Okeson CH 5 & 6
Okeson CH 5 & 6
Okeson CH 5 & 6
Functional Occlusion
95
-
.,.".
96 Functional Allatollllj
inate th
OPTIMUM ORTHOPEDICALLY
STABLE JOINT POSITION
CR.ITERIAFOR1HE .9PTlMUM
FUNCTIONAl··OCClUSION
The ten" celltric rt'latioll [CRI been used
dentistry for many years ever the year: 'H,mr"'"
As discussed, the system IS an l'ad a of definitions.
interrelated system of considered to designate the
bones. I ~eeth and nerves To ~andibie when the
si a discussion of th system difficult stable Ij~~~~i!Rlm"k'
necessary oefore the basic concepts that influence CR as the most retruded
the function and health of al the components can Because this is
beJ nderstood. the I men~s of the
The mandible bone that is at:ached to the . It
skull and It' a muscular
sl irg When the elevator muscles I the masseter. the const;
the medial otemwid, and the temnoral I func tior of CO~ dentures l\t the time it
lion, their contraction raises the considered the most reliable reference pc
that contact is made and torce the obtainable ~n an edentu:Clus natient for accurat
skull in three areas: the two recoraing the oetween the mand:
IIMls) and the teeth I and maxilia and u for contro
(Ptl:H:I',
these muscles have the pabil usa I contact pattern
The popula of CR grew and carried over Positional stabll of the jomt however, is not
into the field of fixed useful determined the articular disc
ness in fixed nt stabi is determined
both its ity and ~esearch muscles that pull the loint and prevent dis
studies associated with muscle function location the articular surfaces The directional
Conclusions from tne Ic 'mum
iE\1G) studies that the muscles of mas
tication function more harmon and with less
when the in C!;: at the time Muscles stabilize joints Therefore each mobile
:hat the teeth are in maximum i nthasa stobielMSI
dental I)' When pursuing most stable
that CR 'Hvlls, the muscles that Dull across the nts must
.'.as a sound More ~ecent be considered The ma muscles that stabil
~r~derstandjng of the biomechanics and ~unction the P,Als are the elevators. The direction the
-: the TM] however, has questioned the retruded on the
ly
t he tern pora I m usc!es have fi bers that
confusing are oriented nevertheless pre,
::-:rcause the definition dom in a
superior These three rruscle groups
ble for joint and
however, the inferior lateral
--:r in tneir most a make contribution
: ~sae Some clinicians' that none of In the postural without any influence
: - -:rse definitions of CR from the occlusal condition, the are sta
ton and that the bilized muscle tonus of the elevators and the
tioned downward and for'ward on the articular inferior :ateral Dter\20ids The temperal muscles
~:ences. The ng the most
0' the wil continue
- conclusive evidence exists tha: one
than the others
ertheless. in the midst of this controversy
. sts must needed treatment for thei r
::'lts The use stable,
-:~cential to treatment. Therefore:t necessary
·c,mine and evaluate all available mfmmation
to draw intel conclusions on \\-hich
treatment.
establishing the criteria for the optimum
stable joint the anatomic
:: J of the TM) must be exarm ned
described. the articular is
dense fibrous connective tssue de\'Oid
and blood vessels" This ailows it wii'l
~eavy forces without damage or the induce
nful stimuli The purpose disc Fig. 5-2 The directional force of che primary elevator
--:c;ate. protect and stabilize ,he In muscles (temporalis o masseter, and medial pterygoid) is to
lar during functional movements seat the condyles in the fossae in a superoanterior posicion,
-
98 Functional Anatoll1Y
position the condyles superiorly in the fossae. The superoanterior is far more orthopedically
masseters and medial pterygoids the acceptable
superoanteriorly. Tonus in the inferior The controversy arises as to whether there an
lateral pterygoids the condyles anteroposterior range in the most superior
against the slopes of the articular tion of the condyle Dawson l6 that there
eminences. not. which that if the condyles move
By way of summary then, the most orthopedi either anteriorly or posteriorly from the most supe
cally stable joint as dictated bv the rior position, they will also move inferiorly This
muscles is when the are located in their may be accurate in the young, healthy but
most superoanterior in the articular fos one must realize that not all joints are the same
sae, fully seated and resting against the posterior Posterior force applied to the mandible is resisted
slopes of the articular eminences. This description in the joint the inner horizontal fibers of the
is not however, until the position of the temporomandibular (TM) I
articular discs is considered. rela superoposterior of the is there
tionship is achieved only when the articular discs fore, by definition. a ligamentous position If this
are interposed between the and ligament is tight, little difference may exist among
the articular fossae The of the discs in the the most superior retruded position, the most
joints is influenced by the interart:cular position (ie Dawsons ), and the
pressures, the morphology of the discs them superoanterior (MS) position However, if the Tl\l
selves, and the tonus in the lateral ptery ligament is loose or elongated an anteroposterior
goid muscles. This last causes the discs to be range of movement can occur while the
rotated on the condyles as far forward as the discal remains in its most position
spaces (determined by interarticular pressure) and The more posterior the force placed on the
the thickness of the border of the discs mandible, the more of the
will allow will occur and the more posterior will be the
The complete definition of the most orthopedi condylar . The degree of anteroposterio~
cally stable position therefore is when the
condyles are in their most superoanterior
in the articular fossae. against the
of the articular with the discs properly inter-
The assume this position when
the elevator muscles are activated with no occlusal
,f
\~
age When a dried skull is examined, the anterior
and superior roof of the mandibular fossa can be
seen to be quite thick and able to
withstand loading forces. \
ing rest and function, this is both anatom
Fig.5.3 The most superoanterior position of the condy e
ically and physiologically sound.
