OCCLUSION II

Presented by Anubhuti Gupta Prepared under the guidance of Dr. Priya Kumar Dr. J. Augustine

Occlusion is a static, morphologic tooth relationship.  It is the contact relationship of teeth in function and parafunction.  Also refers to the factors concerned with development and stability of masticatory system and with use of teeth in oral motor behaviour.


Vertical Relations
VR of occlusion : Amount of separation between the mandible and maxillae when the teeth are in natural max contact i.e. centric occlusion.  VR of rest position : Amount of separation between mandible and maxillae when the mandible and all its supporting muscles are in resting posture.  Interocclusal distance or freeway space is the normal space b/w incisal and occlusal surfaces of maxillary and mandibular teeth in mandibular physiological rest position.


Horizontal Relations

Dried skull with the teeth in centric occlusion and the joint in centric relation.

Horizontal Relations
Centric Relation : Most posterior position of mandible relative to the maxillae at a given vertical dimension.  Relationship of bones of both jaws without tooth contact or with teeth only barely contacting before closing teeth into max intercuspation.  Presence/absence of teeth, occlusion/malocclusion are not factors.


  1. 2. 3.

Centric occlusion : Max intercuspation attained between maxillary and mandibular posterior teeth. Mandible usually forward from CR by 1-2 1mm. Synonyms : Intercuspal position Habitual occlusion Natural bite

Models of human teeth in maximum intercuspation.

Ideal Occlusion


 

Complete harmonious relationship of teeth and all other structure involved in the masticatory system. Teeth conform to a specific pattern that includes 138 occlusal contacts in the closure of the 32 permanent teeth. This rarely exists. Concept of 138 occlusal contacts, presented by Hellman. Hellman.

Importance
Concepts of ideal occlusion are used primarily in orthodontics and restorative dentistry  Application of these has not been shown to be practical or necessary for occlusal stability or function.


Normal/Class I Occlusion

   

Variation from ideal occlusion. Considered optimum if there is functional comfort and stability of alignment Needed to maintain or protect the periodontium and/or TMJ and aesthetics The biting force of posterior teeth is about 100100170 lbs. It is necessary that each tooth be able to withstand the forces exerted during mastication.

In proper occlusion each tooth has appropriate opposing contact. A malpositioned tooth can cause improper distribution of stress resulting in breakdown of periodontium and/or TMJ pathology. First permanent molar are considered key to occlusion - their position is same as in ideal occlusion --- mesiobuccal cusp of maxillary first molar rests in mesiobuccal groove of mandibular first molar.

Centric Stops
Area of occlusal contact that a supporting cusp makes with the opposing teeth in centric occlusion.  Also the area of contact on the supporting cusp that makes contact with the opposing tooth in centric occlusion.  Areas of tooth that make contact with opposing teeth in centric occlusion and contribute to occlusal stability.


Eg. Mesiolingual cusp of maxillary 1st molar (supporting cusp) makes contact with central fossa (central stop) of mandibular first molar.

Biomechanics Of Chewing Function



   

During the masticatory process, the individual generally chews on one side only at any one chewing stroke. Shifting material from one side to the other when convenient Is limited to posterior regions, aided by the canines. The shift of mastication may be directed anteriorly. Tongue, lips, cheeks manipulate food; throw it around continuously during jaw movements.

Eccentric Movements
 1. 2. 3. 4.

Occlusal contact away from centric occlusion include Lateral Lateral protrusive Protrusive Retrusive

Protrusive Movements

Protrusive Movements

 

These negotiate the process of biting, shearing food material.

Mandible moved anteriorly, downward. Both condyles are forward in their glenoidal fossae, functioning against and beneath their articular eminences. As the mandible moves forward,incisal edges of mandibular anterior teeth glide against lingual fossae of maxillary anterior teeth.

When mandible is fully protruded, incisal edges of mandibular incisors are in front of maxillary anterior teeth.  Range of avg max forward protrusion for men and women- - 2.5 to 16 mm women Extremes represent very tight joint compartment (Smallest) and a very large jaw with loose ligamentous attachment (largest)


Jaw is opened and moved directly forward in protrusion mandibular arch bears forward relation of 1-2 mm to 1its centric relation with maxillary arch

Labio incisal areas of incisal ridges of mandibular incisors come in contact with the linguo incisal areas of incisal portions of maxillary incisors. Mesio labial portion of mesial cusp ridge of mandibular canine should be in contact with maxillary lateral incisors distolinguoincisally.

Teeth glide over each other in retrusive movement of mandible- - terminating in centric occlusion. Incisal ridges mandibleof lower incisors are in continuous contact with linguo incisal thirds of maxillary incisors return to centric Occlusion


Maxillary canines may assist distal cusp ridges in contact with mesial cusp of mandibular first premolar. Cooperation with incisors come together in a biting manner Canine contact in eccentric occlusion lend final effectiveness to process.


