will not interfere with the condylar guidance

37. Part 4.
Restoration of the upper posterior occlusion in harmony with the anterior
guidance and condylar guidance. The functionally generated path technique is
so closely allied to this reconstruction technique.

38. Advantages of the following technique are
1. Possible to diagnose for entire rehabilitation before a single tooth is prepared
2. It is well organised logical procedure that progresses smoothly
3. There is never need to prepare or rebuild more than 8 teeth at a time
4. It divides the rehabilitation into series of appointments

39. 5.There is no danger of getting lost at sea and losing patients present vertical
dimension
6.All posterior contours are programmed by and are in harmony with both
condylar border movements and perfect anterior guidance
7.There is no need for time consuming techniques and complicated equipment
8.Laboratory procedure is simple

40. Long Centric……
Defn: As freedom to close the mandible either into centric relation or
slightly anterior to it without varying the vertical dimension at the
anterior teeth.
Long centric is not needed on posterior teeth
1. Long centric involves primarily the anterior teeth.
2. Long centric refers to Freedom from centric and
not freedom in centric.

41. Amount of long centric needed…
……In the absence of centric relation
interferences, this difference rarely exceeds 0.5 mm.
…….The usual long centric would be close to 0.2
mm.
When interference to centric relation are
eliminated by equilibration , “LONG CENTRIC”
is usually provided automatically unless VD is
closed.

42. Determining a patients need for
freedom of a long centric……
Patient seated upright, no headrest, lips
relaxed, red ribbon is used.
Patient Supine position,
mandible manipulated into
terminal axis. Centric
relation contact marked
with green or blue ribbon.
If red mark extends forward of blue mark ….need for long centric

43. Failure to provide a needed “long centric” may lead to clenching and
bruxism, a locked-in feeling of mild discomfort.
Long centric is permissive
When the mandible is free to go where the muscles wish to move it , the
result is predictable comfort with minimal stress to the entire gnathic
system.
“Any occlusion that is worthy of restoration , is worthy of ‘long centric.’”
A knife edge inverted carborundum stone

44. Restoring lower anteriors
Principle :lower incisal edges are the starting point for the anterior guidance and
the “view” when speaking .
five important points to be remembered while restoring lower anteriors
1.Esthetics : visibility should be checked while smiling
2.Phonetics : various sound patterns
3. The occlusal plane :starting point in front .
4. The anterior guidance :how it embraces the lingual contours of the upper
anteriors
5. Stability: removal of the interferences .

45. Analysing the incisal edge outline

46. Determination of incisal edge position requires three decisions
1.Curvature of the incisal plane
2. The height of the incisal plane
3. The horizontal position of the
incisal edges

47. 1.Curvature of the incisal plane
Normal
curvature
Flattned
curvature

48. The height of the incisal plane
There should be no sudden variation in the height between
anteriors and posteriors
Proper vertical centric holding contacts should be present

49. The horizontal position of the incisal edges.
1.Lips sealed
2.Speaking

50. 3.Smiling
4.Lips slightly parted

51. Restoring upper anterior teeth
7 factors that determine labial and lingual contours and relate them to the
correct incisal edge position as follows :
1.Mandible –to-maxilla relationship at centric relation
2. Lip support
3. Lip closure path
4. Tooth to lip relationship during formation of “f” and “v” sounds
5. Envelope of function
6.Tooth to tooth relationships during the s sound
7. Neutral zone

52. Guidelines for upper anterior tooth contours
Midline Tooth contour ratio

53. Gingival
contours
Canine
inclination
Canine contour, mesially
inclined ,no roundness

54. Anterior guidance
The 5 steps to the harmony :
Step1. Establish coordinated centric relation stops on all anterior teeth
step2. Extend centric stops forward at the same vertical dimension to include
light closure from the postural rest position .
Step3. Determining the incisal edge position

55. Step 4 .Establishing group function in straight protrusion
Step5. Establishing the ideal anterior stress distribution in lateral excursions

56. Centric relation
Normal protrusive contacts
Interferences

57. For optimum stability ,comfort ,and function , the anterior teeth must be
In harmony with
1.The Neutral zone
2.The lips
3. With phonetics
4. With centric relation
5.The envelope of the function

58. Procedural steps in restoring anteriors
Refine lower
incisal edge
,positon ,shape
,and plane
Establishing
centric holding
contacts
Lip support
with the
alveolar contour