(solid line) is musculoskeletally the most stable positic
The MS position is now described in the Glossary of the joint. However, if the inner horizontal fibers of [C~
of Prostnodontic Terms as CR 2i earlier defi
nitions 9ll of CR emphasized the most retruded
temporomandibular ligament allow for some posteric
movement of the condyle, posterior force will displace tr t
position of the condyles, most clinicians have
come to appreciate that seati ng the condvle in the
mandible from this to a more posterior, less stable positic
(dotted line).The two positions are at the same superior leve
,, ,'.~ -,1!"
Criteria for Optimum FUl1ctiOflal Occ/usioll 99
3nd the elevator muscles contract. the condyles of reproducible, Because the
!.dl be seated superiorly. leaving only posterior condyles are in a superior border position, a repeat
:eeth to occlude. The only way the occlusal posi able terminal movement can be executed
.. on can be maintained is to maintain the inferior (see Chapter
3~eral pterygoid muscles in a partial state of con
--action bracing the condyles the posterior
OPTIMUM FUNCTIONAL TOOTH
of the articular eminences. This, of course.
CONTACTS
'e::lresents a "muscle-braced" position and not an
','5 as previously discussed. just described has been consid
-"nother consideration in a desirable ered in relation to the infl factors of
~. :;'ldibular position by pulsing the elevator mus the joint and muscies. As previously discussed. the
• e3 is that this position is almost always found to occlusal contact pattern influences the
an increased vertical dimension. The highest muscular control of mandibular When
that can be by the elevator mus closure of the mandible in the MS position creates
:5 at 4 to 6 mm of tooth separation 32 It is at an unstable occlusal condition, the neuromuscular
=iistance that the elevator muscles are most system quickly feeds back muscle
c': =2nt in breaking through food substances, action to locate a mandibular position that will
the teeth into maximum intercuspation at result in a more stable occlusal condition. Therefore
.ertical dimension would cause a great the MS of the joints can be maintained
--:::se of forces to the teeth and periodontal when it is in harmony with a stable occlusal
. _::Jres, increasing the for breakdown. condition. The stable occlusal condition should
~ :~.ird consideration in using this technique is allow for effective functioning while minimizing
~: : ~~ce the muscles are relaxed, the mandibular to any components of the masticatory
can be greatly
influenced by system The clinician should remember that the
:·re the patient's head
musculature is capable of much greater
::::uired maxillary/mandibular
force to the teeth than is necessary for function
=~:ent moves his or her head forward or back Thus it is important to establish an occlusal condi
~ ~- tilts it to the right or left, the mandibular tion that can heavy forces with a minimal
: : :- will change It would not appear likelihood of and at the same time be
,ype of variation is reliable when restoring effici en t.
The optimum occlusal condition can be deter
:- er concern with this is that basi mined by the following situations
_::::.- individual. whether healthy or with a I. A patient has only the right maxil and
:: ~.ar disorder, will assume an open and for mandibular first molars present. As the mouth
==~tion of the mandible following muscle these two teeth provide the only occlusal
Therefore this technique is not helpful for the mandible (Fig. 5-6) Assuming that
patients from normal healthy 40 Ib of force is applied d function. it can
·.'.'hen this occurs, individuals be seen that all this force will be applied to
considered for unnecessary therapy, these two teeth. Because contact is only on the
_. ~',,' 8e quite extensive, right the mandibular position will be
'., -'ary, from an anatomic standpoint one unstable and the forces of occlusion provided
-' ,je that the most superior and anterior by the musculature will likely cause an over
the condyles resting on ~he discs closure on the left side and a shift in the
slopes of the articular em mandibular position to that side This con·
most orthopedically sound position dition does not the mandibular stabil
3:e standpoint it also appears that this ity necessary to function effectively
- of the condyles is mal, An addi instability) If forces are applied to ~he
.-: is that it also has the teeth and ioints in this situation breakdown to
"~
102 Functional AnatomlJ
...""""
~
104 Functional Allatomy
J.
A B
Fig. 5-12 Axial loading can be accomplished by (A) cusp tip-to-flat surface contacts or (B)
reciprocal incline contacts (called tripodization).
