Occlusion of crown and bridge

and clinical important in prognosis of treatment

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Prepared by DR .shahen arif khdir HIGH DEGREE DIPLOMA STUDENT 2013

The way in which the upper and lower teeth relate to each other or in
most of these ,the maxillary and mandibuler teeth contact simultaneously when the condylar processes are fully seated in

the mandibular fosse and the teeth do not interfere with

harmonious movement of the mandible during function. Clinical Relevance: Occlusion is of fundamental importance in

restorative dentistry, as all restorations placed in the mouth can

have a profound effect on it. From Intra coronal direct placement restorations to complex crown and bridgework, the restoration must be planned to conform to an occlusal pattern.

Static occlusion: stationary position of upper and lower jaw (or upper & lower teeth) in relation to each other, thats why its call static because its not moving, its a postural position, close position where the patient not moving his

mandible against his maxilla.

Centric occlusion (CO

the occlusion the patient makes when they fit
their teeth together in maximum inter cuspation CO is also called Inter- cuspal position (ICP) Bite of convenience

Habitual bite

1.. At this position occlusal force is directed along the long axis of the

teeth. As we know, its the most favorable position. It is the most

histological direction of forces that will be accommodate by dental tissues & surrounding structures. 2. At this position, its an End point of chewing cycle. This position where patient end their chewing cycle. Patient move their jaw laterally and all around when theyre chewing and the end point of the chewing is static position

.3.The position in which simple restoration are

made. Usually we made our restoration in this position. Because it is reproducible, easy, simple, safe to do.

Dynamic occlusion: describe occlusal contacts when the

mandible is moving relative to the maxilla When you move laterally , or protrusive , all this contact are part of dynamic

occlusion. Which is very important because its the chewing

action.

Guidance from the teeth:

Determined by the shapes of teeth and TMJ
Canine guidance vs. group function Protrusive guidance

Anterior Guidance :The influence of the contact relationship

between the labial surface of the mand. incisors and the lingual surface of the max incisors on mandibular Movement

Purpose

Disclude posterior teeth in excursions Determined by horizontal/vertical overlap horizontal overlap A.G. vertical overlap A.G.

Recorded by custom anterior guide table

Anterior determinants of occlusion. Different incisor relationships with differing horizontal and vertical overlaps (HO and VO) produce different anterior guidance angles (AGA). A, Class 1. B, Class 11, Division 2 (increased VC; steep AGA). C, Class 11, Division 1 (increased HO; flat AGA

shape of the articular

eminences, anatomy of the

medial walls of the mandibular fossae , configuration of the mandibular condylar processescannot be controlled , nor is it possible to influence the neuromuscular responses of the patient, unless it is

done by indirect means (e.g., through changes in the

configuration of the contacting teeth or by the provision of an occlusal appliance).

Posterior determinants of occlusion. A, Angle of the articular eminence (condylar guidance angle). 1, Flat; 2, average; 3, steep. B, Anatomy of the medial walls of the mandibular fosse. 1, Greater than average; 2, average; 3, minimal side shift

In a unilaterally balanced articulation, excursive contact occurs between all opposing posterior teeth on the latero trusive (working) side only. On the medio trusive (nonworking) side, no contact occurs until the mandible has reached centric relation. Thus , in this occlusal arrangement the load is distributed among the

periodontal support of all posterior teeth on the

working side.

Group function or unilaterally balanced occlusion During lateral excursions, there are no contacts between teeth on the mediotrusive (nonworking) side, but even excursive contacts occur on the laterotrusive (working side)

Canine protected occlusion : The contact between maxillary and mandibular canine in lateral movement lead to no contact of posterior teeth

on

either

working

or

balancing

(non

working)sides.

