Evolution Occlusion and Occlusal Instruments: Academics
Evolution Occlusion and Occlusal Instruments: Academics
Evolution Occlusion and Occlusal Instruments: Academics
All occlusal concepts are based, in part, on theory, and all theories may have borrowed from the
past. This article reviews the evolution of occlusal concepts to understand how differing theories
interrelate, where they agree, and where each concept contributed to the ongoing understanding
and evolution of occlusion principles. Also, the flexible and practical concept of biologic occlusion is
presented. The philosophy of biologic occlusion is one that functions in health. The goals of biologic
occlusion are also presented.
J Prosthod 2:33-43.Copyright 0 1993by the American College of Prosthodontists.
HEN STUDYING modern concepts of occlu- concept of bilatcral balanccd occlusion3 and devcl-
sion, one should consider how curreni princi- oped an articulator that applied his 4-inch triangular
ples evolved (Fig 1). Because modern schools of theory.4 In 1866 Balkwill discovered that during
occlusion may vary, acccptance or rejection of princi- lateral jaw movement, the translating condyle moved
ples tends to be based on: (1) past training (dental medially." In 1890 the German anatomist Von Spee
school), (2) personality of the authority presenting observed that the occlusal plane of the teeth followed
the theory, (3) the latest fad, (4)ease in technique, a curve in the sagittal plane. Von Spec attempted to
and (5) scientific evidence. All occlusal concepts are describe the relationship between the condylar path
based in part on theory, and all of these theories and this compensating curve, or "curve of Spee," by
borrow in part from the past. This article reviews the stating that the steeper the condylar path (in protru-
evolution of occlusal concepts: not with thc idca of sive), the more pronounced would be the compensat-
criticism of each theory, but with attempt to evaluate ing We know today that this relationship is
these theories, their interrclationships, where they not necessarily true; however, from the concepts of
agree, and where each concept contribuied to our these three mcn came thc age of occlusal theory and
ongoing understanding of occlusion. occlusal articulators. Literally hundreds of articula-
tors came and went in the early 1900~.',~
Early Concepts
The first mechanical articulator was invented by J.B. Age of Occlusal Theories and
Gariot in 1805.',*It was a plain line instrument and it Occlusal Articulators
is still in use today (Fig 2). In 1858 Bonwill dcscribed
his triangular thcory whereby he postulated that the In 1899 Snow devised a method for transfcrring
distance from the incisal edges of the lower incisors articulated casts to the articulator with a face bow.'
to each condyle is 4 inches, and the distance between In 1901 Christensen observed the opening of the
the condyles is 4 inches (Fig 3). Honwill proposed a posterior teeth in mandibular protrusion (Christen-
sen phenomenon) .9Jo Christensen thcn devclopcd a
technique for registering the degree of posterior
*ilrsoriate Ciiniral Prufissor, Department of Fixed A-octhodorrtics,
School ofDentisty, lIniversi@~Coloradu,Dmzer, GO. separation and an articulator with adjustable condyle
TAssociatePr&w and Intm.m Chairman, Dejmrlment of Prnsthodon- controls. This was still a lwo-dimensional instru-
tics, Unznluerrigqf Texas Health Science Center at Sari Antonio, TX. ment, but an cvolutionary improvement over the
Address repnril teguestJ tu Dauid A. Kaiser. DDS, MSD, Dioirion of Gariot instrument. In 1908 Bennctt described the
Pmthodontir Dmtisty, Unioenity o j Texas Health Scimce Center ot Son
immediate side shift (Bennett tnovernent)." The
Antonio Dental School, 7703 Floyd Curl Dr, San ilntonio, TX 78284-
7890. origin for the introduction of the incisal pin to
Cofyright 01993 by the A w n c a n College oJFrodhodontirts articulators is uncleare; howcvcr, the first published
I0.59-981XJ 931O201-00O78.iOOj 0 article where an incisal pin is dcmonstrated was
Evolution of Occlusion
Gariot 1805
Snow 1806
Gysi 1910
Balkwill 1866
c M Y I I'IWIWIYJUIY
GNATHOLOGY
McCollum
P. M. S. SYSTEM Lauritren
Stallard
Sluart
Lucia
Thomas
Granger
3
Guichet
TR ANSOGRAPHICS
Dawson I ~
J
Page 1951
1PERIODONTAL PROSTHESIS I
x 1
Amsterdam
Prichard CRANIAL ORTHOPEDICS
Yuodelis
Lindhe Harold Gelb
Eversaul
BIOLOGIC OCCLUSION
t
Figure 1. Diagrammatic reprrsrntation o f the evolution of occlusion.
