This document discusses concepts of occlusion in fixed partial dentures. It defines key terms like centric relation and occlusion. It describes the requirements for optimal occlusion, including simultaneous bilateral contact of posterior teeth in centric occlusion and forces directed along the long axis of teeth. It also discusses mandibular movements, border movements, and functional movements. The document outlines the diagnosis of occlusion through intraoral exam, radiographs, and mounted casts. It describes planning occlusion and achieving an optimal occlusion.
Centric relation is a maxillomandibular relationship where the condyles are positioned at the anterior-superior position against the posterior slopes of the articular eminences, allowing purely rotary movement. There are several theories regarding what determines centric relation, including muscle, ligament, osteofiber, and meniscus theories. It is important to record centric relation for complete dentures as it provides a reproducible reference position and orients the lower cast on the articulator. Common methods to record centric relation include interocclusal records, graphic tracings, and functional methods.
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
The document discusses various concepts of occlusion for fixed partial dentures, including bilaterally balanced occlusion, unilaterally balanced occlusion, and mutually protected occlusion. Bilaterally balanced occlusion aims for simultaneous contact on both sides but is difficult to achieve, while unilaterally balanced occlusion distributes forces to multiple teeth on the working side only. Mutually protected occlusion relies on anterior guidance to prevent posterior contact during excursive movements. The concepts vary in their distribution of forces and indications depending on a patient's needs.
Full mouth rehabilitation using pankey mann schulyer techniqueFebel Huda
This document describes the full mouth rehabilitation technique using the Pankey-Mann-Schuyler method. It discusses the treatment objectives of comfort, stable occlusion, and aesthetics. It outlines the indications and goals for occlusal rehabilitation, including multiple tooth contacts and protected occlusion. It then describes the specific steps of the Pankey-Mann technique, including facebow transfer, mounting casts, wax pattern fabrication, and functionally generated paths to achieve the treatment goals.
This document provides an overview of full mouth rehabilitation. It defines full mouth rehabilitation according to GPT-8 as restoring the form and function of the masticatory apparatus as nearly normal as possible. It discusses the objectives and indications for full mouth rehabilitation. It classifies full mouth rehabilitation into three categories based on the degree of wear and available space. It reviews different occlusal approaches, schemes, concepts and philosophies for full mouth rehabilitation including balanced articulation, group function and mutually protected articulation. It also discusses Hobo's twin table and twin stage techniques.
This document discusses precision attachments used in removable prosthodontics. It begins with an introduction and history, then covers definitions, classifications, indications, advantages and disadvantages. It describes the selection process for abutment teeth and attachments, including requirements. It examines intracoronal and extracoronal attachments in detail, discussing various types such as the Chayes attachment, O-ring attachment, and bar attachments. It explores the role of attachments in breaking stress and their mechanics of retention. In conclusion, precision attachments can provide improved function, retention and aesthetics for removable partial dentures when the appropriate abutment teeth and attachment are selected.
This document discusses mandibular movements including their importance, methods of study, factors regulating movement, classifications, and literature review. It describes several types of movements such as hinge, protrusive, lateral, and border movements. Key points covered include condylar and incisal guidance, neuromuscular factors, basic jaw positions like centric relation and occlusion, and classification systems based on axis of movement, direction, extent, and habitual functions. Diagrams illustrate concepts like condylar paths, Bennett movement, and border tracings.
Centric relation is a maxillomandibular relationship where the condyles are positioned at the anterior-superior position against the posterior slopes of the articular eminences, allowing purely rotary movement. There are several theories regarding what determines centric relation, including muscle, ligament, osteofiber, and meniscus theories. It is important to record centric relation for complete dentures as it provides a reproducible reference position and orients the lower cast on the articulator. Common methods to record centric relation include interocclusal records, graphic tracings, and functional methods.
One of the best seminar of the author. Covered in detail regarding the increasing vertical dimension, centric relation, methods to record centric relation, philosophies of occlusion and in detail everything about full mouth rehabilitation.
The document discusses various concepts of occlusion for fixed partial dentures, including bilaterally balanced occlusion, unilaterally balanced occlusion, and mutually protected occlusion. Bilaterally balanced occlusion aims for simultaneous contact on both sides but is difficult to achieve, while unilaterally balanced occlusion distributes forces to multiple teeth on the working side only. Mutually protected occlusion relies on anterior guidance to prevent posterior contact during excursive movements. The concepts vary in their distribution of forces and indications depending on a patient's needs.
Full mouth rehabilitation using pankey mann schulyer techniqueFebel Huda
This document describes the full mouth rehabilitation technique using the Pankey-Mann-Schuyler method. It discusses the treatment objectives of comfort, stable occlusion, and aesthetics. It outlines the indications and goals for occlusal rehabilitation, including multiple tooth contacts and protected occlusion. It then describes the specific steps of the Pankey-Mann technique, including facebow transfer, mounting casts, wax pattern fabrication, and functionally generated paths to achieve the treatment goals.
This document provides an overview of full mouth rehabilitation. It defines full mouth rehabilitation according to GPT-8 as restoring the form and function of the masticatory apparatus as nearly normal as possible. It discusses the objectives and indications for full mouth rehabilitation. It classifies full mouth rehabilitation into three categories based on the degree of wear and available space. It reviews different occlusal approaches, schemes, concepts and philosophies for full mouth rehabilitation including balanced articulation, group function and mutually protected articulation. It also discusses Hobo's twin table and twin stage techniques.
This document discusses precision attachments used in removable prosthodontics. It begins with an introduction and history, then covers definitions, classifications, indications, advantages and disadvantages. It describes the selection process for abutment teeth and attachments, including requirements. It examines intracoronal and extracoronal attachments in detail, discussing various types such as the Chayes attachment, O-ring attachment, and bar attachments. It explores the role of attachments in breaking stress and their mechanics of retention. In conclusion, precision attachments can provide improved function, retention and aesthetics for removable partial dentures when the appropriate abutment teeth and attachment are selected.
This document discusses mandibular movements including their importance, methods of study, factors regulating movement, classifications, and literature review. It describes several types of movements such as hinge, protrusive, lateral, and border movements. Key points covered include condylar and incisal guidance, neuromuscular factors, basic jaw positions like centric relation and occlusion, and classification systems based on axis of movement, direction, extent, and habitual functions. Diagrams illustrate concepts like condylar paths, Bennett movement, and border tracings.
This document discusses the theoretical background and techniques of the Hobo full mouth rehabilitation approach. It defines key terms like condylar guidance, incisal guidance, and disocclusion. It explains that the goal of reorganizing occlusion is to address issues like trauma, poor function, or lack of space. The optimal occlusion balances factors like condylar path, incisal guidance, and cuspal angles. The articulator aims to replicate these concepts to guide reconstruction of the full mouth.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
This document provides an overview of occlusion concepts in fixed partial dentures. It discusses theories of occlusion such as Bonwill's triangular theory, the conical theory, and the spherical theory. It also covers classifications of occlusion by Dawson, concepts such as bilateral balanced occlusion and mutually protected occlusion, determinants of occlusion including condylar guidance and anterior guidance, and curves of occlusion like the curves of Spee and Wilson. The document is intended as a reference for understanding occlusion in prosthodontic treatments involving fixed partial dentures.
The document discusses the Hanau Wide-Vue II articulator. It begins by providing Weinberg's classification of articulators and discusses the parts that make up the Hanau Wide-Vue II articulator. It then shows how to mount a facebow transfer on the articulator and program it using records. The document concludes by mentioning some accessories that can be used with the articulator and providing brief instructions for its care and maintenance.
This document discusses occlusion in removable partial dentures. It outlines several types of occlusion including static and dynamic occlusion. Desirable occlusal contacts are bilateral contacts of posterior teeth in centric occlusion. Methods for establishing occlusion include direct apposition of casts if enough teeth remain, interocclusal records with posterior teeth, or using occlusal rims. The functionally generated path method can also be used to develop a dynamic occlusion record without an articulator. Proper occlusion is important for the success, comfort and longevity of removable partial dentures.