Criteria for OptimullI FUllctiollal Oce/usion 105
Amount of Force Placed on the Teeth it is closer the fulcrum to increase the
The criteria for um occlL:sion have now been likelihood of its cracked This demonstrates
First. even and simultaneous contact of that greater forces can be to an oblect as
teeth shoL:ld occur when the mandibu its nears the fulcrum The same can be
said of the 5-1 '31 If a hard
nct is to be cracked between the teeth, the mcst
inences desirable is not between the anterior
::econd, each tooth should contact in such teeth but between the teeth, beca use as
:or that the forces of closure are directed the nut is closer to the fulcrum (the
-~e
TMII and the area of the force vectors (tne mas
aspect that has been left undis seter and medial muscles), greater force
~3sed relates to the of the TMI The can be ied to the Dosterior than to the anterior
-'.:1 permits lateral and excursions, teeth ..)(,-;'
-ch allow the teetn to contact during different The however, more Whereas the
of eccentric movements. These lateral excur fulcrum of the nutcracker is
1S allow horizontal forces to be to the system is free to move. As a when
-22-C; As alreadv stated, horizontal forces are not forces are to an on the poste
the su structures and tne rior teeth the mandible ;s of
-"_:omuscular system, yet the of the downward and forward obtam the occlusal rela
.-~ requires that SOr,le teeth bear the burden of that wiil best the desired task
-:oe forces, Thus several factors This snifting of the
0- be considered wnen identifying which tooth mandibular Additional r,luscle groups
- -2eth can best accept these horizon:al forces such as the inferior and lateral pterygo
--e lever system of the mandible can be com and the temporals are then called on to stabil
with a nutcracker When a nut is being the fT~andib!e resulti in a more com
':':- ed it is between the levers of tile nut than that of a nutcracker.
:'.2r and force is aPDlied It it is extremelv hard th concept and realizing that
A B
I
Fig. 5·13 The amount of force that can be generated between the teeth depends on the
distance from the temporomandibular joint and the muscle force vectors. Much more force
can be generated on the posterior teeth (A) than on the anterior teeth (B).
~
106 Fundional Anatomy
fewer muscles are active when canines contact during laterotrusive movements than are :.....::::r.i.::
during eccentric movements than when posterior cusp-to-lingual cusp contacts (lingual to
teeth contact. 5556 Lower levels of muscular working) ( 5-16, Aj ir~
would decrease forces to the dental and joint The laterotrusive contacts Ieither canine gu i I. cc,··",,"
structures, minimizing pathosis, Therefore when ance or group function] need to provide adequa-c.
the mandible is moved in a right or left laterotru guidance to disocclude the teeth on the :'J ~:lil~::.::;;rJ
sive excursion. the maxillary and mandibular side of the arch lmediotrusive or nonworking sic"
canines are appropriate teeth to contact and dissi immediately I Fig 5-\6. B) Mediotrusive contac
pate the horizontal forces while disoccluding or
disarticulating the posterior teeth. When this con
dition exists. the patient is said to have canifle 9l1id
ance or canine rise ( 5-14).
Many patients' canines, however. are not in the
proper position to accept the horizontal forces
other teeth must contact during eccentric move A
ments. The most favorable alternative to canine
guidance is called group fltftction In group function.
several teeth on the working side contact during
the laterotrusive movement. The most desirable
group function consists of the canine, premolars,
and sometimes the mesiobuccal cusp of the first
molar (Fig. 5-15) Any laterotrusive contacts more
posterior than the mesial portion of the first molar B
are not desirable because of the increased amount
of force that can be created as the contact gets
closer to the fulcrum (TM])
The clinician should remember that the buccal Fig. 5-15 GROUP FUNCTION GUIDANCE
cusp-to-buccal cusp contacts are more desirable A, Laterotrusive movement. B, Clinical appearance.
B
A L
13 47.52.57.58 I 47 52 57. 58
108 Functional Anatomy
~ontact sl more than anterior teeth On the basis of the concepts presented in th'
.. hen the teeth are occluded in the lCP This condi a summary of the most favorable func
~ion is described as mutlwlly vratected accilJsion. tional occlusal conditions can be derived The fc'
lowing conditions appear to be the least pathogen:
Postural Considerations and Functional for the greatest number of patients over tr 11'1,
~~:e articular eminences with the discs properly 1.5. Posselt ll: of ('cciusion and re/t,liJiiit,l1ion,
~terposed In this position there is even and Philadelphia, 1968, FA Davis, p 60.
;:::multaneous contact of all posterior teeth. The 16. Dawson Pl.: El'aluation, diagnosis and treatment of occlusal
~.terior teeth also contact but more lightly problems, St Louis, 1989. \1osby, pp 28·34.