Canine-guided or mutually protected occlusion. During lateral excursions, there are no contacts on the mediotrusive (nonworking)

side; all contacts are between the laterotrusive (working side) canines

1. Non-axial loading

Heavily restored teeth at risk of fracture or decementation:

contact of dynamic occlusion, when you move laterally or protrusive youre loading the teeth in contact in a nonaxial direction, in an oblique direction , those forces are destructive by nature and they need more adaptation. That would make heavily restored teeth or crown teeth at a higher risk of fracture and crown seated on this teeth usually because theyre subjected to oblique forces, theyre usually subjected to higher risk of being decementation.

other manifestations: wear, mobility, fracture, migration, when you check older age patient for example most of the canine had been worn due to its role as guidance for long time. With aging usually the occlusion change, from canine guidance to group function (because of wear). Because the canine already become short. Cusp worn. So the guidance will be shared by another cusp of teeth, adjacent cusp of teeth. We have mobility, fracture, migration, TMJ dysfunction (possibility to have) . 2.Identify guidance teeth before preparation If guidance tooth is satisfactory, I mean good, sound, strong, we should re-establish the same guidance pattern in the new restoration #If guidance tooth is weak, transfer guidance contacts to the adjacent stronger teeth. 3.Provide clearance during preparation in excursive positions: We provide clearance during preparation in excursive movement, we have to provide adequate occlusal reduction clearance to accommodate the material of the crowns 4..Select appropriate material to restore the guidance tooth: we want to restore it with strong enough and doesnt distort because it is subjective to un favorably pattern direction of forces, and subjective to excessive wear ,and again its come in contact with opposing teeth more frequently than other teeth

The vertical dimension of occlusion: (VDO) is the vertical height of the face when the teeth are in maximum inter cuspation teeth are held apart in the rest position by the muscles of mastication acting on the mandible creating a freeway space or Intero cclusal distance of 24 mm

*Resting vertical dimension :a measured distance between the upper and lower jaws when all forces upon the mandible are in equilibrium and the patient is in an upright position

Occlusal vertical dimension :

A measured distance between the upper and lower jaws when the teeth are in full intercuspation.

Centric relation:

The relation of the mandible to the maxilla when the condyles are in the Most superior anterior position in the glenoid fossa ,from which unstrained lateral movements can be made at the occluding vertical dimension normal for the patient(Arch to Arch relation ship).

Centric occlusion(co):
The centered contact position of the occlusal surfaces of the mandibular teeth against those of the maxillary teeth, irrespectives of condaylar Position (teeth to teeth relation) It can be taken when there are enough occlusal stops after preparation for a crown or bridge.

Contacts during

Speech
Swallowing Mastication:((teeth should not be together during talking or chewing) Contacts are:

Infrequent(short duration)

Glancing
Low intensity

Contacts other than functional

Clenching Grinding

Biting on foreign objects

Fingernails Pipes Nails.

Increased force

Clinical findings

Intensity Frequency

Mobility
Tooth /restoration fracture

Duration
Adverse loading
Non axial Un braced mandible

Restoration displacement Muscle pain/dysfunction TMJ pain/dysfunction Aggressive wear for teeth and restoration

The occlusal disharmony caused by improper fixed prothodontics work can cause The following adverse results: 1.Pulpitis 2 .bruxing 3.Premature occlusal wear and restoration perforation. 4.Accelerated periodontal breakdown and teeth mobility. 5.TMJ disturbances caused by high spots and excessive lateral forces. 6.Dislodgment of fracture of facing s caused by excessive contents of anterior teeth in protrusion and excessive lateral forces on fixed restoration.

A pathogenic occlusion is defined as an occlusal relationship capable of producing pathologic changes in the stoma to gnathic system. In such occlusions sufficient disharmony exists between the teeth and the TMJs to result in symptoms that require intervention SIGNS AND SYMPTOMS There are many indications that a pathogenic occlusion may be present. Diagnosis is often complicated because patients almost always have a combination of symptoms.

the following symptoms can help confirm this diagnosis.

Teeth. The teeth may exhibit hyper mobility, open

contacts, or abnormal wear. caused By excessive occlusal force. This may be due to premature contact in centric

relation or during excursive movements. Open proximal

contacts may be the result of tooth migration because of an unstable occlusion and should prompt further

investigation . Abnormal tooth wear, cusp fracture, or

chipping of incisal edges may be signs of parafunction activity.

Periodontium.: There is no convincing evidence that chronic periodontal disease is caused directly by occlusal overload. However, a widened periodontal ligament space(detected radio graphically)may indicate premature occlusal contact an often associated with tooth mobility Similarly ,isolated or circumferential periodontal defects are often associated with occlusal trauma. .
.