Full mouth rehabilitation aims to restore the form and function of the masticatory system to as close to normal as possible. It involves restoring multiple teeth that are missing, worn down, broken, or decayed. The document discusses various classifications of patients for full mouth rehabilitation based on the degree of wear and available space. It also covers the objectives of occlusal schemes, philosophies for full mouth rehabilitation including gnathological and Youdelis approaches, and considerations for treatment planning such as examination, diagnosis and dividing treatment into pre-prosthetic, prosthetic and maintenance phases.
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
The biological fixation determines the longevity of dental implant treatment. It ensures the long term survival of dental implant. Better the osseointegration,higher will be the survival rate
The document discusses face bows, which are used to record the spatial relationship between the maxilla and temporomandibular joints. This allows for accurate transfer of jaw relations to an articulator. The document covers the history and evolution of face bows, from early prototypes to modern designs. It describes the parts of face bows including the U-shaped frame, condylar rods/earpieces, bite fork, and locking/reference points. Different types are classified including arbitrary, fascia, and earpiece models. The uses, advantages, and limitations of various designs are also outlined.
The study compared the reproducibility of two techniques for recording centric relation: Dawson's Bilateral Manipulation and Gysi's Gothic Arch Tracing. Twenty subjects underwent each technique five times over a week. The average standard error was calculated, with Gothic Arch Tracing (0.27) showing less variability than Bilateral Manipulation (0.94). Statistical analysis found Gothic Arch Tracing to be more accurate in reproducing centric relation records.
Biofunctional prosthesis system complete dentureNikitaChhabariya
The document summarizes the Biofunctional Prosthetic System (BPS) for complete dentures. The BPS is a systematic approach that uses specialized trays, materials, and techniques from impression making to the final denture insertion. It aims to create dentures with optimal aesthetics, comfort, fit and function. The summary discusses the key steps of the BPS including primary and secondary impressions, jaw relation recording, tooth set-up using articulators, and injection molding of the final denture. Clinical examples are provided to illustrate the BPS approach.
The human mandible can be related to the maxilla in several positions in the horizontal plane. Among these centric relation is a significant position, because of its usefulness in relating the dentulous and edentulous mandible to maxilla, where the teeth , muscles and temporomandibular joint function in harmony. It is a position of occluso-articular harmony.
Occlusion in complete denture must be developed to function efficiently and with the least amount of trauma to the supporting tissues. this ppt content Difference between artificial and natural dentition
Requirements of complete denture occlusion
Occlusal schemes for complete denture
Axioms for balance occlusion
Theories of occlusion
Concepts of occlusion
balance occlusion
Non-balance occlusion
Conclusion
covers overall every topic of occlusion in complete denture
This document provides information on impression making for complete dentures. It begins with an introduction on impression making being an art that requires skill and knowledge of oral anatomy. It then covers the history, definitions, theories, objectives, related anatomy, materials and techniques for preliminary and final impressions. The key steps discussed are preliminary examination, selection of tray and material, making the preliminary impression, border molding, and making the final impression. The goals of impression making are to preserve ridges, provide support, retention, stability, and aesthetics.
This document discusses the key factors involved in developing balanced occlusion for complete dentures. It outlines five main factors: 1) Condylar guidance, 2) Incisal guidance, 3) Plane of occlusion, 4) Compensating curves, and 5) Cusp angle. It describes how each factor influences mandibular movement and must be considered in relation to the others to achieve balanced occlusion without trauma to tissues. Formulas from Hanau and Theilmann relate these five factors and how modifying one requires adjusting the others to maintain occlusion balance.
This document discusses balanced occlusion for complete dentures. It begins with an introduction that defines occlusion and the goal of reducing trauma to supporting tissues. It then defines various occlusion terms like centric occlusion, eccentric occlusion, functional occlusion, and balanced occlusion. The document discusses theories of complete denture occlusion and various concepts like balanced, monoplane, and lingualized occlusion. It outlines the objectives, characteristics, types, advantages, and factors influencing balanced occlusion. The factors discussed are condylar guidance, incisal guidance, plane of occlusion, cuspal angulation, and compensating curve. The document provides details on each of these factors and their significance in achieving balanced occlusion.
Centric relation relevance and role in complete denture construction NAMITHA ANAND
This document discusses centric relation, which refers to the relationship between the mandible and skull when the condyles are in their most superior position in the mandibular fossa against the posterior slope of the articular eminence. It has gone through various changing definitions but is now widely accepted to mean the anterior-superior position. Recording centric relation is important for complete denture construction as it provides proprioceptive feedback and acts as the starting point for occlusion. There are various passive and active methods to retrude the mandible as well as intraoral and extraoral graphic methods to record the position.
Revision of Complete Denture Occlusion 5th yearAmalKaddah1
Revisions of
Definitions
Differences between natural and artificial dentition
Types of artificial tooth forms
Types of balance
Factors affecting balanced occlusion
Concepts of occlusion
00- Revision of occlusion 5th year.pptxAmalKaddah1
The Stomatognathic system
Definitions.
Difference between natural and artificial Occ.
Balanced Occlusion and Factors affecting Balanced O.
Concepts of occlusion (Balanced and Non-balanced Occlusion).
This document discusses the theoretical background and techniques of the Hobo full mouth rehabilitation approach. It defines key terms like condylar guidance, incisal guidance, and disocclusion. It explains that the goal of reorganizing occlusion is to address issues like trauma, poor function, or lack of space. The optimal occlusion balances factors like condylar path, incisal guidance, and cuspal angles. The articulator aims to replicate these concepts to guide reconstruction of the full mouth.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document discusses lingualized occlusion for removable prosthodontics. It begins by providing background on the search for ideal denture occlusion and defines lingualized occlusion. Key points include:
- Prof. Alfred Gysi first introduced the concept of lingualized occlusion in 1927 using maxillary teeth with single linear cusps fitting into shallow mandibular depressions.
- Lingualized occlusion aims to maintain esthetics and food penetration of anatomic teeth while providing the mechanical freedom of non-anatomic teeth. It utilizes anatomic maxillary teeth and modified non-anatomic mandibular teeth.
- The document outlines the evolution and advantages of lingualized occlusion and provides principles for its use in
This document provides an overview of occlusion concepts in fixed partial dentures. It discusses theories of occlusion such as Bonwill's triangular theory, the conical theory, and the spherical theory. It also covers classifications of occlusion by Dawson, concepts such as bilateral balanced occlusion and mutually protected occlusion, determinants of occlusion including condylar guidance and anterior guidance, and curves of occlusion like the curves of Spee and Wilson. The document is intended as a reference for understanding occlusion in prosthodontic treatments involving fixed partial dentures.
The document discusses the Hanau Wide-Vue II articulator. It begins by providing Weinberg's classification of articulators and discusses the parts that make up the Hanau Wide-Vue II articulator. It then shows how to mount a facebow transfer on the articulator and program it using records. The document concludes by mentioning some accessories that can be used with the articulator and providing brief instructions for its care and maintenance.
This document discusses occlusion in removable partial dentures. It outlines several types of occlusion including static and dynamic occlusion. Desirable occlusal contacts are bilateral contacts of posterior teeth in centric occlusion. Methods for establishing occlusion include direct apposition of casts if enough teeth remain, interocclusal records with posterior teeth, or using occlusal rims. The functionally generated path method can also be used to develop a dynamic occlusion record without an articulator. Proper occlusion is important for the success, comfort and longevity of removable partial dentures.
Full mouth rehabilitation aims to restore the form and function of the masticatory system to as close to normal as possible. It involves restoring multiple teeth that are missing, worn down, broken, or decayed. The document discusses various classifications of patients for full mouth rehabilitation based on the degree of wear and available space. It also covers the objectives of occlusal schemes, philosophies for full mouth rehabilitation including gnathological and Youdelis approaches, and considerations for treatment planning such as examination, diagnosis and dividing treatment into pre-prosthetic, prosthetic and maintenance phases.