Pleasur e
Curve
Figure 11. A suspension instrument was originally used
Figure 10. Diagram of the Pleasure curve as proposed by thc Pankey-Mann-Schuyler system of occlusion. Note
byh1.A. Pleasure in 1937. this instrument is basically a plain line instrument.
38 Occlusion and Occlusal Instruments Beckerand Kairpr
increased disclusion rather than laboriously making unanswered questions it raised, such as: ( 1 ) are
the instrument follow the lines of the p a ~ i t o g r a p h . ~ ~ condylar axes collinear or asymmetrical?, (2) is imme-
diate side shift normal function or the result of
pathology?, and (3) should occlusal instruments be
Tmnsographics
expected to reproduce jaw movement? The diminish-
During the 1950s, the engineer Page contended that ing popularity of Transo<graphicsis apparently due
each mandibular condyle has its OWTI axis of rotation more to its awkward instrument, lack of technical
and that these axes are not c o I l i n ~ a r $as ~ ~was
~~ progress, and the passing of its chief spokesman
postulated by gnathologic theory. Page then devel- rather than hard scientific rebuttal from academic
oped an occlusal theory, which was called Transograph- research.
ki, and an occlusal instrument, the Transograph (Fig
14). This was dcsigned to allow for independent
three-dimensional condylar movement.9 Transo-
Cranial Ch-thupedics
graphic theory questioned the need to record the
total envelope of motion (pantographing) and in- The most visible proponent of the concept of cranial
stead advocated using wax rcgistrations to rccord a orthopedics (also called oral orthopedics) is Gelb.5-53
much smaller functional area within the envelope of The basic concept centers around the belief that the
motion, which Page termed the functional envelope. movement of the mandible is not influenced by the
Page felt that the occlusal form of posterior teethwas shape ofthe condyles, but the condyles may assume a
determined by the asymmetrical condylar axis, the certain shape because the mandible has assumed
functional envelope, and thc angle of thc mandible. certain movements. Cranial orthopedics is interested
Transographics lost favor as a widely accepted occlu- in establishing postural relationships of the jaws.
sal theory after Page died, but his theories did bring Occlusion is secondary to obtaining optimal postiiral
renewed interest in research to prove or disprove the relations of the mandible to the maxilla. The proper
existence of collinear condylar axes. Preston, in relationship of the head on the spine is essential for
reviewing this subject, states the following: proper total body posture and balance. Thus, an
Past experiments have been use@, but none haae proven or improper jaw relationship will mean impaired pos-
dirpoaen the presence qf collineur a7 noncollinear condylar ture and balan~e.5~
arcs. On& the arc of the ri,,id clutch and its arsonated Geometry is the primary basis for achieving pos-
mechanirm is h a t e d . Such an a[$arent arc m q re5ultjum tural balance, and like Halll8,lgin the 1920s, geome-
the resolution ojcompund condylar rnouements.j0 try is used to justify the theoretical and therapeutic
treatment recommendations. Extensive planes of
The value of the Transographic theory lies in the
orientation are drawn on unniounted casts of the
maxilla and the mandible. Four classes of malocelu-
sion are possible based on these planes of orienta-
tion? Class A correct occlusion; Class B: structural
malocclusion; Class C: functional malocclusion;Class
D: structuro-ftmctional malocclusion.
The recommended therapy (usually splint ther-
apy, orthodontic movement, and/or reconstructive
dentistry) is based on what is necessary to realign
these planes of orientation into more favorable rela-
tionships.