Some Common Terms

Working side : Side where chewing/work occurs. This is the side towards which the mandible moves.  Usually the condyle on this side does not move much.  It rotates on its vertical axis and moves laterally 1-2 mm or less. This is called 1Bennett Movement.


Balancing side : Side away from which the mandible moves.  Upper lingual cusps aligned over lower buccal cusps, usually not in contact.  Here the condyle moves medially, downward and forward 5-12 mm. 5 Any balancing side tooth contacts thought to be destructive to teeth involved and damaging to joint on opposite side.


Lateral Movements

Lateral Movements
Mandible moved to right/left side and slightly downward.  Eg. If mandible moves to the right (WS)  Right condyle relatively stationary  Left condyle and disc move forward, downward and inward within the articular fossa. This is called the orbiting/balancing side condyle.


Avg max lateral excursion for men and women - - 8.1 mm (both sides 16.2 mm laterally)  Thus mandible can move almost twice as far sideways as it can directly forwards.


Occlusal Stability
Refers to tendency of teeth, jaws, joints and muscles to remain in an optimal functional state  Mechanisms involved in achieving it ::  Mesial migration of teeth  Eruption of teeth to compensate for occlusal wear or intrusion by occlusal forces  Remodeling of bone protective reflexes  Control of occlusal forces  Reparative process


Anterior Guidance
Anterior tooth functions which separate the posterior teeth during eccentric motions of the jaw.  Lower anterior teeth track downwards from their area of centric contact towards incisal edges of maxillary teeth while discluding the non functional posterior teeth.


Condylar guidance has its greatest influence on discluding the most distal posterior teeth Incisal guidance provides discluding effect on the more mesial teeth.

  

Importance . Condylar guidance is a fixed anatomic factor that cannot be controlled by the dentist . Incisal guidance can be controlled by modifying the form and arrangement of anterior teeth . Physical guidance of restoration should be in harmony with neuromuscular system and neuro behavioural attributes of the patient.

Malocclusion

   

Any misalignment of teeth and/or incorrect relation between the teeth of the two dental arches. The upper teeth keep the cheeks and lips from being bitten and the lower teeth protect the tongue. Most often hereditary. There may be a difference between the size of the upper and lower jaws or between jaw and tooth size, resulting in overcrowding of teeth or in abnormal bite patterns

Causes


 

   

Variations in size or structure of either jaw may affect its shape, as can birth defects such as cleft lip and palate. Other causes of malocclusion include: Childhood habits such as thumb sucking, tongue thrusting, pacifier use beyond age 3, and prolonged use of a bottle Extra teeth, lost teeth, impacted teeth, abnormally shaped teeth Ill-fitting dental fillings, crowns, appliances, retainers, or Illbraces Misalignment of jaw fractures after a severe injury Tumors of the mouth and jaw

 

Severe malocclusions may require orthodontic and surgical treatment (orthognathic surgery) to correct the problem. Correction of malocclusion may reduce risk of tooth decay and help relieve excessive pressure on the TMJ. Orthodontic treatment also used to align for aesthetic reasons. Malocclusions may be coupled with skeletal disharmony of the face, where the relations between the upper and lower jaws are not appropriate.

Symptoms
Abnormal alignment of teeth  Abnormal appearance of the face  Difficulty or discomfort when biting or chewing  Speech difficulties (rare) including lisp  Mouth breathing (breathing through the mouth without closing the lips)


Classification : Classes Of Malocclusion

The father of modern orthodontics, orthodontics, Edward Hartley Angle, created the classifications of malocclusion, based on the placement of the first molars. molars.  Malocclusions are divided mainly into three types:  Class I  Class II and  Class III.


Class I Malocclusion

Most common  The relationship of the first molars is normal.  Upper and lower jaws are in a normal relationship to each other.  Other teeth are crowded, irregularly spaced, or overlapped.


Class II Malocclusion

Called retrognathism or overbite  The lower molars fit the upper molars, but are not in correct position.  Bottom jaw grows into a more backward position than normal. So top teeth to protrude over the bottom teeth.  Excessive protrusion of the upper front teeth commonly called 'buck teeth


Class III Malocclusion

Called prognathism or underbite  Occurs when the lower molars are too far forward and don't fit into the upper molars.  Lower jaw grows into a forward position, protruding out beyond the upper teeth.  Most complicated and difficult type of malocclusion to correct.


THANK YOU

Bibliography
1. 2.

Wheeler s Dental Anatomy, Physiology and Occlusion Dental Anatomy Its Relevance To Dentistry V Ed.