This document provides an overview of implant supported overdentures, including definitions, history, indications, contraindications, advantages, disadvantages, treatment options, and procedures. Key points discussed include:
- Overdentures are removable prostheses that cover natural tooth roots, implants, or both for support.
- Implant supported overdentures have better outcomes than conventional dentures or overdentures supported only by natural tooth roots.
- Treatment options depend on factors like jaw, bone quality, number of implants, and can involve bar-retained or independent attachments.
- Procedures involve medical evaluation, treatment planning, transitional dentures, surgical placement, attachment connection, and definitive prosthesis fabrication
This document discusses stress breakers in prosthodontics. It defines stress and stress breakers, and describes their aims in directing occlusal forces and preventing harm to remaining teeth. Various types of stress breakers are presented for different prosthesis applications, including removable partial dentures, fixed partial dentures, and tooth-implant supported prostheses. Philosophies of stress distribution like stress equalization, physiologic basing, and broad stress distribution are covered. Specific stress breaker designs like hinges, non-rigid connectors, split pontics, and key-keyway joints are explained.
1. The functionally generated pathway technique involves recording the paths of tooth movement during excursive jaw motions using wax or other materials.
2. This recording is used to develop the occlusal morphology for dental restorations like crowns, ensuring optimal occlusion during all jaw motions.
3. Studies have found that the functionally generated pathway technique results in restorations with better functional articulation compared to conventional single casting techniques, with less adjustment needed and higher patient satisfaction.
The biological fixation determines the longevity of dental implant treatment. It ensures the long term survival of dental implant. Better the osseointegration,higher will be the survival rate
The document discusses face bows, which are used to record the spatial relationship between the maxilla and temporomandibular joints. This allows for accurate transfer of jaw relations to an articulator. The document covers the history and evolution of face bows, from early prototypes to modern designs. It describes the parts of face bows including the U-shaped frame, condylar rods/earpieces, bite fork, and locking/reference points. Different types are classified including arbitrary, fascia, and earpiece models. The uses, advantages, and limitations of various designs are also outlined.
The study compared the reproducibility of two techniques for recording centric relation: Dawson's Bilateral Manipulation and Gysi's Gothic Arch Tracing. Twenty subjects underwent each technique five times over a week. The average standard error was calculated, with Gothic Arch Tracing (0.27) showing less variability than Bilateral Manipulation (0.94). Statistical analysis found Gothic Arch Tracing to be more accurate in reproducing centric relation records.
Biofunctional prosthesis system complete dentureNikitaChhabariya
The document summarizes the Biofunctional Prosthetic System (BPS) for complete dentures. The BPS is a systematic approach that uses specialized trays, materials, and techniques from impression making to the final denture insertion. It aims to create dentures with optimal aesthetics, comfort, fit and function. The summary discusses the key steps of the BPS including primary and secondary impressions, jaw relation recording, tooth set-up using articulators, and injection molding of the final denture. Clinical examples are provided to illustrate the BPS approach.
The human mandible can be related to the maxilla in several positions in the horizontal plane. Among these centric relation is a significant position, because of its usefulness in relating the dentulous and edentulous mandible to maxilla, where the teeth , muscles and temporomandibular joint function in harmony. It is a position of occluso-articular harmony.
Occlusion in complete denture must be developed to function efficiently and with the least amount of trauma to the supporting tissues. this ppt content Difference between artificial and natural dentition
Requirements of complete denture occlusion
Occlusal schemes for complete denture
Axioms for balance occlusion
Theories of occlusion
Concepts of occlusion
balance occlusion
Non-balance occlusion
Conclusion
covers overall every topic of occlusion in complete denture
This document provides information on impression making for complete dentures. It begins with an introduction on impression making being an art that requires skill and knowledge of oral anatomy. It then covers the history, definitions, theories, objectives, related anatomy, materials and techniques for preliminary and final impressions. The key steps discussed are preliminary examination, selection of tray and material, making the preliminary impression, border molding, and making the final impression. The goals of impression making are to preserve ridges, provide support, retention, stability, and aesthetics.
This document discusses the key factors involved in developing balanced occlusion for complete dentures. It outlines five main factors: 1) Condylar guidance, 2) Incisal guidance, 3) Plane of occlusion, 4) Compensating curves, and 5) Cusp angle. It describes how each factor influences mandibular movement and must be considered in relation to the others to achieve balanced occlusion without trauma to tissues. Formulas from Hanau and Theilmann relate these five factors and how modifying one requires adjusting the others to maintain occlusion balance.
This document discusses balanced occlusion for complete dentures. It begins with an introduction that defines occlusion and the goal of reducing trauma to supporting tissues. It then defines various occlusion terms like centric occlusion, eccentric occlusion, functional occlusion, and balanced occlusion. The document discusses theories of complete denture occlusion and various concepts like balanced, monoplane, and lingualized occlusion. It outlines the objectives, characteristics, types, advantages, and factors influencing balanced occlusion. The factors discussed are condylar guidance, incisal guidance, plane of occlusion, cuspal angulation, and compensating curve. The document provides details on each of these factors and their significance in achieving balanced occlusion.
Centric relation relevance and role in complete denture construction NAMITHA ANAND
This document discusses centric relation, which refers to the relationship between the mandible and skull when the condyles are in their most superior position in the mandibular fossa against the posterior slope of the articular eminence. It has gone through various changing definitions but is now widely accepted to mean the anterior-superior position. Recording centric relation is important for complete denture construction as it provides proprioceptive feedback and acts as the starting point for occlusion. There are various passive and active methods to retrude the mandible as well as intraoral and extraoral graphic methods to record the position.
Revision of Complete Denture Occlusion 5th yearAmalKaddah1
Revisions of
Definitions
Differences between natural and artificial dentition
Types of artificial tooth forms
Types of balance
Factors affecting balanced occlusion
Concepts of occlusion
00- Revision of occlusion 5th year.pptxAmalKaddah1
The Stomatognathic system
Definitions.
Difference between natural and artificial Occ.
Balanced Occlusion and Factors affecting Balanced O.
Concepts of occlusion (Balanced and Non-balanced Occlusion).
This document discusses occlusion in operative dentistry. It defines key occlusion concepts like centric relation, centric occlusion, and mandibular movements. It describes the temporomandibular joint, masticatory muscles, and occlusal schemes like balanced occlusion and canine protected occlusion. It discusses determining centric relation, occlusal contacts, and factors that influence occlusion like contours and marginal ridges. Maintaining a stable, functional occlusion is important for oral health.
Gnathology is the study of jaw and mandible-related problems, including temporomandibular joint (TMJ) disorders and muscles of the jaw. It examines issues with proper bite fitting and can extend to related areas like posture and headaches. Diagnosis of gnathological problems can be difficult as dentists often have limited understanding, leading to vague diagnoses and mediocre treatment results. Ideal occlusion is debated but involves harmony between bite, teeth, and neuromuscular system with concepts like bilateral balanced occlusion and mutually protected occlusion describing arrangements of teeth. Bruxism is excessive teeth grinding that may relate to factors like malocclusion but evidence for a strong relationship is limited.
Contents
Introduction
Rationale for Establishing Tooth Contacts during Fixed Prosthodontics
Concepts of Occlusion
Occlusion in fixed dental prosthesis
Occlusal treatment
Conclusion
References
Introduction
Maxillary and mandibular teeth should contact uniformly on closing to allow optimal function, minimize trauma to the supporting structures and allow for uniform load distribution throughout the dentition.
Occlusion - The static relationship between the incising or masticating surfaces of the maxillary and mandibular teeth. GPT -9
Centric relation - a maxillomandibular relationship, independent of tooth contact, in which the condyles articulate in the anterior-superior position against the posterior slopes of the articular eminences; in this position, the mandible is restricted to a purely rotary movement; from this unstrained, physiologic, maxillomandibular relationship, the patient can make vertical, lateral or protrusive movements; it is a clinically useful, repeatable reference position.
Centric Occlusion [CO] - the occlusion of opposing teeth when the mandible is in centric relation; this may or may not coincide with the maximal intercuspal position.
Maximum Intercuspation [MI] - It is the maximum interdigitation of the maxillary teeth with the mandibular teeth independent of condylar position.