17. Jankelson B, Swain CW: Physiological aspects of mastica
~:' an the posterior teeth.
torv muscle stimulation: the myomonitor, Quime5sence lilt
. I tooth contacts provide axial loading of 3:57-62. 1972,
=:clusal forces 18, Gelb H: Clinical management of IWild, ned? and T\1J paill and
'..:",en the mandible moves into laterotrusive Philadelphia, 1977, Saunders
:: ~sitions, adequate tooth-guided contacts on 19. DuBml EL: Sieller's oral anatomy, St Louis, 1980, Mosby,
P 178.
::: laterotrusive (working) side are present to
20. Moffet BC: Articular remodeling in the adult human
:::3occlude the mediotrusive (nonworking) side temporomandibular joint, Am) Anilt 115:119-127,1969,
The most desirable guidance is 21. Van B1arcom CW, Campbell SD, Carr AB et al: The glossary
: -'·.ided by the canines (canine guidance), of prostltodontic terms, ed 7. St Louis, 1999, ,\-losb", P 58.
en the mandible moves into a protrusive 22. Wu CZ. Chou SL. Ash MM: Centric discrepancy associated
with TM disorders in young adults, J Delli Res 69:.'\34-337,
, ~ sition, adequate tooth-guided contacts on
1990.
anterior teeth are present to disocclude all 23. DuBml EL: Sieher'" ora! anatom,o St Louis, 1980, Mosby.
: ~~erior teeth immediately 24. lankelson B, Adib F: Effect of variation in manipulation
,:-:e upright head position and alert feeding force on the repetitiveness of centric relations registration:
_ : sc:or., posterior tooth contacts are heavier a computer-based study, I Am Dent Assae 113:59-62, 1987,
25, Isberg A, Isacsson G: Tissue reactions associated with
-- - anterior tooth contacts,
internal derangement of the temporomandibular joint.
A radiographic, crvomorphologic, and histologic study,
Acta Odontol Scand 44:160-164,1986,
_____________________
;'t':-tnces ~~_.M
26. Farrar WB, McCarty WL: A clinical outline of temporo
mandibular joint diagno:;is llnd treatment, Momgomerv, /\Ia,
1983, r-;ormandie Publications,
-,;·:.15 illustrated medical dictionary, ed 30, Philadelphia, 27, Dolwick MF: Diagnosis and etiology of mtemal demngemenfS
~ Saunders, p 1298. of the temp(lromandibular joint: Presitieni's COIlFerence on tile
'_' ~ ~ HI: Classification of malocclusion, Dem Cosmos Examination, Diagnosis, <lnd ;\janagement of 'Dyj Disorder"
_. ~~::',-264, 1899, Chicago, 1983. American Dental Association, pp 112-117.
:-,'~; \'1-/: Balanced occlusions, J :1m Dent Assoc 12: 28. Stegenga B, de Bont lG, Boering G: Osteoarthrosis as the
: .. 33, 1925. cause of naniomandibular pain and dysfunction: a unif)'
_~,;: IL: Physiologic occlusion, J Am Dent Assoc 13: ing concept, J Oral A,jaxillofilc Surg 47:249-256, 1989.
:,v)3, 1926. 29. '\1amyama T, r-;ishio K. Kotani :VI, Miyauchi S, Kuroda T:
~~ FS: Cast bridgework in functional occlusion. J Am The effect of changing the maxillomandibular relationship
~_','lY 20:1015·1019.1933 by a bite plane on the habitual mandibular opening and
'.,c:r C: Correction of occlusion: disharmony of the closing movement, J Oral Rehabil 11 :455·465, 1984,
.~"; dentition. N Y Dent J 13:455-463. 1947, 30. Rugh ID, Drago C): Vertical dimension: a study of clinical
H. Stuart C: Concepts of occlusion, Dent Clin rest position and jaw muscle activity. I Prosthet Dent
~'n "iovember:591-601, 1963. 45 :670-675, 1981.
- -- ,'rd SP, Ash MM: Occlusion, ed 3, Philadelphia, 1983. 31. Manns A, Zuazola RV, Sirhan mvL Quiroz M, Rocabado .\1:
... :2rs pp 129-136. Relationship between the tonic elevator mandibular activ
_:.'a CO: Current clinical dental terminology, 5t Louis, ity and the vertical dimension during the states of vigilance
: \!osby. and hypnosis, Crania 8: 163-1 70, 1990,
"~.: U Studies in the mobility of the human mandible, 32. Manns A, 1'.1iralles R, Santander It Valdivia J: Influence
. ;.-n[O! Scand lO(Suppl): 19-27, 1952. of the vertical dimension in the treatment of myofascial
::,c CO: Swenson's complete den tH res, St Louis, 1970, pain-dysfunction syndrome, J Proslhet Dent 50: 70()-709.
112. 1983 .