59. Lip closure path Smile line
Refine incisal
edge position

60. Long centric Establishing
lingual contours
Evaluating
cingulum
contours

61. Fabrication of the anterior guide table
Anteriors harmonised
Centric relation mounting
Flat guide table

62. Acrylic dough placed
Pin moved through the dough
In centric relation

63. Methods for determining the plane of occlusion
Casts mounted in centric relation
Calipers set to 4 inch radius

64. Making anterior survey line
Posterior or condylar survey line

65. Survey center & marking
the survey line
1.5 mm another line drawn
Preparation guide fabricated in wax

66. Restoration of posteriors

67. Requirements for occlusal stability
5 requirements
1.Stable centric stops on all the teeth
2. An anterior guidance that is in harmony with the border movements of the
envelope of function
3. Disclusion of all posterior teeth in protrusive movements
4. Disclusions of all posterior teeth on the non working side
5. Non interferences of all posterior teeth on the working side

68. Solving occlusal wear problems
Causes of wear
1.Attritional wear
2.Wear from erosion
3. Abrasive wear
4.Tooth paste abuse

69. Pre op view Diagnostic mounting and wax up
Lower teeth prepared Provisional placed

70. Repeated for uppers

71. Putty index of lower provisionals
Lower permanent seated

72. Putty index of
provisionals
Recording
anterior guidance
Upper permanent
teeth checked and
contoured
Post op final cemented
restorations

73. Solving over bite problems
A deep overbite is not a problem if all teeth have stable holding contacts in
centric relation
Poorly made
anterior bridge
Reshaping Repositioning

74. Orthodontic elastics therapy

75. Completed alignment Prepared teeth
If necessary reposition lower anteriors also for equal contacts

76. Provisionals with good centric holding contacts

77. Solving anterior overjet problems
Teeth erupt until some thing stops them
Pre op with palatal tissues contact and lip trap

78. Repositioning the teeth with predetermined positioning appliance
Provisionals prepared and verified

79. Putty index recorded
Final restorations fabricated
Post op stabilization for new
contacts that are created with
biostar material(soft vinyl)

80. Solving anterior open bite problems

81. tongue thrusting habit
Pre treatment
After occlusal equilibration Post treatment

82. Treating end to end occlusions
Stability maintained
if contacts kept in
strong neutral zone
Lower cusp tip to
upper flat surface
relationship
Centralised lower cusp
contours can work
well ,can be made to
look natural

83. Treating the cross bite anterior cross bite
Anterior cross bite at
maximal closure
End to end relation
ship in centric when
condyles have moved
up their eminance
Vertical dimension
at occlusion raised
posteriorly

84. D ad Teeth prepared
according to need
Preformed cast
continuous clasp for
realigning
Claps held with rubber
bands ,alignment in
progress

85. Alignment in progress
Alignment in progress
Direct composite built
to hold the contacts

86. Posterior cross bite
Long axis of the teeth
Warping of the occlusion?
Over Creating balancing inclines ? working side disoccludes the balancing side

87. Patients should be told to report any of the following indications of the occlusal
disharmony
1.Any discomfort in the teeth when chewing
2. Any indication of a high tooth or any sign
3. Any sign of tooth hyper mobility
4. Any discomfort in the tmj area
5. Any limitation of the function
Post operative care

88. 3 NO S that are to be instructed for full mouth rehabilitated patients are
1.No smoking – prone for periodontal breakdown
2. No hard candy – prone for root caries
3. No more than two soda drinks per week

89. Things to be kept in mind before sending the patient
1.Cleanability
2.Cleanliness
3. Occlusal stability
4. Temporomandibular joint stability

90. Compare and contrast of techniques
Advantages of Hobo s philosophy …
More mathematical
More faster
Lesser appointments
More research based
Easier communication

91. Advantages of Pms philosophy
More logical approach
Cutomised approach
Less chances of losing vertical dimension

92. Some differences ?
Customised anterior guide table ?
Canine guided or group function ?
Reconstructing anteriors first ?
Uniform disocclusion ?

93. To conclude …………….

94. References
 Evaluation, diagnosis and treatment of occlusal problems. Peter F Dawson.
 Functional occlusion from tmj to smile design Peter F Dawson
 Management of Temporomandibular disorder and occlusion. Jeffery P Okeson.
 Fundamentals of fixed prosthdontics. Shillinburg.
 Contemporary fixed Prosthodontics . Rosensteil.
 10 practical approaches to full mouth rehabilitation. JPD 1997; 57: 261-65.

95. Thank you