GPT 9
Anatomy
Temporomandibular joint
Occlusion /certified fixed orthodontic courses by Indian dental academy Indian dental academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.
Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078
The document discusses the stomatognathic system, which includes the structures and functions involved in chewing, swallowing, breathing, and speaking. It describes the key structures - jaws, teeth, tongue, and muscles. The muscles involved include the temporalis, masseter, medial and lateral pterygoid muscles. It discusses the functions of mastication (chewing), deglutition (swallowing), respiration, and speech. Mastication involves preparing the food, crushing it between teeth, and grinding it using temporal and masseter muscles. Swallowing then moves the crushed food to the pharynx.
- The temporomandibular joint is comprised of the articular eminence, condyle, articular disc, and other structures. It works with the teeth, muscles of mastication, and other tissues as part of the masticatory system.
- Mandibular movement involves both rotation and translation in the temporomandibular joint and is regulated by the neuromuscular system within limits defined by the condyle path and opposing tooth contacts.
- Proper understanding of mandibular movement is important for occlusion, prosthodontic treatments, and articulator selection and adjustment.
This document provides an overview of mandibular movements and the temporomandibular joint (TMJ). It discusses the anatomy of the TMJ, types of mandibular movements including rotation and translation, and the three planes of border movements: sagittal, frontal, and horizontal. It also examines the determinants of mandibular movement, including condylar guidance, anterior guidance, and the neuromuscular system. The chewing stroke and neuromuscular regulation of movement are described.
This document discusses various definitions and factors related to occlusion. It defines static occlusion as the alignment and articulation of teeth within the arches and their relationship to supporting structures. Dynamic occlusion refers to the functioning of the stomatognathic system as a whole, including teeth, supporting structures, TMJ, and muscles. It also discusses ideal occlusion, physiologic occlusion, and therapeutic occlusion. Normal occlusion depends on the position and growth of bones, eruption path and forces on teeth, and forces generated during occlusion. Factors like heredity, trauma, disease and tongue position can influence occlusion development.
Classification of malocclusion by dr. golamIshfaq Ahmad
The document discusses occlusion, malocclusion, and various classification systems. Some key points:
- It defines terms like occlusion, normal occlusion, ideal occlusion, and discusses Andrew's six keys to normal occlusion.
- It also defines intra-arch and inter-arch malocclusions, and different types under each. Skeletal malocclusions affect the underlying jaw structure.
- Several classification systems are described, the most prominent being Angle's classification which is based on the mesiodistal relationship of the first molars. It outlines the three main classes: Class I, Class II, Class III.
- The advantages and drawbacks of Angle's classification are discussed. Modifications like Dewey's
This document provides an overview of occlusion evaluation and therapy. It defines key terminology related to occlusion and mandibular movements. It describes the components of the masticatory system and discusses normal occlusion and occlusal dysfunction. The document outlines clinical evaluation procedures for occlusion including TMD screening, tooth mobility testing, and cast analysis. It discusses occlusal appliance therapy and requirements for occlusal stability. The summary emphasizes evaluation of occlusion, use of appliances to encourage tooth tightening, and progressive occlusal adjustment.
This document discusses key concepts in occlusion and mandibular movements. It defines important occlusion terms like centric relation, centric occlusion, maximum intercuspation, and types of occlusal contacts and relationships. It describes the temporomandibular joint anatomy and condylar movements including rotation, translation, opening, protrusion, and lateral excursions. It also summarizes the process of occlusal adjustment to correct prematurities and establish optimal occlusion.
4- Revision >> Concepts of occlusion for 4th year Students.AmalKaddah1
Occlusion for Removable Prosthodontics.
Revision:
What 'occlusion' is and why it is important
Definitions.
Difference between natural and artificial Occlusion.
Types of artificial posterior teeth
Problems with anatomic and non-anatomic teeth
Factors affecting selection of tooth forms.
Rational for Arranging Posterior Teeth in Balanced Occlusion
Contraindications of balanced occlusion.
Types of Balance as Related to Complete Denture
- Lever balance
-Occlusal Balance.
Balanced Occlusion and Factors affecting Balanced Occ. (Third year)
Concepts of occlusion (Balanced and Non balanced Occlusion).
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
Mandibular movements occur around the TMJ which is capable of making complex movements. Temporomandibular joint is the joint connecting your lower jaw and your skull.
The movements can be categorized as follows -
Basic movements
Excursive movements
Border movements
Functional movements
Parafunctional movements
Factors affecting mandibular movements are –
Condylar path / guidance
Opposing tooth contact and Anterior guidance
Neuromuscular control
Indian Dental Academy: will be one of the most relevant and exciting training
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courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry,
Prosthetic Dentistry, Periodontics and General Dentistry.
Gypsum (calcium sulphate dihydrate) is a naturally occurring mineral used in dentistry to fabricate models (Figure 12.1a), casts and dies (Figure 12.1b). Calcination is the process of heating the gypsum to dehydrate it (partially or completely) to form calcium sulphate hemihydrate. Plaster and stone are products of the dehydration process. It is the calcination process that determines the strength of the gypsum material. The differences in the types of gypsum are related to the amount of water removed, resulting in varying densities and particle sizes of the material.
Gypsum materials are combined with water and spatulated to create a slurried mixture that is poured into a dental impression (negative reproduction of the teeth and surrounding tissues). It is allowed to set, after which the gypsum and impression are separated, resulting in the positive reproduction of the patient’s tooth/teeth, arch and surrounding tissues. Many dental appliances and restorations are constructed extra-orally using models, dies (one tooth) and casts (replicas of the patients tooth/teeth and surrounding tissues).
It is desirable that all gypsum products are strong, compatible with impression materials and waxes and fluid at the time of pouring into the impression; they should also have good dimensional stability.
This document discusses various types of failures that can occur in fixed partial dentures (FPDs). It classifies failures as either biologic, mechanical, or aesthetic. Biologic failures include issues like caries, pulpal degeneration, endodontic failure, periodontal failure, tooth perforations, sub-pontic inflammation, and occlusal problems. Mechanical failures involve loss of retention, connector failure, occlusal wear, and tooth fracture. Aesthetic failures can be immediate due to issues in design, materials or workmanship, or delayed due to gingival recession or sub-pontic tissue shrinkage over time. The document provides details on causes and treatments for each type of failure.
This document discusses the restoration of endodontically treated teeth. It begins by noting the increased interest in restoring such teeth and challenges posed by coronal tooth structure loss. The complete coverage crown is identified as the ideal restoration. Posts are needed when inadequate structure remains to retain a core. Key considerations for restoration include coronal sealing, preserving remaining structure, and distributing stresses favorably. Treatment planning depends on the extent of coronal and root damage. Post selection is based on length, diameter, shape, and location. Custom cast and prefabricated posts each have advantages and disadvantages. The document provides guidelines for restoration procedures and materials selection.
This document discusses different die and die systems used in fabricating fixed partial dentures. It describes the ideal properties and requirements of die materials, as well as the main types of die systems including separate die systems, removable die systems using dowel pins, di-lok trays, or pindex drilling. The advantages and disadvantages of each system are provided. Removable die systems allow dies to be easily removed and replaced in the working cast for wax pattern fabrication.
This document discusses phonetics and speech production considerations for complete dentures. It covers the key components of speech production including the motor, vibrator, resonator, articulator and initiator. It describes the three principal physiologic valves in speech production and classifications of speech sounds. The document outlines how different aspects of complete dentures can impact speech, such as denture thickness, tooth position, arch form, vertical dimension and esthetics. Specific consonant sounds and their production are discussed, along with evaluating speech following obturator placement for cleft palate patients.
Overdentures - Indications, Contraindication and Treatment Procedure.pptShrimant Raman
This document discusses overdentures, which are removable partial or complete dentures that cover and rest on remaining natural teeth, tooth roots, or dental implants. It defines overdentures and provides indications for their use, such as when retention is difficult to obtain or for patients with a poor prognosis for complete dentures. The document describes preparations for retained teeth, classifications of overdentures, advantages and disadvantages, and references for further information.