. ~d SP: Dysfunctional temporomandibular joint and 33. Gibbs CH, ,>"1ahan PE, Lundeen He. Brehan K: Occlusal
o pain, J Prostltet Dent 11 :353-362, 1961. forces during chewing: influence on biting strength and
-:- ~d S' Bmxism: a clinical and electromyographic food consistency, J Prosrl1er Dem 46:561-567, 198:,
\m Dent AsSN 62:21-28, 19G1. 3 .. , Bates IF: l\IasticatOlY function-a review of the liter.llure. IL
" Int1uence of occlusal patterns on movement of the Speed of movements of the mandible. rate of and
- :.c'c J Prostltet Dem 12:255-261, 1962 forces developed in chewing. J Oral Rehal>i12:24'l-256. 1
II
Determinants of Occlusal
Morphology
n health the occlusal anatomy of the teeth func As the condyle moves out of the centric relation
III
I "111_ _- -
I 12 FUilctiolwl Ana/omy
.'
Fig. 6-1 Horizontal reference plane (HRP) of the mandible at both the posterior (PCF)
and the anterior (ACF) controlling factor. The mandible moves horizontally four units from a
position marked by the dotted line. No vertical movement occurs. The solid line represents
the position of the mandible after the movement has taken place.
the ACF the more its movement wiil one that 259c closer to the ACF than to the PCF
.~ 57 (because of the greater :nflu will move away from horizontal at an of
.-\CF on its movement I. A 54 (one fourth of the way between 57 a:'d
the factors will move a'way from 45 i
of To examine the influence of any anatomic varia
tion on the movement pattern of the mandible.
114 FUI1cti011lli Al1alolH!J
x y
" _R;~"do""wacd
~
•••••••••••••••• ' \ } •••••••••••••••• ~ •••••••••••• - . I I
_~r' 54' ==' I
_ necessary to control all factors except the one distance it extends into the depth of an
ng examined Remember that the fossa are determined three factors
the anterior and guidances lies in how I. The ACF of mandibular movement (ie anter,:'
,ill,
;nfl uence tooth Because the guidance)
. cclusal surface can be affected in two manners 2. The PCF of mandibular movement (i.e,
and width\. it is to separate the guidance)
~~ructural influence on mandibular movement into 3. The nearness of the cusp to these control:,
that influence the vertical components and factors
that influence the horizontal components The centric cusps are de\
anatomy of the occlusal surface is also influ to disocclude eccentric mandibu
ced by its relationship with the tooth that movements but to contact in the intercuspal pc<
:asses across it during movement. Therefore the tion. For this to occur, they must be enoug~ ,
. cation of the tooth to the center of rotation is contact in the i position but not so Ie .
discussed. that thev contact dunng eccentric movements
""'"
t
EFFECT OF CONDYLAR GUIDANCE
VERTICAL DETERMINANTS
(ANGLE OF THE EMINENCE) ON
OF OCCLUSAL MORPHOLOGY
CUSP HEIGHT
=actors that influence the of cusps and the As the mandible is protruded, the desce:'
of fossae are the vertical determinants 0: the articular eminence. Its descent in rela~
:::c;usal morphologv. The len2th of a cusp and the to a horizontal reference plane is determined
-
'.""''''1 41311.
I,., :"Uiil;;;MMl,1I11l!f"
'·::"!ii\ft~:.."
~---
j')
A cr
Fig. 6-4 A, The posterior and
anterior controlling factors are
the same, causing the mandible to
move away from the reference
plane at a 45-degree angle. B. For
premolar A to be disoccluded
from premolar B during a protru
sive movement. the cuspal inclines
must be less than 45 degrees,
/'//
/
/
,
I
I
\
\
\
~
,,
\ ' ..... _
A 8
116 Functional Arlalomy
\
\
\
B c
I I
HO
, I
HO
Fig. 6-6 The anterior gUidance angle is altered by variations in the horizontal and vertical
overlap. In A to C the horizontal overlap (HO) varies, whereas the vertical overlap (VO)
remains constant. When the HO increases, the anterior guidance angle decreases. In D to F
the VO varies, whereas the HO remains constant. As VO increases, the anterior guidance
angle increases.
.. .... -,"
15°
60°
-;-
I ----,
evident (45 + 15 = 60 degrees). This
allows for taller and steeper poste
rior cusps.
81 , V'
25°
- PO;
-. •
The of curvature of the curve of Spee to the radius I will have shorter cusps. whereas'
influences the height of the cusps that molars (located mesial) will have cusc:
will function in ,;vith mandibular move 6- 10. B. the radi us forms a 60-degree d :---::::- JF
ment. In Fig. 6-9 the mandible is moving away from ( ..,': ~ . '" S .... !.. T I(
a horizontal reference plane at a 45-degree curve Of more the (, ':.~,:: -E!Ct
Movement away from the maxi teeth more forward with respect to the horizontal p
will vary depending on the curvature of the curve one can see that all the teeth Iprem'
Determinants of Occlusal Morphology I 19
A B
Fig. 6·8 CURVE OF SPEE. A, A longer radius causes a flatter plane of occlusion. B,
A shorter radius causes a more acute plane of occlusion.