The primary appeal to cranial orthopedics lies in
the realization that the temporomandibular joint
has an adaptable remodeling capacity that has been
overlooked by- the static relationship concepts tradi-
tionally espoused by the other modern schools of
occlusion. The apparent universal lack of enthusiasm
by the dental community for the teachings of cranial
orthopedists can be traced to its reliance on unscien-
Figure 14. The Transograph articulator. tific geometrical justification.
40 Occlusion and Occlwal Instruments Becker and Kairer
Mandibular Centricity (Centric Relation) position, and terminal hinge position added con-
fusion. Even the different disciplines within dentistry
With the exception of cranial orthopedics, nearly all
could not agree on the definition of centric relation.
concepts of occlusion have embraced the practice of
Goldman and Cohen defined centric relation as the
mandibular centricity, which early writers loosely
most posterior relation of the mandible to the max-
referred to as centric relation (CR) but rarely de-
illa from which lateral movements can be made.61
fined this jaw position. Hanau, in 1929, defined
Glickman stated ccntric relation is the most re-
centric relation as the position of the mandible in
truded position to which the mandible can be carried
which the condylar heads are resting upon the
by the patients musculat~ire.~~ Graber refused to bc
menisci in the sockets of the glenoid fossae, regard-
drawin into the controversy, stating only that the
less of the opening of the jaws, and he also states
position must be the unstrained, neutral position of
that the relation is either strained or unstrained.
Hanau preferred the unstrained centric relation the mandible.. .63 Schluger, Yuodelis, and Page
associated with an accepted opening for the refer- stated that centric relation is the position assumed
ence j a w r e l a t i ~ n ?Niswonger,
~ in 1934, described CR by the mandible relative to the maxilla when the
as a position where the patient can clinch the back condyles are in their rearmost, midmost position in
teeth.j5 Schuyler, in 1935, defined the centro- the glenoid fossae.li4This definition is very close to
maxillomandibular position or centric position as the gnathologic RUM definition as proposed by
when the upper lingual cusps are resting in the McCollum and Stuart, where the condyles are in
central fossae of the opposing lower bicuspids and their rearmost, uppermost, and midmost position
molars.. . .5G Thompson, in 1946, lamented the lack in their respective f o ~ s a eIn
. ~an
~ effort to standardize
of knowledge upon which clinical procedures were this and other commonly used terms, the Academy
based by stating . . . some believe that, in centric of Prosthodontics (formerly the Academy of Denture
relation, the condyles are in the most retruded Prosthetics) has published the Glossay $Prosthodontic
position in their fossae, while others maintain they Terms.This glossary is updated periodically and has
are five editions since the first in 1956. Every time there
The earl,: writers rarely if ever advocated manual is an update, the definition of centric relation changes.
manipulation of the mandible to achieve their centric Avant, in 1971, decried the seven definitions of
jaw registration. Needles, in 1923, used an intraoral centric relation appearing in the 2nd edition of
arrow point tracer in which the patient retruded the 196flb6 Schluger, Yuodelis, and Page confessed that
mandible to its fullest extent.58 Schuyler, in 1932, the word centric may bc the most controversial
advised using wax interocclusal records and the term in dentistry, not only from a semantic point of
patient may be requested to place the tip of the view but also due to differences in concept, and they
tongue Far back on the palate and to hold it there admit that these serious differences in concept may
while closing. It is quite impossiblc for one to pro- never be resolved.@The newest edition (1987) of
trude the mandible when this position of the tongue the Glossa91 ?f Prosthodontics Term defines centric
is retained.59 Meyer, using the functionally gener- relation as A maxillomandibular relationship in
ated path Lechnique, did not attempt to manipulate which the condyles articulate with the thinnest avas-
the mandible other than to instruct the patient cular portion oftheir respective disks with the com-
occasionally in getting started by exerting a little plex in the anterior-superior position against the
pressure on the chin.*q Mandibular nianipulation slopes of the articular eminesces. The authors of
grew in acceptance with the increased interest in this 5th edition of the Glo.~say$Prosthodontic T m
gnathologic philosophy, and writers began to warn of state This term (CR) is in transition to obsoles-
strain to the condyles. Robinson, in 1951, stated that ~ e n c e . ~Wishful
thinking, or admission that the
the rnandible can be retruded beyond what we more we attempt to define this important concept of
should consider centric into a strained retruded clinical dentistry, the more confusing it becomes?
