This document discusses requirements for occlusal stability including having light anterior contacts, well-distributed posterior contacts, coupled contacts between opposing teeth, and forces directed along the long axis of each tooth. It also discusses screening evaluations for temporomandibular disorders including range of motion tests and palpation of the jaw joints and muscles. An intraoral evaluation of occlusion includes identifying the intercuspal position and examining excursive movements and tooth mobility. Bruxism can cause tooth wear, fractures, and pain and is treated with occlusal appliances or adjustment to limit damage.

2. Requirements for Occlusal Stability
1. Maximum intercuspation :
▪ Light or absent ant. contacts
▪ Well-distributed post. contacts
▪ Coupled contacts between opposing teeth
▪ Cross-tooth stabilization
▪ Forces directed along long axis of each tooth
2. Smooth excursive movements without interferences
3. No TFO
4. Favorable subjective response to occ. and function

3. 1- Temporomandibular Disorder (TMD) Screening Evaluation
1. Maximal interincisal opening:
The patient is instructed to “open as wide as possible”…… mm ruler is placed
on the lower incisors. (normal range 40–50+ mm)
2. Opening/closing pathway:
observe any deviations from a midline path.
3. Range of lateral and protrusive excursions (at least 7–9 mm)
4. Auscultation for TMJ sounds: use of a stethoscope.
5. Palpation for TMJ:
Light bilateral palpation over the lateral aspect of the condyles. Any tenderness
is recorded as mild, moderate, or severe. The patient is asked to compare Rt &
Lt sides.
6. Bilateral Palpation for muscle tenderness:
The masseter, pterygoid, and temporalis (anterior and middle) muscles using
moderate finger pressure.

4. 2- Intraoral Evaluation of Occlusion
a. Identification of Intercuspation or Intercuspal Position:
▪ The patient should be able to close into maximum
intercuspal position without searching for a stable or
comfortable bite.
▪ Place Mylar strips between the teeth and ask the patient to
“close and hold” and then try to remove the strip from the
occluding teeth to feel how firm a contact exists.
▪ More detailed information are obtained by marking ribbon.
b. Excursive Movements
Ask the patient to move into Rt & Lt excursions and maximum
protrusion. Any deflective occ. contacts or interferences to closure
should be noted + any mobility of teeth
c. Tooth Mobility & Feramtus

5. ▪ Bruxism is a nocturnal parafunctional activity that includes clenching
and grinding of the teeth.
▪ BRUXISM CAN CAUSE:
1. Tooth mobility.
2. Tooth wear and fracture.
3. Periodontal pain.
4. Masticatory system disorders.
d. Attrition
It is defined as wear caused by tooth-tooth contact.
significant wear facets Indicate occ. Parafunction H +TFO
Clenching …….the most damaging form of occ. Parafunction habits where the
constant “pumping” of the major masticatory muscles intrudes and rocks the teeth
within the alveolus.

6. Therapeutic goals and treatment
▪ The goal is to maintain the periodontium comfort and function.
Treatment considerations ( include one or more of the following) :
1) Occlusal adjustment
2) Management of parafunctional habits
3) Temporary or long-term stabilization of mobile teeth with removable or
fixed appliances
4) Orthodontic tooth movement
5) Occlusal reconstruction
6) Extraction of selected teeth

7. Occlusal Appliance Therapy
▪ A well-designed fitted appliancebenefit masticatory system + help to tight the
loose teeth periodontium heals.
▪ They are not expected to cure parafunctional habits but LIMITS masticatory
disharmony, damage to the teeth, and overstressing of implants.
Occlusal adjustment
▪ Also called occlusal equilibration or coronoplasty,
▪ is the selective irreversible reshaping of occ. surfaces to establish a
non-traumatic, stable occlusion.