What is occlusion ?
Occlusion (in simple words) is the teeth contact relationship which might
be dynamic or static , means that any teeth movement like closure,
protrusion , excursion ...is considered as occlusion .
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Fractured teeth or restorations //Accelerated
tooth wear //
neuromuscular control (your brain ask your mandible to move), and other
thing called:
guidance system .
This guidance system, once your brain ask your mandible to move ,this
mandible will move controlled by two things :
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Now this posterior guidance together with anterior guidance are totally in
harmony, and if there is any disharmony we will go forward for the
complications .
_The condyle will move in the joint depending on the morphology of the
joint itself , in your edentulous patient, there is nothing to guide
mandibular movement except this joint, so the patient in this case will not
be able to put his mandible in the proper position , so for this reason we
ask him to go to centric relation because it is the only thing which is
reproducible in that patient (there is no anterior guidance). In case of
dentate patient, mandible is not totally free to move because there is
another factor beside the TMJ guides its movement.
_Working side versus non-working side :working side means that the
movement is toward it , when you move your mandible to the right, the
right side is your working side and the left is the non-working side .
If your articulator can do the whole stuff (movements and angels ),then
your articulator is perfectly the joint of your patient, and the more complex
the articulator , the closer to the posterior guidance .
>>far away from the joint, and the longer the distance from the joint, the longer
the resistance arm , the better the resistance to the applied force (coming
from TMJ movement).
>> the threshold of proprioceptors in the PDL of canine is quiet low , means if there is a
high spot on the canine this will easily cause an opening reflex of the
mandible, and it is a very protective reflex to minimize complications. So
all of these tell that the best occlusion I can create for the patient is a
canine guided occlusion .
Posterior teeth when they bite in the habitual bite, they are actually protecting
anterior teeth,
_This anterior guidedwhile during excursion
occlusion when anterior
is manifested teeth(canines)
mainly through are in contact
they(*there
excursion are protecting posterior
are 4 main teethmovements
excursion -which are not in contact- retrusive
: protrusive, from being loaded.
, left lateral ,
this is called mutual protection system ,which is the ideal occlusion . Page | 4
,if you protrude your mandible the only teeth which are
and right lateral )
allowed to be in contact are the anterior teeth(incisors mainly). When you
move your teeth to the working side( lateral excursion), the only tooth
which is allowed to be in contact is the canine, the rest of the teeth
(ideally)should be out of contact .So this excursion movement should be
controlled by the canine, but canine is connected as other teeth with the
posterior guidance, so the idea is : a problem in the occlusion on this
anterior guidance (high spot for example) will affect the posterior guidance
and create a form of disharmony .
_ This means ;the best is to have your canine in contact during excursion
and other teeth are not .There is also another concept called
Christensen’s phenomenon during excursion , the only teeth
which contact are the guiding teeth which are canine ideally , or all
anterior teeth in some situations. With time ,people who have canine
guided occlusion could become group function guided ,this is because with
time , canine start to suffer from attrition and Posterior teeth start to guide
occlusion ,and this is called group function guided occlusion , this is still
good , but the best is canine guided.
_As you start having posterior contact (posterior guiding) then you are
closer to the TMJ which is the fulcrum of mandible movement, so this
increase the resistance arm , increase the load ,then you may end with
tooth wear, fractured restorations , or TMJ problem.When the mandible
moves, a sort of harmony exists between posterior and anterior guidance ,
this harmony could be easily spoiled by interferences (in case of removable
prosthodontics they are called premature contacts).
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there is anything preventing canine from coming into contact during
excursion this called interferences .
**Types of interferences :
• 1-working side interferences .
• 2-non-working side, the worst interference in term of possible
complications, we will talk about them later in this lecture.
• 3-prutrusive.
• 4-retruded contact position: which is called deflective contact
because it cause the mandible to move some distance in order to
come in the habitual bite . Or it can be called sometimes premature
contact, means that the patient has a premature contact on some of
his teeth when he try to make intercuspation so prevent him from
doing that.(interferences is the term which we use commonly in fixed
prosthodontics) .
_(the same slide, lower pictures) : patient is trying to go to the left side
,ideally this should be controlled by canine ,but if you notice , there is an
interference created by the 2ed molar in the non-working side prevents
canine from coming into contact in the working side .
The significance here is that when you have interferences , your anterior
and posterior guidance don’t work in harmonious way , and if the mandible
tries to go simply through glenoid fossa , teeth will prevent it because there
is a premature contact on the 2ed molar , so patient is supposed to
manipulate his joint to let his bit come in the correct way.This manipulation
will affect the joint !
*The most bearable interferences are the centric and working side
interferences . and the most destructive interference is the non-
working side ,then the protrusive interference .
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**Why do you need to learn about anterior guidance ?
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mounting , so you need sometimes anterior and lateral guidance on top of
ICP.
_why should you chose a rigid not flexible material ?? because in case of
rigid material the chance for deflection the casts is much less , and the
more rigid the material , the less the details(it doesn’t enter fissures and
doesn’t take cusp tip in details but relative to each other ).So thin , rigid ,
and minimum details .Avoid flexible bite and too detailed bite , they will
make mounting inaccurate . {Note: You have to take 2 bites , in case if the
technician have missed one }
_The material which gives this advantages is Duralay Acrylic Resin .it is
rigid with very high dimensional stability , and not much accurate . I can
use hard wax but it could be distorted , or I can use ZOE which is rigid but
the problem is that it takes details and this will cause difficulty in mounting
. Or you can use rubbers ,it is less detailed than ZOE but it’s flexibility is
the main problem and the two casts could not be stable on each other in
the articulator.
_So your best choice is Acrylic , it is thin , rigid ,and less accurate( accuracy
in the bite should be in the relation between the 2 casts and not in
surface details ).
*Now after I took the bite, the next step is choosing the articulator , and
this is according to what I need from this articulator. If I need full movement
, I have to chose a fully adjustable articulator, but if I don’t need that I can
use my hands, simply by approaching the two casts together by your
hands .
*There is also ARCON and Non-ARCON articulator , you need to know that
ARCON articulator is better. And that there are two things determine the
path of closure ; FACE BOW an ARCON articulator .
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**What type of articulator ? what type of restoration ?
1-Single crown :
If no one of them is guiding occlusion , then the same thing applies: you
can chose any method of articulation .
Now if you are doing a 3-unite bridge which has a high chance to create an
interference, you have to use an articulator which is very close to the
posterior guidance in term of movements ,then , after you have chosen
your articulator you have to do the next significant step which is : adjusting
the movement records on your articulator which include ; protrusive
condylar guidance, lateral condylar guidance, and anterior guidance.
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_How could I set all of these on my articulator ?
_by taking the bite : protrusive bite, lateral bite and retruded contact bite
or maximum intercuspation .
واعلممم أنممه ل يممدرك المفمماخر مممن..وإن هممت فثابر.. إذا عزمت فبادر
والمممال ل يجمممع إل,العلم ل يحصل إل بالنصممب.. كان في الصف الخر
ول يحوز أحد لقب الشممجاع إل بعممد, واسم الجود ل يناله بخيل,بالتعب
.. جهد طويل
وإن لممك معممادا ً ينممزل اللممه فيممه, ولممن تممترك سممدى, ً إنك لم تخلق عبثا
فاجعل من قلبك قلبا ً قويا ً دائم الثأر.. ليحكم بين الناس ويفصل بينهم
ج مدَ ولمممح.. فإذا غافله شيطان في غلبة شهوة أو همموى...من شيطانه
..."قول الله تعالى "إن الحسنات يذهبن السيئات
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