This document discusses obturators, which are prostheses used to close openings in the palate. Obturators can be used to treat both congenital and acquired palatal defects from injuries or tumor removal. They help restore functions like speech, swallowing, and chewing. Obturators provide support, retention, and stability. They are classified based on the location and extent of the palatal defect. Surgical obturators are placed immediately after surgery, while definitive obturators are placed 3-4 months later once healing is complete. The objectives of obturators include comfort, restoring functions, and acceptable aesthetics.
Compensating curves are artificial curves introduced into complete dentures to achieve balanced occlusion. They compensate for the space formed between the posterior teeth during jaw movements. There are two main types of compensating curves:
1. Anteroposterior curves (like the Curve of Spee) which raise the distal portions of the posterior teeth to compensate for the wedge-shaped opening that occurs in back teeth during protrusion.
2. Mediolateral curves (like the Curve of Monson) which compensate for the opening formed when the jaw moves laterally by incorporating curvature in the frontal plane. These curves help distribute forces during mastication.
This document discusses laminate veneers, including:
1. Laminate veneers have evolved over decades to become a popular aesthetic restoration, providing a conservative alternative to full coverage restorations.
2. They involve bonding thin ceramic restorations to etched tooth structure to restore the facial and proximal surfaces.
3. Indications include masking diastemas, discoloration, enamel defects, malpositioned teeth, while contraindications include insufficient tooth structure or parafunctional habits.
The document discusses resin bonded fixed partial dentures (RBFPDs), also known as adhesive bridges. It covers the history, definitions, classifications, indications, contraindications, and various types of RBFPDs including bonded pontics, cast perforated resin-retained FPDs, etched cast resin-retained FPDs, and macro-mechanical retention resin-retained FPDs. Preparation designs for anterior and posterior teeth are described. Bonding involves cleaning, etching, priming, and using composite resin cements.
1) Dental composites are resin-based materials reinforced with filler particles that are used for tooth-colored restorations. They have evolved from large macrofilled particles to smaller microfilled and nanofilled particles for improved esthetics.
2) Modern composites come in various types depending on their handling properties, including packable, flowable, and bulk-fill versions. They are also classified based on their filler sizes as macrofilled, microfilled, or hybrid.
3) Resin composites offer esthetic, conservative restorations but have disadvantages like polymerization shrinkage, sensitivity to technique, and relatively lower wear resistance compared to other materials. Continual development aims to improve their mechanical properties and
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
3. Introduction
The reason for replacement of natural
teeth is not only to aid in mastication,
but for various functions like the
maintenance of proper support for the
oro-facial musculature, esthetic
appearance, proper speech production,
prevention of teeth migration,
maintenance of the morphologic facial
height and prevention of TMJ
dysfunction syndromes
4. Occlusion:-
“Is a static relationship between
the incising or masticating surfaces
of maxillary or mandibular teeth or
tooth analogue”
GPT 8th ed.
5. Requirements of occlusal
contact relationships
It should be within the adaptive
capacity of the patient
To restore and maintain the health
& function of the stomatognathic
system
Simultaneous bilateral contact of
opposing posterior teeth must
occur in centric occlusion
6. Some criteria established by
OKESON for optimum occlusion are
1. In closure, the condyles are in the most
supero–anterior position against the
discs of the posterior slopes of the
articular eminences
2. The posterior teeth are in solid and
even contact and the anterior teeth are
in slightly lighter contact.
3. Occlusal forces are directed in the long
axes of the teeth
7. 4. In lateral excursions, working side
contacts (preferably on canines)
disocclude (or) separate the non-
working teeth instantly
5. In protrusive excursions, anterior
tooth contacts will disocclude the
posterior teeth
6. In an upright posture, posterior
teeth contact more heavily than
do anterior teeth
8. Centric Relation
Definition: The maxillo-mandibular
relationship in which condyles articulate
with the thinnest avascular portion of
their respective disc with the complex in
the anterior - superior position against the
shape of the articular eminencies. This
position is independent of tooth contact.
This position is clinically disernible when
the mandible is directed superior &
anteriorly. It is restricted to a purely
rotatory movement about the transverse
horizontal axis. GPT 8th ed.
10. Centric relation is considered a
learnable, repeatable and recordable
reference position
If the intercuspal position coincides
with the centric relation position –
restorative treatment is often
straightforward
When they do not coincide – it is
necessary to determine whether
corrective occlusal therapy is needed
before restorative treatment
11. Mandibular movements
These complex 3 dimensional
mandibular movement can be broken
down into two basic components:
Translation – when
all points within a
body have identical
motion and
Rotation – when the
body is turning about
an axis
12. In addition, Mandibular movement
can be easily understood when the
components are describe as:
Horizontal axis
This movement occurs
in the sagittal plane. It
occurs when the mandible
makes a rotational opening
and closing movement from
centric relation around the
transverse horizontal axis
13. Vertical axis
This movement occurs in the
horizontal plane. It occurs when
the mandible makes lateral
excursion. The center for this
rotation is a vertical axis extending
through the working-side condyle
14. Sagittal axis
This movement occurs in the
frontal plane. It occurs when the
mandible makes lateral excursion. The
condyle on the side opposite from the
direction of movement travels forward
and downward producing a downward
arc rotating about an anteroposterior
or sagittal axis passing through the
other condyle
15. Lateral side shift
When mandible makes a
lateral excursion, the condyle
on the working side will shift
laterally and slightly posteriorly. The angle
formed in the horizontal plane between the
pathway of the non-working condyle,
mandibular lateral translation and the
sagittal plane is called Bennett angle.
The lateral side shift is also called as Bennett
side shift or progressive side shift.
16. BORDER MOVEMENTS
Mandibular movements are
limited by the
temporomandibular joints
and ligaments, the
neuromuscular system, and
the teeth.
Posselt was the first to
describe the extremes of
mandibular movement, which
he called border movements
17. Mandibular incisors
track along the
lingual
concavity of the
maxillary anterior
teeth
Edge-to-edge
position
Incisors move
superiorly until
posterior
tooth contact
recurs
Most protrusive
mandibular
position
1
2
3&4
5
18. Posterior and Anterior
Determinants
The characteristics of mandibular
movement are established posteriorly
by the morphology of the temporo-
mandibular joints and anteriorly by
the relationship of the anterior teeth
19. Posterior Determinants
1. Shape of the articular eminences,
2. Anatomy of the medial walls of the mandibular
fossae
3. Configuration of the mandibular condylar
processes
These cannot be controlled nor is it
possible to influence the neuromuscular
responses of the patient
It is done by indirect means only
Through changes in the configuration of the
contacting teeth or by the provision of an
occlusal appliance
20. Condylar guidance angle:-
1, Flat
2, Average
3, Steep
Anatomy of the medial walls of
the mandibular fossae:-
1, Greater than average
2, Average
3, Minimal sideshift
21. Anterior Determinants
Vertical and horizontal overlaps and the
Maxillary lingual concavities of the anterior
teeth
These can be altered by restorative and
orthodontic treatment
If greater vertical overlap
Increased vertical mandibular opening during
the early phase of protrusive movement and
Creates a more vertical pathway at the end of
the chewing stroke
Increased horizontal overlap allows a more
horizontal jaw movement
22. FUNCTIONAL MOVEMENTS
Most functional movement of the
mandible (as occurs during mastication and speech)
takes place inside the physiologic limits
established by the:
Teeth,
Temperomandibular joints,
Muscles and ligaments of mastication;
therefore, these movements are rarely
coincident with border movements
23. Chewing
When incising food, adults open their mouth
a comfortable distance and move the
mandible forward until they incise, with the
anterior teeth meeting approximately edge
to edge
The food bolus is then transported to the
center of the mouth as the mandible returns
to its starting position, with the incisal
edges of the mandibular anterior teeth
tracking along the lingual concavities of the
maxillary anterior teeth
24. The mouth then opens slightly, the
tongue pushes the food onto the occlusal
table, and after moving sideways, the
mandible closes into the food until the
guiding teeth (typically the canines) contact
The cycle is completed as the mandible
returns to its starting position
This pattern repeats itself until the food
bolus become small enough to be
swallowed
25. Phonetics
The teeth, tongue, lips, floor of the mouth,
and soft palate form the resonance
chamber that affects pronunciation.