~ B
45°
Fig. 6·9 The mandible is moving away from a horizontal reference plane at a 45-degree
angle. The flatter the plane of occlusion (A), the greater will be the angle at which the
mandibular posterior teeth move away from the maxillary posterior teeth and therefore
the taller the cusp can be.The more acute the plane of occlusion (B), the smaller will be the
angle of the mandibular posterior tooth movement and the flatter the teeth can be.
. ·-li
120 FUllaiollal Allatomy
•
" ""
A
~
B
~ c
:
lar to a horizontal reference plane. Posterior teeth located distal to the radius will need
shorter cusps than those located mesial to the radius. B, If the plane of occlusion is rotated
more posteriorly. it can be seen that more posterior teeth will be positioned distal to the
perpendicular from the reference plane and can have shorter cusps. C, If the plane is rotated
more anteriorly. it can be seen that more posterior teeth will be positioned mesial to the
fr
\\, \
,
'I'.'.'"
1\'1,,\1:
1111
Ii
./ ./
Fig.6·12 When there is distance between the medial wall Fig. 6·14 The direction of the lateral translation move
-: 11edial pole of the orbiting condyle and the temporo ment is determined by the direction taken by the rotating
-3ndlbular (TM) ligament allows some movement of the condyle. When the rotating condyle follows pathway I.
-: :3.ting condyle, a lateral translation movement occurs. the central fossa of the teeth will need to be wider than
pathway 2 to disengage the opposing teeth.
1
2
3 -
,./
,./
Fig. 6-15 The greater the lateral translation movement, -'i :- :: 'T
Fig.6·17 The more superior the lateral translation move
the shorter is rhe posterior cusp. Pathway 3 will require
ment of the rotating condyle (I), the shorter the posterior
.....r.-- ::,"'- ,.
shorter cusps chan pathway I.
cusp. The more inferior the lateral translation movemen:
(3), the taller the cusp.
the I'M joint ng rotation The movemen'
occurs within a (or less) cone. the apex
of wh ich is located at the aXIs of rotation ( 6-16)
Therefore in addition lateral movement, the as a determinant of cusp
may also move in (I) a superior is the vertical movement of
( ) an inferior. (3) an anterior, or (4) a a lateral translation mo'. e:
direction. comb:nations of these can
occur. In other words, shifts movement of : c.
and so on re shorter
lateral movement; likewise
lateroinferior movement will p05~
rior cusps than will a straight lateral movement
yi CJ?
~\ ).
.., (
'~Al ;/
\
./
Fig. 6·18 TIMING OF THE LATERAL TRANS· Fig. 6·19 The pathway that the cusp of a tooth follows in
LATION MOVEMENT. /, Immediate lateral transla passing over the opposing tooth is a factor of its distance
: :on movement (immediate side shift): 2, progressive lateral (radius) from the rotating condyle. Mediotrusive pathway
:-~nslation movement (progressive side shift). The more (A) and laterotrusive pathway (B).
-1iediate the lateral translation, the shorter the posterior
:_sp.
EFFEC
ROTAT
THE .\1
~'D G
A B
B
Fig. 6-20 The greater the distance of the tooth from the rotating condyle, the wider the
angle formed by the laterotrusive and mediotrusive pathways. This is true for both mandibu ~,
lar (A) and maxillary (8) teeth. A, Mediotrusive pathway; B, laterotrusive pathway.
Midsagittal Midsagittal y~
plane plane
!1B=-=
~
A B 'I~ =-a::
Fig. 6-21 The greater the distance of the tooth from the midsagittal plane, the wider ::111!11;r:1,9~" <~
the angle formed by the laterotrusive and mediotrusive pathways. This is true for both
(A) mandibular and (8) maxillary teeth. A, Mediotrusive pathway; B, laterotrusive pathway.
... .1 "'-'
Dftennil1allts of Occ/usal MorpflO/oqU 125
t?
EFFECT OF DISTANCE FROM THE
ROTATING CONDYLES AND FROM Midsagittal
THE MIDSAGITTAL PLANE ON RIDGE plane
AND GROOVE DIRECTION
has been demonstrated that a tooths position in
:elation to the rotating condyle and ~he midsagit
:31 plane influences the laterotrusive and medio
:-usive pathways The combination of the two
!J B
-j A~
A
JJ B
Fig. 6-23 As the amount of lateral translation movement increases, the angle between the
(A) mediotrusive and (8) laterotrusive pathways generated by the centric cusp tips increases.
This is true for both mandibular (A) and maxillary (B) teeth. -:-~I
I'_~IZ::' ~
rr
A, B1A1 B·
_._ B2 A2 B2
A2
A3
B3
/ '" Ao
.l!jJ,J
A E
B,
B2
B3
~~
Fig. 6-24 Effect of anterolateral and posterolateral translation movement of the rotating
.!~I,.::&o
condyle. The more anterolateral the movement of the rotating condyle. the smaller the angle
formed by the mediotrusive and laterotrusive pathways (Al and Bl).The more posterolateral the
movement of the rotating condyle. the wider the angle formed by the mediotrusive
and laterotrusive pathways (AI and BI)' This is true for both mandibular (A) and maxillary """"':~2
(8) teeth.