position.jo The current definition of CR is considerably different
As the debate of how to define the centric jaw from the definitions used by Hanau, Niswonger,
position escalated, new terms began to appear in Schuyler, and the other early giants of dentistry.
the literature. Terms like posterior border closure; These clinical dentists recorded centric relation differ-
relaxed closure, bracing position, hinge ently than is commonly done today, but the concept
position, ligamentous position, retruded contact of mandibular centricity remains constant even
March I993>Volume 2, Number I 41
though the definition and the tcchniques have evolved ing contacts in natural dentitions have the potential
and probably will continue to evolve. of being very destructive. The criteria requires that
disclusion occurs as thc mandible moves laterally.
Because the mandible can flex68.6qand the articulator
Biological Occlusion does not (except for the Transograph), the amount
There is ample reason to believe that many success- of disclusion needed can vary and must be tested in
ful long-term clinical treatments have bcen accom- the mouth for each individual patient.
plished using each of the modern schools of occlu-
sion. Because dentitions can be maintained
Cusp-to-FossaOcclusal Scheme
successfullywith several apparently conflicting occlu-
sal conccpts, there is a growing realization that While cusp tips can function effectively against mar-
occlusal concepts are not as cut and dried as we ginal ridges, a cusp-fossa relationship is potentially
once thought. The flexible concept of occlusion is more stable than any other relationship.
termed biological occlusion, and its philosophical
goal is to achieve an occlusion that functions and
maintains health. This occlusion may include malp- A Minimum of One Contactper Tooth
posed teeth, evidence of wear, missing teeth, and It is preferred that every vertical dimension cusp
centric occlusion may not always equal centric rela- (buccal of the lower and lingual of the upper) be in
tion. The dominant factor is that this occlusion has full contact with the opposing fossa. However, there
shown its ability to survive, thus implying an age are times when this is not practical, thus as a bare
factor, ie, a teenager with temporomandibular joint minimum one should have at least one cusp-to-fossa
symptoms does not fit this occlusal concept, while an contact for each posterior tooth. If this is not achieved,
asymptomatic 80-year-old with balancing side con- the noncontacting tooth has the potential of erupting
tacts does. One who fits this concept needs no and shifting into a malposition, producing a balanc-
occlusal therapy. However, when occlusal therapy is ing interference. The potential for a contacting tooth
indicated (ie, mutilated dentition, occlusal trauma- to shift into malposition is diminished if the vertical
tism, temporomandibular joint dysfunction), then dimension cusps are engaging opposing fossas.
basic guidelines for occlusal design are needed. These
goals are compatible with almost all of the occlusal
concepts commonly used today for natural dentitions Cuspid Rise or Group Function
including P.M.S., Gnathology, and Transographics.
In order to assure that there are no balancing
contacts, the working side must disclude the poste-
Goals of Biological Occlusion rior teeth on the balancing side during lateral ecccn-
tric jaw movements. It is equally acceptable to
No Intet$mnces Between Centric Occlusion achieve this disclusion with a cuspid rise or group
and Centric Relation [unction where the cuspid and/or bicuspids engage
Very few patients naturally function in centric rela- in lateral motion to disclude the balancing side
tion occlusion; however, centric relation is a very occlusion. Also acceptable is a combination of cuspid
valuable position in restorative dentistry. To demand rise and group function.
that the condyles be in their hinge position when the
teeth are in the maximum intercuspal position and
to stay that way for long periods of time is unreason-
No Posterior Contacts With Protrusive Jaw
able. It is not unreasonable to assure that there are
Movements
no cuspal interferences between centric relation As the mandible slides forward from the maximum
(CR) and centric occlusion (CO), CR and CO as intercuspal position, the anterior teeth should en-
defined by the Glossay ofProsthodontic Terms, 1987.3 gage and progressively disclude the posterior teeth.
33. Schuyler C: Factors of occlusion applicable to restorative 52. GelbH Evaluation ofstaticccntric rclation in the temproman-
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