Dawson Academy Whitepaper

5 Requirements for Occlusal Stability By Glenn DuPont, DDS

There is nothing more critical for the practicing dentist than the abilities to both recognize occlusal instability and achieve occlusal stability. The fundamental goal of treatment planning is to achieve a result that will not cause breakdown in the stomatognathic system and to provide long-term stability. When an unstable occlusion is diagnosed, the starting point is to ask, What do I need to do to create a stable, ideal occlusion? In other words, determining how to create an occlusion that provides each patients stomatognathic system long-term stability, comfort and maintainability is the place to begin treatment planning. Following are the 5 requirements for long-term occlusion stability used to recognize an unstable occlusion as well as to design an ideal stable occlusion. They create the essence of all occlusal analysis. An ideal occlusion is one that reduces stress on the whole system. This means that the occlusion reduces stress on the TMJs, muscles of mastication, teeth, periodontium, and all restorations. These 5 requirements of occlusals stability are: 1. Stable contacts on all teeth of equal intensity in centric relation 2. Anterior guidance in harmony with the envelope of function 3. Disclusion of all posterior teeth during mandibular protrusive movement 4. Disclusion of posterior teeth on the non-working side during mandibular lateral movement 5. Disclusion of posterior teeth on the working side during mandibular lateral movement There is a specific sequence to follow when applying the 5 requirements of occlusal stability. The first step, and one which is extremely critical, is to evaluate the TMJs for stability and comfort. Once the TMJs have been determined to be stable, the occlusion can be evaluated for long-term stability. The 5 requirements of occlusal stability are now applied to create equilibrium so that the teeth are in harmony with the muscles and the TMJs. These requirements are not new. They have been tried and tested over many decades of studies and clinical experience. Lets look at each requirement. Criteria 1: Stable contacts on all teeth of equal intensity in centric relation. Centric relation is defined as the relationship of the mandible to the maxilla when the properly aligned condyle-disc assemblies are in the most anteriorsuperior-medial position in the glenoid fossa. This is consistent with the direction of force of the masseter, temporalis and medial pterygoid muscles when they contract in closure of the mandible. Part of this first criterion is to shape the teeth so they contact each other with equal force, thereby distributing the forces evenly so as not to allow any one tooth to take more force than another. Also, the equal intensity contacts must
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Glenn DuPont, DDS, graduated from Emory University School of Dentistry in 1979, and joined the practice of Dr. Peter Dawson and Dr. Reuben PeteRoach in St. Petersburg, Florida. Since then he has been learning, practicing and teaching concepts of restorative dentistry. Dr. DuPont is a member of the American Academy of Restorative Dentistry and Past President of the Florida Academy of Dental Practice Management. He is involved with many study groups and professional organizations in addition to lecturing extensively both nationally and internationally.

2013 The Dawson Academy. All rights reserved.

Dawson Academy Whitepaper

be in a direction that reduces stress on the teeth and periodontium. Therefore posterior tooth contacts should be directed axially, not on inclines. Criteria 2: Anterior guidance in harmony with the envelope of function. Because the anterior teeth are designed to protect the posterior teeth, an anterior guidance that is in harmony with the envelope of function is essential for a successful, long-term, stable result. Furthermore, proper anterior guidance reduces elevator muscle activity when teeth guide in excursive movements. When anterior guidance is in harmony with the muscles, joints and tooth function, harmony with the envelope of function is also achieved. Therefore, proper anterior guidance, determined by the mandibular anterior teeth and the lingual contours of the maxillary anterior teeth, ensures there are no interferences with the normal, functional movements of the patients mandible. So, when solving occlusal problems, establishing an acceptable anterior guidance is the first key decision to make once the TMJs are stable. Criteria 3: All posterior teeth disclude during mandibular protrusive movement. Criteria 4: All posterior teeth disclude on the non-working side during mandibular lateral movement. Criteria 5: All posterior teeth disclude on the working side during mandibular lateral movement. Criteria 3, 4 and 5 can easily be evaluated together. The goal of these criteria is that the posterior teeth contact in centric relation with equal intensity (not on inclines), and immediately disclude as soon as the mandible moves in any direction. When considering requirement #5, there may be a situation where the posterior teeth all hit in precise harmony with the anterior teeth. This is not ideal and all studies have shown that this will increase elevator muscle activity. This is because our limitations as dentists do not allow us to create precise harmony in this excursion. If this precise harmony changes slightly over time then the ideal occlusion will be violated. This is why immediate disclusion is desired in this excursion as well as the others. Another consideration that must be addressed and considered when striving for long-term stability is that of the neutral zone. When bone and muscle war, muscle always wins because bone is malleable. Also when teeth are in a position in the mandible or the maxilla that is at odds with the muscles, bone (periodontium) will adapt and teeth will move or shift creating crowding and occlusal instability. In summary, when the TMJs are stable, the muscles comfortable, and the teeth in the neutral zone, the 5 requirements of occlusal stability can be utilized to evaluate for occlusal stability and to treatment plan any corrections needed to achieve a long lasting, stable, comfortable occlusion.

This material may not be reproduced, displayed, modified or distributed without the express prior written permission of the copyright holder. For permission, contact info@thedawsonacademy.com.

2013 The Dawson Academy. All rights reserved.