'~-;'Ir'
6-251 The latter factor negates the most often minimai and therefore the leas::
~":illll!JnI~~~,
influence of the former to the extent that the net enced of the determinants.
effect of increasing the distance is to A summary of the vertical and horizontal h, IHji~,'II!Qj:r'
.:
~Al\(-;-V·_A2).
\~i\..:-l\.-~:'~
,\-.~.-Y
' \: i\
\ I \
1\\ 1 \
I
\
\
Fig. 6-25 The greater the intercondylar
distances, the smaller the angle formed by the
\ \ I \ laterotrusive and mediotrusive pathways. The
~ •.. ~ greater the intercondylar distances. the smaller
the angle formed by the laterotrusive and
mediotrusive cusp pathways (AI and 8 1 ), The
smaller the intercondylar distance. the wider
A2
the angle between the laterotrusive and
A,
mediotrusive cusp pathways (A2 and 8 2),
TABLE 6-1
TABLE 6-2.
- ::::~ce from rotating condyle Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
_ ':::-ce from midsagittal plane Greater the distance Wider the angle between laterotrusive and
mediotrusive pathways
_::~-:" translation movement Greater the movement Wider the angle between laterotrusive and
mediotrusive pathways
- =-: ::>ndylar distance Greater the distance Smaller the angle between laterotrusive and
mediotrusive pathways
128 FUllctiorwl Ana/oll1t}
E'
lateral translation movement) This phi
horizontal
that moverrent becomes mere
in articular eminence
editor Complete demure prosthodolllics, New York, 1·'
,\!cGrdw-llilL pp 2J 3-230.
Ricketts R'\I: Variations of the temporornandihular jOiL:
rewaled by cephalometric laminagrarhy, :\m J 0,:'
of
with increase in lateral translationi tr:e 'i
concavities of the maXillary anterior teeth will
:lG:R77-892, 1')50 .
•\nglc IL: ~dctorS in temporom':lIldibular form, Alii I ~:
83.223-234, J ')4S.
If
increase reflect a similar movement characteristic
However, scientific evidence to support a corre
lation betvveen the .ACFs and rCFs IS -...
.
'hlI!!
..."
.,.
.rje
mn'l'
l
Ie
':;"'5:
.;.~
54 FUIICliolllll Anatomy
Tris condition
of Ilal
ttle ng this condition cal
muscles are activated while the elevator muscles 51',151115 r;;ecel:t stud ies however. feli 1
Clre relaxed In the presence of in however ~;le the that m a r e aCil
CNS to resoond differentlv Stohler< has spasms·' ':-hererore this condltic'i
Fundional NeuroanatolHij and Phijsiologij of tile Masticatorij System 55
is more called mLiscle The key to determin whether these symp
This condition can become a diagnostic problem toms are a result of the central effect is
for the clinician because the patient continues to their unilaterality Clinicians should remember
report suffering after the nal source of that central effects do not cross the r:lid
pain has resolved. line in the trigeminal area. Therefore the ciinical
Because muscle pain is an important clin manifestations will be seen only on the side of the
ical problem to understand. the example constant deep pain. In other words. one eye will be
is given to illustrate SOr:le considerations in its red and the other normal. or one nostril may be
management mucus and the other not If the source
of the autonomic were le.g ..
allergy). both eyes would be red and both nostrils
discha rging.
Understanding these central
basic to the management of facial pain
A third molar is extracted, and during the ensuing week a
The role that such conditions play in the diagnosis
;ocalized osteitis (dry socket) develops. This becomes a
source of constant deep pain that, by way of the central
and treatment of temporomandibular disorders is
excitatory effect, produces protective co-contraction discussed in detail in later chapters
I muscle splinting) of the masseter and medial pterygoid
"You wl1not treat [wiess ~IOU neurologic structures and 12) the musc,es. The
wldfrsta ml functioll.·· anatomy and function of each of components
-JPO is reviewed in many instances It
difficult to separate function. With a'l understand
T
he function of the system is ing of these components, basic neuromuscula r func
, Discr:minatory contraction of tion can be revie\ved
the various head an,d neck muscles is 'lec
2ssary to move the mandible
MUSCLES
,;:ffective :unctioning A h neu
:::ont:ol system coordi nates the Motor Ullit
"ctivities of the entire The of the neuromuscular system
rill' of nerves is the rroto r unit. v.,hich consists of a nL;mber of
~2rm l1eUrGI1Hj5CUfar 5&151011 ,A basic un.ders~anding of mUSCle fibers that are innervated ore motor
~he anatomy and function of the neuromuscular neuron. Each neuron with the muscle fiber at
stem is essential to the in,fjuence a motor When the r.euror is activated
-:lat tooth contacts as \'1ell as other conditions, the motor
-:'jV on mandibular movement. amounts of which initiates depOlar
This chaoter divided into :hree The ization of the muscle fibers. causes
:st section reviews In detail the basic the muscle fibers to shortell or contract.
