Occlusal equilibration./ orthodontic seminars
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Occlusal equilibration./ orthodontic seminars
- 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
- 2. • Introduction • Terminologies • Situations requiring occlusal équilibrations • Requirements for occlusal stability • Types of centric holding contacts • Types of occlusion www.indiandentalacademy.com
- 3. • Equilibration procedure • Interference in centric relation • Lateral excursion interferences • Protrusive interferences • Harmonization of anterior guidance • Materials for marking interference • Conclusion • References www.indiandentalacademy.com
- 4. Routine problems- sore tooth, excessive wear, mobility, TMJ problems etc.. Occlusion is a perspective that pays huge dividends of predictability and increased productivity regardless of type of practice. - Peter E. Dawson www.indiandentalacademy.com
- 5. • Centric relation: The maxillo-mandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterior-superior position against the shapes of the articular eminencies. • Condylar guidance: Mandibular guidance generated by the condyle and articular disc traversing the contour of the glenoid fossae. www.indiandentalacademy.com
- 6. • Anterior guidance : The influence of the contacting surfaces of anterior teeth on tooth limiting mandibular movements. • Non working side: That side of the mandible that moves toward the median line in a lateral excursion. The condyle on that side is referred to as the non working side/ orbiting condyle. www.indiandentalacademy.com
- 7. • Working side condyle/ rotating condyle : The condyle on the working side during lateral excursion. www.indiandentalacademy.com
- 8. • Occlusal equilibration : The modification of the occlusal form of the teeth with the intent of equalizing occlusal stress, producing simultaneous occlusal contacts or harmonizing cuspal relation. www.indiandentalacademy.com
- 10. Healthy TMJ Firm teeth No wear All teeth in present position Healthy supporting tissue www.indiandentalacademy.com
- 11. •Hypermobility of one or more teeth •Excessive wear •Migration of one or more teeth www.indiandentalacademy.com
- 12. • Prerestorative/ prosthodontic equilibration • Postoperative restorative/ prosthodontic equilibration • Post orthodontic equilibration www.indiandentalacademy.com
- 13. • As a part of treatment for bruxism/ clenching • For esthetic reasons • Treating temporomandibular dysfuction • As a part of periodontal therapy www.indiandentalacademy.com
- 14. Surface to surface contact Tripod contact Cusp tip to fossa contact www.indiandentalacademy.com
- 15. • During lateral excursion lower teeth follow lateral border path, there are several options regarding their contact with upper tooth inclines. • No contact • Contact at the cuspal inclines www.indiandentalacademy.com
- 16. • During lateral excursion, movements differ at rotating and orbiting condyles. • No balancing side contacts present • Working side – group function, partial group function or posterior disclusion www.indiandentalacademy.com
- 17. • Posterior disclusion: – Anterior guidance harmonized to functional border movement, then lateral inclines are opened up – Posterior teeth built first and then discluded by restriction of anterior guidance www.indiandentalacademy.com
- 18. • Reductive reshaping • Repositioning • Additive reshaping • Surgical repositioning of dento-alveolar segment without changing skeletal base • Surgical repositioning of skeletal segment in relation to cranial base www.indiandentalacademy.com
- 19. • Most conservative • Combined with other treatment • Guesswork grinding can be mutilative • If strict protocol followed, it is most successful treatment www.indiandentalacademy.com
- 20. • Proper equilibration requires knowing in advance that it will be successful. • Proper examination of TMJ and muscles should be done. • Proper euilibartion is selective www.indiandentalacademy.com
- 21. • Proper equilibration never harms the patient • Proper equilibration never restricts • Proper equilibration is stable www.indiandentalacademy.com
- 22. Harmonization of anterior guidance Eliminate interferences in protrusive excursions Reduction of interferences in lateral excursion Reduction of interferences in centric relation www.indiandentalacademy.com
- 23. • Locating the occlusal interferences • Guide patient to centric relation www.indiandentalacademy.com
- 24. Interference to arc of closure Interference to the line of closure www.indiandentalacademy.com
- 25. • Tooth structure that interferes with the arc of closure deflects the condyle downward and forward to achieve maximum intercuspation • Anterior glide • Grinding rule is MUDL www.indiandentalacademy.com
- 27. • Line of closure interfernce deviates mandible to left or right from point of contact www.indiandentalacademy.com
- 28. • If mandible deviates toward cheek - BULL • If mandible deviates toward tongue - LUBL www.indiandentalacademy.com
- 29. • Narrow stamp cusp before reshaping fossa as cusp tips have worn off to wide contours www.indiandentalacademy.com
- 31. • Dont shorten a stamp cusp www.indiandentalacademy.com
- 32. • Tilted teeth Mark buccal to central fossa Mark lingual to central fossa www.indiandentalacademy.com
- 33. • Adjust centric interferences first Improving cusp-fossa relation Occlusal grinding evenly distributed in upper and lower arches Easy to remove eccentric interferences • Eliminate all posterior incline contact. Preserve cusp tip only www.indiandentalacademy.com
- 35. • Lateral inteferences can be working side and balancing side interferences www.indiandentalacademy.com
- 36. • No balancing contact should be present • Grinding rule BULL • Rule for equilibrating working side is LUBL www.indiandentalacademy.com
- 37. • Only front teeth should touch in protrusion • Rule : DUML • Posterior disclusion in protrusion is accomplished by both the anterior guidance and downward movement of the protruding condyles. www.indiandentalacademy.com
- 38. • Clench test • Anterior deprogramming device www.indiandentalacademy.com
- 39. • Ribbons • Miller ribbon holder • Marking paper • Waxes • Pastes, spray or paint on material www.indiandentalacademy.com
- 41. T scan Measure occlusal force and timing www.indiandentalacademy.com
- 42. • Markings in perfected occlusion www.indiandentalacademy.com
- 43. • Observation of occlusion, providing patient education about occlusion and treatment of occiusal conditions sadly are neglected in the profession. • Occlusal equilibration is one of the major treatments for occlusally oriented diseases, however this procedure is not accomplished frequently by many practitioners. www.indiandentalacademy.com
- 44. The conditions needing occlusal equilibration and procedures of equlibration is discussed to encourage its practice among us. www.indiandentalacademy.com
- 45. • Functional occlusion from TMJ to Smile design- Peter E. Dawson • Management of TMJ disorder- Okeson • J Am Dent Assoc 2005;136:497-499 • J Am Dent Assoc 2004;135:767-770 • J Prosthet Dent 1964;14:74-86 • J Prosthet Dent 1961;11:353-374 • Arch oal Biol 1977;22:25-32www.indiandentalacademy.com
- 46. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com
Editor's Notes
- There are 5 requirements for occlusal stability. These must become a dominant factor in any occlusal analysis and every occlusion should be evaluated to see wheteher or not all requiremnts r fullfilled or not. Anterior guidance play the key role. Anterior teeth are better able to resist stress than posterior teeth, because of their relation to tmj fulcrum and muscle force. Posterior teeth should not interfere with complete seating of the jaw joints and should not interfere with the anterior guidance. The ideal occlusal scheme is complete separation of all the posterior teeth by anterior guidance the moment the condyles leave the centric relation. When in centric realtion the goal is to have simultaneous equal intensity contact of all posterior teeth at the same instance the anterior teeth contact.