Widened periodontal ligament space and increased mobility of mandibular molars .Occlusal premature contacts were noted in lateral and protrusive movements.

Musculature.

Acute or chronic muscular pain on palpation can indicate habits associated with tension such as bruxing or clenching. Chronic muscle fatigue can lead to muscle spasm and pain.

Temporomandibular Joints. Pain, clicking, or popping

in the TMJs can indicate TM disorders .Clicking and popping may be present without the patient's awareness. A stethoscope is a useful diagnostic aid. Clicking may also be associated with internal derangements of the joint. A patient with unilateral clicking when opening and closing (reciprocal click)in conjunction with a midline deviation may have a displaced disk. The midline deviation will typically occur toward the side of the affected joint because the displaced disk can prevent (or slowdown) the normal anterior translatory movement of the condoyle..

Myofascial Pain Dysfunction.

The mayo facial pain dysfunction (MPD)syndrome presents
as diffuse unilateral pain in the pre auricular area, with

muscle tenderness, clicking, or popping noises in the contra

lateral TMJ and limitation of jaw function. Often the muscles,

and not the TMJ, are the primary site, but over time the
functional problem may lead to organic changes in the joint.

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2.

3.

4.

5.

Simultaneous and uniform contact of as many teeth as possible in centric occlusion. Anterior teeth may touch, but the intensity should be slightly less than the posterior teeth as the forces of occlusion are at an angle to the long axis for anterior teeth. This criterion provides for the optimum distribution of forces. The forces of the occlusion are directed down the long axis of the teeth. Axial forces have been shown to be more favorably received by the attachment apparatus than horizontal or oblique forces. Anterior tooth contacts compatible with functional movements. A deep vertical overlap of the anterior teeth may allow for taller/sharper posterior cusps No posterior teeth should contact on the non working side during lateral excursions. No posterior teeth should contact during protrusive excursions.

Occlusal design 1. Distribute forces proportionate to the ability of the teeth to resist 2. Distribute forces to as many teeth as possible. 3. Direct forces most favorably relative to the supporting tissues. 4. Avoid heavy force application in unbraced jaw positions

OCCLUSAL TREATMENT
The objectives of occlusal treatment are as follows: 1. To direct the occlusal forces along the long axes of the teeth 2. To attain simultaneous contact of all teeth in centric relation 3. To eliminate any occlusal contact on inclined planes to

enhance the positional stability of the teeth

4. To have centric relation coincide with the maximum intercuspation position 5. To arrive at the occlusal scheme selected for the patient (e.g., unilateral balanced versus mutually protected)

The diagnostic process begins with. careful history taking .clinical examination. Signs an symptoms of clicking or locking of the temporo mandibular joints, muscle spasm, excessive or uneven occlusal wear and pain on

chewing must be recorded. Further investigations

including radiographs, vitality tests and articulated study casts will provide additional information.

The examination should include

*.Extra-oral components Temporo mandibular joints, muscle hypertrophy/spasm. Mandibular movement painful, deviated, abnormal or restricted. *Intra-oral features: 1. Intercuspal position, retruded contact position, lateral and anterior guidance. 2. Location and extent of occlusal face tin . 3. Ease of movement between mandibular positions . 4. Extent of posterior support. 5. Over-erupted, tilted or mobile teeth.

1Articulating paper ( marking contact

Teeth must be dry!!!!

Use fresh paper for best results Apply Vaseline film to paper

Helps transfer ink

Sandblast metal / porcelain

Helps with ink transfer 2 Articulated study casts ,mounted on a semi-adjustable articulator using a face bow record, provide more detailed

information that cannot be readily assessed in the mouth

3.T Scan system

Computerized occlusal analysis Detects Presence of contacts Intensity of contacts Timing of contacts

Similar to digital radiology, sensor between teeth and can detect certain things.

T Scan system Computerized occlusal analysis Detects contact Presence Location Intensity Timing

Restorative dentistry book(A.J. MCCULLOCK) Dent Update 2003; 30: 150-157 2 . contemporary fixed prothodontic book(3rd edition) By STEPHEN F. ROSENSTIEL, BDS, MSD and MARTIN F. LAND DDS, MSD JUNHEI FUJIMOTO, DDS, MSD, DDS c 3 .internet research
1.

Thank you