During speech, the teeth are generally not
in contact, although the anterior teeth may
come very close together during "C,“ "CH,"
"S," and "Z" sounds, forming the "speaking
space.“
26. When pronouncing the "F," the inner
vermilion border of the lower lip traps air
against the incisal edges of the maxillary
incisors.
Phonetics is a useful diagnostic guide
for tooth position during fixed
prosthodontic treatment
27. PARAFUNCTIONAL
MOVEMENTS
Parafunctional movements of the mandible
may be described as sustained activities
that occur beyond the normal functions of
mastication, swallowing, and speech
There are many forms of parafunctional
activities, including
Bruxism,
Clenching,
Nail biting, and
Pencil chewing
Typically, parafunction is manifested by
long periods of increased muscle
contraction and hyperactivity
28. Over a protracted period this can result in
Excessive wear,
Widening of the PDL,
Mobility,
Migration, or
Fracture of the teeth
Muscle dysfunction may also occur such
as:-
Myospasms,
Myositis,
Myalgia, and
Referred pain (headaches) from trigger point
tenderness
29. Bruxism
Sustained grinding, rubbing together, or
gnashing of the teeth with greater-than-
normal chewing force is known as
bruxism.
This activity may be diurnal, nocturnal,
or both
Although bruxism is initiated on a
subconscious level, nocturnal bruxism is
potentially more harmful because the
patient is not aware of it while sleeping.
Therefore, it can be difficult to detect
The etiology of bruxism is often unclear.
30. Some theories relate bruxism to
malocclusion, neuromuscular
disturbances, responses to emotional
distress, or a combination of these
factors
Altered mastication has been
observed in subjects who brux and
may be due to an attempt to avoid
premature occlusal contacts
(occlusal interferences).
31. Clenching
Clenching is defined as forceful clamping
together of the jaws in a static
relationship
The pressure thus created can be
maintained over a considerable time with
short periods of relaxation in between
Etiology can be associated with:-
Stress,
Anger,
Physical exertion, or
Intense concentration on a given task,
rather than an occlusal disorder
32. As opposed to bruxism, clenching does
not necessarily result in damage to the
teeth because the concentration of
pressure is directed more or less through
the long axes of the posterior teeth
without the involvement of detrimental
lateral forces.
Abfractions-cervical defects at the CEJ
may result from sustained clenching.
33. Also, the increased load may result
in damage to the periodontium,
temporomandibular joints, and
muscles of mastication
As with bruxism, clenching can be
difficult to diagnose
34. Optimum Occlusion
In an ideal occlusal arrangement, the
load exerted on the dentition should be
distributed optimally. Occlusal contact
has been shown to influence muscle
activity during mastication.
Horizontal forces on any teeth should be
avoided or at least minimized, and
loading should be predominantly parallel
to the long axes of the teeth.
35. This is facilitated when the tips of
the centric cusps are located
centrally over the roots and when
loading of the teeth occurs in the
fossae of the occlusal surfaces
rather than on the marginal ridges.
Horizontal forces are also minimized
if posterior tooth contact during
excursive movements is avoided
36. The chewing and grinding action of the
teeth is enhanced if opposing cusps on the
laterotrusive side interdigitate at the end of
the chewing stroke
The mutually protected occlusal scheme
probably meets this criterion better than
the other occlusal arrangements. The
features of a mutually protected occlusion
are as follows:-
1. Uniform contact of all teeth when the
mandibular condylar processes are in their most
superior position
2.Stable posterior tooth contacts with vertically
directed resultant forces
37. 3. Centric relation coincident with maximum
intercuspation (CR = MI)
4. No contact of posterior teeth in lateral or
protrusive movements
5. Anterior tooth contacts harmonizing with
functional jaw movements
In achieving these criteria, it is assumed
that (1) a full complement of teeth
exists, (2) the supporting tissues are
healthy, (3) there is no cross bite, and (4)
the occlusion is Angle Class I
38. Rationale
It might seem illogical to load the single-
rooted anterior teeth as opposed to the
multirooted posterior teeth during
chewing.
However, the canines and incisors have a
distinct mechanical advantage over the
posterior teeth: the effectiveness of the
force exerted by the muscles of
mastication is notably less when the
loading contact occurs farther anteriorly
39. The farther anteriorly initial tooth-to-
tooth contact occurs (i.e., the longer the lever arm),
the less effective will be the forces
exerted by the musculature and the
smaller the load to which the teeth are
subjected
40. The canine-with its long root, significant
amount of periodontal surface area, and
strategic position in the dental arch-is
well adapted to guiding excursive
movements
The elimination of posterior contacts
during excursions reduces the amount
of lateral force
Therefore, molars and premolars in
group function are subjected to greater
horizontal and potentially more
pathologic force than the same teeth in a
mutually protected occlusion
41. Diagnosis
This is necessary to determine the
basis for patient’s treatment.
Information about the existing
occlusal scheme can be derived
from 3 sources:
Intra-oral examination
Radiographic survey
Evaluation of mounted diagnostic
casts
42. 1. Intra oral examination
This examination is done to reveal
signs and symptoms of occlusal
pathosis, if present
In case occlusal pathosis is present,
they will be found during
Testing the teeth for the presence or
absence of mobility
Severe dental attrition
Charting of periodontal pockets
Determination of defective occlusal
contacts from CR to CO
43. 2. Radiographic Survey
A radiograph is a 2 dimensional
representation of a 3 dimensional
object.
Therefore, a complete radiographic
survey can’t be used exclusively to
arrive upon a diagnosis. Yet, there
are certain radiographic signs that
are indicative of pathologic changes
that may have been caused by the
occlusion
44. Radiographic signs of occlusal
pathosis are:
Widening of the PDL space
Angular bony defects
Changes in lamina dura
Thickening
Thinning
These radiographic findings have to
be correlated with clinical evidence
found during the time of patient
examination
45. 3. Examination of the mounted
diagnostic casts
The relationships between the jaws
and teeth that can be visualized from
the mounted diagnostic casts must
be identified before treatment
planning. This knowledge is
necessary for 3 reasons:-
1. Identification of existing initial tooth
contacts and the analysis of factors
that may contribute to any existing
pathosis or may cause damage to a
future planned occlusion.
46. 2. Occlusal plane and occlusal contacts study
to facilitate and aid in designing the
occlusal scheme of the FPD
3. In order to plan for an occlusal scheme, the
dentist has to first decide whether changes
have to be made in respect to:-
Character of the opposing dentition
Location and amount of tooth contact
Plane of occlusion
The position in which the occlusion must be
established (CR or CO)
Type and number of lateral tooth contacts that
occur during eccentric mandibular movements.
47. Factors to be studied on the
mounted diagnostic casts
A. Centric relation, centric occlusion and
initial tooth contacts
CR is an anatomic position i.e. more
specifically a neuromuscular position
It is a position dictated by the muscles
attached to the mandible and articular
disc and ligaments and not dictated by
tooth position
Since it is a position controlled by the
NM system, it can vary slightly from day
to day and different times of the day
48. CO is a tooth position. It is the
position of the maxilla in relation
to the mandible when the teeth are
in maximum inter-cuspation. CO
changes through attrition, tooth
migration, tooth loss though it does
so very slowly
49. Only when casts are mounted in CR,
the occlusal information of the
patient can be portrayed in three
dimensions. The information is in
regard to:
Initial tooth contact
Subsequent tooth position
This must then be correlated with
that from radiographic and intra-oral
examination so that the patient’s
adaptive ability can be assessed.
50. The areas to be observed specifically are
Interference from CR to CO caused by
deflective tooth contacts.
Magnitude and direction of the interference
from CR to CO.