- Some of the most stable occlusion can appear serious malocclusion if analysed on the basis of Angle,s classification. Many occlusion can be maintained in good health and stability. Before any treatment is initiated it is important to recognize if the occlusion is stable or not. There are definete, recognizable signs that tells whether the occlusion is stable or not.
- Some disharmony between teeth and movement of mandible
- Surface to surface contact also called as mashed potato occlusion. It results if articulator is closed when the wax is in molten state. It is stressful and produces lateral interference in anything other that vertical chop chop function. In tripod contact the tip of cusp never touches the opposing tooth. Contact is made on the sides of the cusp that are convexly shaped.3 points in the cusp is made to contact at three points on the sides of the opposing fossa.lateral n protrusive disclusion is necessary in this type of contact because convex lower cusp cant follow normal concave border path against upper teeth which are also convex. If cusp tip are properly located in the opposing fossa it provides excellent function and stability with flexibility to choose any degree of distribution of lateral forces. It is the easiest occlusion to equilibrate. Excellent resistance to wear.
- The lower cusp-fossa inclines are determined by the anterior guidance and the condylar guidance. If the lower lingual cusp is to have functional contact in working side, its buccal incline must be the same as the lateral anterior guidance. If lower lingual cusp is to be disoccluded in working excursion , its buccal incline must be flatter than the lateral ant guidance.
- Most conservative treatment choice. Can be combined with other treatment choices. If rules are not understood, guesswork grinding can be more mutilative and unpredictable. But if the requirements for stabiltiy and masticatory system equilibrium is understood and a strict rationale for occlusal correction is followed then it is one of the most successful procedures
- Proper equilibration requires knowing in advance that it will be successful. It is designed to eliminated all premature or deflective tooth contacts that prevent condyle disk assembly from complete seating in their fossa when jaw close in max intercusaption. Key to prdictability is to know with certainity that TMj are nt source of pain or discomfort. Any disorder that would prevent the musculature from a comfortable , cordinated response should be evaluated. Equilibration indicates selective grinding of tooth structure, doesnt eliminate possibility of restoring tooth contours.
- If occlusal euilibration leads to occlusal awareness or if they force a patient to function wher jaw is not comfortable. The equilibration is improperly done or not completed. Proper equilibration frees the mandible to move consiously and unconsiously.it eliminates tooth-tooth interferences that trigger the “erasure” mechanism of bruxism. Occlusal eqilibration just don’t eliminate the interferences but the resultant tooth contacts are such that forces are favourable .
- Improper manipulation is main cause of failure in occlusal equilibration. Don’t force the mandible in centric relation. Forcing ll activate stretch reflex contraction of lateral condyle muscle, causing them to hold the condyles forward of centric relation. Centric relation position shud be confirmed before tooth contacts are marked.continue slow opening-closing movement until the first tooth contact occurs.hold that position and then squeeze. This ll determine direction n degree os slide
- Most important concept. A stamp cusp is the cusp that fits into the fossa. Normally they are palatal cusp of upper and buccal cusp of lower . The reason for narrowing the cusp first is because in many deflecting occlusion the cusp tip have worn out to a wider contour. If first reshaping is directed towards widening the fossa to accept bulky stamp cusp, it unnecessarily grinds away more enamel than would be needed to accommodate narrower stamp cusp.
- Instead of shorterning the stamp cusp, grind the sides of stamp cusp. Avoid the cusp tip.
- Tilted teeth or wide cusp teeth can be adjusted to improve stability as well as to eliminate interferences. Should not be done if it will require shortening of cusp out of occlusion
- Path followed by the lower posteriors as they leave centric relation and travel laterally is dictated by 2 determinants. The border movement of condyle- posterior determinant and the anterior guidance- anterior determinant.
- Mandible should be guided with firm upward pressure through the condyles to ensure that all interferences are recorded and eliminated through the upper most range of motion that can occur at true border path. If unguided excursion, ther ll be a tendency to mark anterolaterally
- Rule doesn’t specify cusp, it refers to incline and can be applied to all situation including crossbite cases.