~'-d fU'lction of the neuromusCl;lar system The The nJmber of muscle fibers in'lervated by one
~::::ond describes the basic aclvities of motor neuron according the fu'lc
3stication, swal and The third tlon of the motor unit. The fewer the muscle fibers
- Il reviews important concepts and mechanisms per motor 'leu ron, t he more the move
are necessary to understand orofacia l ment. /\ motor neuron may innervate only
the concepTS in these three sections should two or three rnuscle fibers, as in the cil muscles
enhance the clinicians abll to understand a control the lens of the eye).
~~en,t's comolaint and orov:de effective one motor neuron may innervate ~Ull
dreds of muscle fibers, in any muscle (e.g.
the rectus femoris in the l.... similar variatio'l
ANATOMY AND FUNCTION OF THE
exists in the number of muscle [ibers per motor
NEUROMUSCULAR SYSTEM
neuron v:ithin the muscles of masticaton The
inferior lateral muscle has a
:~'urposesof discussion, the neuromuscL;lar sys low muscle fj ber/motor neu ron ratio: therefore it is
divided Into tViO maior comuonents ( I J the capable the fine adlustments in length needed
25
..
'i
~!ili
:'"
Functional NeuroanatolllY mid PflysioloflY of the Masticatory System 31
The limbic structures function to control our In most areas the cerebral cortex is about 6 mm
emotional and behavioral activities. Within the th and all it contains an estimated
limbic structures are centers or nuclei that are 50 to 80 billion nerve cell bodies Perhaps a biilion
for speci fic behaviors such as anger. nerve fioers lead away from the cortex. as well as
The limbic structures also control numbers into it. to
fear. or other areas of the cortex. to and from deeper struc
center apparently exists. tures of the brain. and some al the way to the
on an instinctive level. the individual driven cord
toward behaviors that stimulate the side Different regions of the cerebral cortex have
of the center. These drives are not generaly been identified to have different functions A motor
perceived at a conscious level but more as a basic area is primarily involved with motor
nstinct The instinct will certain function. A sensory area receives somatosensory
behaviors to a conscious level For when input for evaluation. Areas for I senses. such
an individual chronic pain behavior as visual and auditory areas. are also found.
xiiI be oriented toward withdrawal from any stimu If one were to again compare the human brain
us that may increase the pain. Often the sufferer with a computer. the cerebral cortex wou:d represent
.'.ill withdraw from life itself. and mood alterations the hard disc drive that stores all information
3uch as depression will occur. It is believed that of memory and motor function. Once one
of the limbic structures interact and should remember that the thalamus keyboard)
associations with the cortex, thereby coor is the necessary unit that calls the cortex to function
::i;'ating the conscious cerebral behavioral func
-ons with the subconscious behavioral functions Sensory Receptors
: the deeper limbic system are neurologlC structures or
from the limbic system leading into organs located in all tissues that proVide
can anyone or all of the information to the CNS way of the afferent
~-any internal bodily functions controlled by the neurons the status of these tissues. As in
Impulses from the limbic system other areas of the body, various types of sensory
into the midbrain and meduila can control receptors are located the tissues that
~ch behavior as wakefulness, excitement make up the masticatory system Specialized sen
o.-.:J attentiveness. With this basic understanding sory receptors information to the
.. Iimbic function, one can quickly understand the afferent neurons and thus back to the CNS. Some
_. oact it can have on the overall function of the indi receptors are specific for discomfort and pain These
::Jal. The limbic system certainly a major role are called Other receptors provide infor
. :Jain problems, as discussed in later chapters mation regarding the position and movement of the
Cortex. The cerebral cortex represents the mandible and associated oral structures. These are
. _.~er of the cerebrum and is made up called that carry informa
• -"domi of gray matter. The cerebral cortex is tion regarding the status of the internal organs are
-" portion of the brain most associated referred to as Constant input received
the process, even though it cannot from all of these receptors allows the cortex and
.ide thinking without simultaneous action of brainstem to coordinate action of individual
c'::per structures of the brain The cerebral cortex muscles or muscle groups to create appropriate
- ·-e portion of the brain in which all response in the individual
_ne's memories are stored, and it is also the Like other s, the masticatory system uses
-~~ most responsible for one's abil to four malor types of sensory receptors to mon:tor
~ -.' muscle skills. Researchers still do not know the status of its structures ( 1) the muscle
basic mechanisms which the which are receptor organs found in the
-c'Jral cortex stores either memories or muscle tissues (21 the tendon organs,
. _. Jscle skills. located in the tendons: (3) the pacinian corpuscles
11