Knowing the difference that exits
between CR and CO will help future
planning for any occlusal adjustment
necessary to achieve harmonious and
simultaneous contact during function
51. B. Plane of occlusion
The plane of occlusion of the natural
dentition can be visualized as an
imaginary curved plane that connects the
incisal edges of the anterior teeth with
cusp tips of the posterior teeth. This
antero-posterior and mesio-distal curved
plane is important functionally as it
allows the mandibular teeth to be cradled
within the confines of the maxillary
dental arch. It aids in protecting the soft
tissues from injury and in stabilizing the
mandible during final closure to CO
52. Disruption of this can occur due to
supraeruption of tooth due to the
missing antagonist tooth. This
results in an indentation of the
occlusal plane, such that during
protrusion movement of the
mandible this extruded tooth will
contact the proximal surface of the
tooth bonding the indentation
resulting in a deflection downwards.
This leads to increase stresses to
tooth, bone and musculature
53. When this exceeds the patient’s
adaptive capacity, it leads to:
Increase tooth wear
Changes of lamina dura
Increase tooth mobility
TMJ dysfunction
This problem can be due to one
single tooth extrusion or the entire
segment of an arch.
54. C. Anterior and posterior
determinants of occlusion
The anatomic determinants of
mandibular movements i.e. anterior
guidance and condylar guidance
have a strong influence on the
occlusal surface morphology of the
teeth being restored.
55. (i) Condylar Guidance / Posterior
determinant
Condylar guidance that has an impact on
the occlusal surface of posterior teeth is
the protrusive condylar path inclination
and mandibular lateral translation
The inclination of the condylar path during
protrusive movement can vary from steep
to shallow in different patients. If the
protrusive inclination is steep, the cusp
height may be longer. However, if the
inclination is shallow, the cusp height must
be shorter
56. Immediate mandibular lateral
translation is the lateral shift
during lateral movement. If
immediate lateral translation is
great, then the cusp height must be
shorter. With minimal immediate
translation, the cusp height may be
made longer.
57. (ii) Anterior Guidance / Anterior
Determinant
The track of the incisal edges from
maximum intercuspation to edge-edge
occlusion is termed as the protrusive
incisal path. The angle formed by the
protrusive incisal path and the
horizontal reference plane is the
protrusive incisal path inclination
(Ranges 50º – 70º). In healthy dentition,
the anterior guidance is approximately
5º-10º steeper than the condylar path in
the sagittal plane
58. Therefore when the mandible moves
protrusively, the anterior teeth guide the
mandible downward to create disocclusion
or separation between the maxillary and
mandibular posterior teeth. This should
also occur during lateral mandibular
excursions
The mandibular incisal edges should
contact the maxillary lingual surface at the
transition. Anterior guidance which is the
combination of the vertical and horizontal
overlap of anterior teeth also governs the
occlusal surface morphology of the
posterior teeth
59. Greater the vertical overlap, longer
the posterior cuspal height and vice
versa
Greater the horizontal overlap, less
cuspal height needed and vice versa
60. D. Compensating curves in prosthesis
Vs the curve of Spee and Wilson in
natural teeth
The antero-posterior and
mediolateral compensating curves
generated in prosthesis has to
follow the already existing curves of
spee and curves of Wilson present
in the natural dentition. If the
curves are shallow, then a shallow
curve should be generated
61. But it should be kept in mind that the
anterior guidance and posterior guidance
are the physiologic limits or border
movements of mandibular function. Any
factors that will create a steeper
guidance than those dictated by border
movements should be considered
pathologic interferences. The dentist
must work within these limits to develop
an individual occlusal scheme for each
patient’s particular needs that will
preserve the remaining dentition.
62. E. Inter-Ridge Space
Often the maxillo-mandibular space
is very greatly reduced, due to
natural teeth opposing residual
ridges extrude.
The extruded teeth needs to be
evaluated, if minimal
“odontoplasty” will bring back the
tooth into plane of occlusion or will
it require endodontic therapy
followed by the restoration of a FPD
63. Planning the occlusion
Historically, the study of occlusion has
undergone an evolution of concepts.
These can be broadly categorized as
bilaterally balanced, unilaterally
balanced, and mutually protected.
Current emphasis in teaching fixed
prosthodontics and restorative dentistry
has been on the concept of mutual
protection
64. Bilateral Balanced Occlusion
having a maximum
number of teeth in
contact in maximum
intercuspation
and all excursive positions
It helps in complete denture fabrication
helps in maintaining denture stability due to
the nonworking side contact prevents the
denture from being dislodged
65. However, as the principles of bilateral
balance were applied to the natural
dentition and in fixed prosthodontics, it
proved to be extremely difficult to
accomplish
In addition, high rates of failure resulted.
An increased rate of occlusal wear,
increased or accelerated periodontal
breakdown, and neuromuscular
disturbances were commonly observed
Thus the concept of a unilaterally
balanced occlusion (group function)
evolved
66. In a unilaterally balanced articulation,
excursive contact occurs between all
opposing posterior teeth on the
laterotrusive (working) side only. And not
on the mediotrusive (nonworking) side
Thus, in this occlusal arrangement the load
is distributed among the periodontal
support of all posterior teeth on the
working side
This can be advantageous if, for instance,
the periodontal support of the canine is
compromised
In the protrusive movement, no posterior
tooth contact occurs
Unilateral balanced occlusion / group
function
67. Long Centric
As the concept of unilateral
balance evolved, it was suggested
that allowing some freedom of
movement in an anteroposterior
direction is advantageous. This
concept is known as long centric
Schuyler was one of the first to advocate
such an occlusal arrangement
He thought that it was important for the
posterior teeth to be in harmonious
gliding contact when the mandible
translates from centric relation forward
to make anterior tooth contact
68. Others have advocated long centric
because centric relation only rarely
coincides with the maximum
intercuspation position in healthy natural
dentitions
However, its length is arbitrary ranging
from 0.5 to 1.5 mm
This theory presupposes that the condyles
can translate horizontally in the fossae
before beginning to move downward.
It also necessitates a greater horizontal
space between the maxillary and
mandibular anterior teeth (deeper lingual
concavity), allowing horizontal movement
before posterior disocclusion
69. Mutually protected occlusion /
organic / canine guided occlusion
During the early 1960s, an occlusal scheme
called mutually protected occlusion was
advocated by Stuart and Stallard, based on
earlier work by D'Amico
In this arrangement, centric relation
coincides with the maximum
intercuspation position
Anterior maxillary & mandibular teeth,
together guide excursive movements of the
mandible, and no posterior occlusal
contacts occur during any lateral or
protrusive excursions
70. In a mutually protected occlusion,
the posterior teeth come into
contact only at the very end of
each chewing stroke, minimizing
horizontal loading on the teeth
Concurrently, the posterior teeth
act as stops for vertical closure
when the mandible returns to its
maximum intercuspation position
71. Interferences
When the teeth are not in harmony with the
joints and the mandibular movements,
interference is said to exist
Interferences are undesirable occlusal
contacts that may produce mandibular
deviation during closure to maximum
intercuspation or may hinder smooth
passage to and from the intercuspal position
4 types of interferences:-
Centric interference
Working interference
Non-working interference
Protrusive interference
72. (i) Centric interference
Premature contact that occurs when
the mandible closes with the
condyles in their optimum position
in the glenoid fossae
Causes deflection of the mandible in
a posterior, anterior and/or lateral
direction.
Interference occurs between the
mesial inclines of maxillary teeth and
distal inclines of mandibular teeth.
73. (ii) Working interference
Occurs when there is contact between
the maxillary and mandibular posterior
teeth on the same side as the direction
in which the mandible has moved and
should be heavy enough to disocclude
anterior teeth
(iii) Non-working interference
Is an occlusal contact between maxillary
and mandibular teeth on the side of the
arches opposite to the direction in
which the mandible moves in a lateral
excursion.
It is destructive in nature
74. (iv) Protrusive interference
Occurs when distal facing inclines of
maxillary posterior teeth contacts the
mesial facing inclines of mandibular
posterior teeth during a protrusive
movement
Causes destructive forces
These interferences may lead to
pathologic occlusion
75. Pathologic Occlusion
A pathologic occlusion is defined as
the one in which sufficient
disharmony exists between teeth
and the TMJ’s to result in
symptoms that requires
intervention
76. Signs and Symptoms
(i) Teeth
May exhibit hyper mobility, open contacts or
abnormal wear like fracture or chipping of
incisal edges
(ii) Periodontium
Chronic periodontal disease.
Widened PDL space (radiographically).
Tooth movement
(iii) Musculature
Chronic muscle fatigue leading to muscle
spasm and pain
Restricted opening or trismus
Myositis
(iv) TMJ’s
Pain, clicking or popping in the TMJ’s
77. Treatment
Includes certain objectives. They are
To direct the occlusal forces along the
long axes of the teeth
To attain simultaneous contact of all teeth
in CR
To eliminate any occlusal contact on
inclined planes to enhance the positional
stability of the teeth
To have CR coincident with the
intercuspal position
To arrive at the occlusal scheme selected
for the patient (e.g. Group function or mutually protected
occlusion)
78. In the short term,
these objectives
can be
accomplished
with a removable
occlusal device
fabricated from
clear acrylic resin
that overlays the
occlusal surfaces
of one arch
79. On a more permanent basis, this
can be accomplished through
Selective occlusal reshaping,
Tooth movement,
The placement of restorations, or
Combination of these
80. Definitive occlusal treatment involves
accurate manipulation of the mandible,
particularly in centric relation. Because
the patient may resist such
manipulation as a result of protective
muscular reflexes, some type of
deprogramming device may be needed
(e.g., an occlusal device)
81. OCCLUSAL DEVICE THERAPY
Occlusal devices (sometimes referred
to as occlusal splints, occlusal
appliances, or orthotics) are
extensively used in the management of
TM disorders and bruxism.
In controlled clinical trials, they have
effectively controlled myofascial pain.
82. However, no clear hypothesis about the
mechanism of action has been proved, and
none of the various hypotheses
repositioning of condyle and/or the articular
disk,
reduction in masticatory muscle activity,
modification of "harmful" oral behavior, and
changes in the patient's occlusion
has been consistently supported by
scientific studies
Occlusal devices are particularly helpful in
determining whether a proposed change in a
patient's occlusal scheme will be tolerated.
83. If a patient responds favorably to
an occlusal device, the response to
restorative treatment should be
positive as well.
Thus, occlusal device therapy can
serve as an important diagnostic
procedure before initiation of fixed
prosthodontic treatment.
84. Fabrication of Device:
There are several satisfactory methods
for making an occlusal device
One made from heat-polymerized acrylic
resin will have the advantage of
durability, but autopolymerizing resin
used alone or in conjunction with a
vacuum-formed matrix can serve equally
well
85. Direct Procedure Using
a Vacuum-Formed Matrix
1. Adapt a sheet of clear thermoplastic
resin to a diagnostic cast using a
vacuum-forming machine
Block excessive undercuts
Trim the excess resin
On the facial surfaces, the device must be
kept well clear of the gingival margins
86. 2. then check for fit and stability
Add a small amount of
autopolymerizing acrylic resin in the
incisal region
Guide the mandible into CR to make
shallow indentations in the resin
87. 3. Add more resin to the incisor and canine
regions and guide the patient to retrusive,
protrusive, and lateral closures in the soft
resin
4. Adjust the resin to give smooth, even
contacts during protrusive and lateral
excursions as well as a definite occlusal
stop for each incisor in centric relation
Confine protrusive contacts to the incisors
lateral contacts to the laterotrusive canines
All posterior contacts should be relieved at
this stage.
88. 5. Repeated protrusive and lateral
movements will overcome most problems
in jaw manipulation
Occasionally it will be necessary for the
patient to wear the device overnight before
the acquired protective muscle patterns are
overcome
6. Add autopolymerizing acrylic resin to
the posterior region of the device and
guide the patient into centric relation.
Hold CR until the acrylic resin has
polymerized
89. 7. Remove the device and examine the
impressions. Polymerization can be
accelerated by placing the device on the
cast in warm water
8. Place pencil marks in the depressions
formed by the opposing centric cusps. If a
cusp registration is missing, new resin can
be added and the device reseated
9. Remove excess resin and leave only the
pencil marks. All other contacts must be
eliminated if posterior disclusion is to be
achieved
90. 10. Check the device in the mouth for CR
contacts. Relieve heavy contacts by
continued adjustment until each centric
cusp has an even mark.
11. Identify protrusive and lateral
excursions. Adjust excursive contacts as
necessary
12. Smooth and polish the device, again
being careful not to alter the functional
surfaces
13. After a period of satisfactory use, the
device can be duplicated in heat-
polymerized resin using a standard
denture reline technique.
91. Indirect Procedure Using Autopolymerizing
Acrylic Resin
Accurately mounted diagnostic
casts are essential for this
procedure
Particular attention must be given
to occlusal defects or interfering
soft tissue projections on the casts,
which could cause errors during
mounting
92. 1. Be sure that the device is made at
the same vertical dimension of
occlusion as the CR record. This
will reduce mounting errors derived
from using an arbitrary facebow
2. Incisal guidance table initially set
flat
3. Lower the incisal guide pin until
there is approximately 1 mm of
clearance between the
posterior teeth
93. 4. Now reposition the incisal guide
table after
5. Check the clearance between
opposing casts during protrusive
movement of the articulator. Where
this is less than 1 mm, increase it
by tilting the incisal guidance table
6. Raise the platform wings
of the incisal guidance table
so there is at least 1 mm of
clearance in all lateral
excursions
94. 7. Mark the height of contour of each
tooth on the cast and block out
undercuts with wax
8. Form wire clasps to engage facial
undercuts and seal the cast with a
separating medium
95. 9. Fabricate the device
with autopolymerizing
clear acrylic resin
10. While the resin is still soft, close
the articulator into protrusive and
lateral excursions. Add or remove
resin until it is in constant contact
with the anterior teeth when the
incisal guide pin contacts the incisal
guidance table
96. 11. after the polymerization, Refine
the occlusion on the articulator
a. There should be even contact in
centric relation
b. A stop should exist for each anterior
tooth in CR
c. Protrusive contact on the incisors
should be smooth and even
d. There should also be smooth and even
lateral contact on the laterotrusive
(working-side) canines
97. 12. lastly, smooth and polish the
device, taking care not to alter the
functional surfaces
13. At try-in, check for fit and
stability. Also check the occlusal
contacts and adjust as necessary
98. Indirect Procedure Using Heat
polymerized Acrylic Resin
A more durable device can be made
with heatpolymerized acrylic resin
Desired occlusal surface is shaped
in wax on articulated diagnostic
casts, or the direct device made
with a vacuum-formed matrix can
be used as a pattern
99. Lastly, flasked and processed in a
manner similar to that for a
complete denture
Because of processing errors, it is
important to remount the cast and
make necessary adjustments before
finishing and polishing are
completed
100. FOLLOW-UP
After delivery to the patient, the
occlusion must be verified and
corrected as necessary
The patient is instructed to wear
the device 24 hours a day,
removing it only for oral hygiene,
and to return at regular weekly and
biweekly intervals for modification.
101. A reduction in discomfort suggests
that definitive occlusal adjustment
or restorative dentistry, or both,
will likely be successful
If device therapy fails to relieve the
discomfort, further evaluation and
diagnosis of the etiology and
parameters of the chief complaint
should be pursued
102. Conclusion
Knowing everything about the
occlusion enables the dentist to
provide a fixed partial denture
which helps the patient in restoring
the function and appearance
103.
104. References
Herbert.T Shillingburg JR, Sumiya
Hobo: Fundamentals of Fixed
Prosthodontics; 3rd Edition.
Stephen.F Rosentiel, Martin F. Land,
Junhei Fujimoto: Contemporary Fixed
Prosthodontics; 3rd Edition.
William F.P Malone, David L Koth:
Tylman’s Theory and Practice of Fixed
Prosthodontics; 8th Edition.