Determinants of Occlusion

Determinants of Occlusion
By Associate prof. Manal Rafei Hassan

A Successful restoration should restore:
1- Function
( mastication, phonetics, arch stability ).
2- Appearance (esthetics).
3- Patient’s occlusal scheme.
HARMONY IS THE KEY WORD

Important definitions
• Centric relation:
• Most retruded physiologic relation of
the mandible to the maxilla to, and
from which, the individual can make
lateral movements.
• Rearmost, uppermost, and midmost
position of the condyle in the glenoid
fossa
• Maximum intercuspation:
• Maximum occlusion of teeth regardless
of the condylar position
• Centric occluding relation:
• Coincidence of the MI and CR
• Vertical dimension of occlusion
• Vertical height of the lower third of face
when teeth are in contact
CONDYLE:
The mandible is a U shaped

bone that articulates with the
temporal bone by means of
the articular surface of its
condyle.
The head is covered with

fibrocartilage and articulates with
temporal bone to form TMJ.
Mentioned
before
Intercondylar distance
 Distance between the rotational center of one

condyle to the rotational center of the other
side of condyle is called as intercondylar
distance.
 Larger the distance, more distal positioning of
oblique ridges and grooves on mandibular
teeth and mesial positioning of ridges and
grooves of maxillary teeth.
• Smaller the distance& vice-versa.
TMJ Examination
• Digital palpation.
• Sounds.
Extra Capsular
• Joint restriction.
Intra Capsular
• Dental examination
- Mobility
- Widening of period. Space.
- Osteosclerosis
- Hyper cementosis
• TMJ Imaging
• Principle(1): Neuromuscular harmony depends on
structural harmony between the occlusion and the
tempromandibular joints .
• Principle(2): Determination of the correct physiologic
jaw relationship must always be determined before we
can determine the correct alignment and occlusal
relationship of the teeth. i.e. the teeth must fit into
harmony of jaw relationship-not vice versa.
• That is why we mount casts in centric relation on an
articulator ,so we can see the correct mandible to
maxilla relationship regardless of how the dental arch
align.(teeth alignment )
Primary requirements for successful occlusal therapy
• Comfortable and stable TMJs: the jaw joints must be

able to function and accept loading forces with no
discomfort. This is always the starting point for any
dental treatment that involves the occlusal surfaces of
the teeth.
• Anterior teeth in harmony with the envelope of
function and in proper relationship with lips ,the
tongue, and the occlusal plane.
• Non-interfering posterior teeth: posterior teeth should
contacts without interference with the TMJs in
protrusion or retrusion.
VERTICAL AND HORIZONTAL OVERLAP OF ANTERIOR TEETH
 Greater the vertical

height, greater will be
cusp height.
 Greater the horizontal

overlap, lesser will be
cusp height.
Facial position of teeth
 Position of teeth in relation to

rotational centers of condyle and
to horizontal cranial reference
plane is transferred to articulator
by means of facebow.
 Interocclusal records made in
centric relation are used to place
mandibular cast in proper
relation to rotational centers and
cranial reference planes.
Occlusal plane
 The more plane of occlusion

diverges from path of non
working condyle, greater is
allowable cuspal height.
 The more nearly parallel
occlusal plane to path of non
working condyle the shorter
is allowable cuspal height.
 Faulty occlusal contours of dental restorations may also
produce deflective occlusal contacts causing mandible
to move away from centric relation closure in order to
allow maximal intercuspation of teeth. This maximum
intercuspal position is an eccentric closure. Premature
contacts occurring on the inclines of cusps produce
lateral forces on teeth that create undesirable lateral
pressure and tension on periodontal tissue. While
occlusal forces do not cause periodontal disease, it
produces increased tooth mobility because of
compensatory widening of periodontal ligament space.
 The craniomandibular articulation allows changes in
relation of its parts in order to accommodate guiding
influence of tooth inclines during mandible”s attempt
to reach the position of maximal intercusping. The
accommodation produces an eccentric maximal
intercusping of teeth. The repeated demands resulting
from this intercusping can produce hypertonicty in
associated muscle beyond their capacity to adapt and
myofacial pain develops.
• Disharmony between condylar centricity and maximal
intercusping may also produce excessive wear of the
teeth that are responsible for the deflective
interferences.
Cusp ridge pattern of occlusion
• Development of occlusion can result in fitting one

stamp cusp into fossa and fitting another stamp cusp
into embrasure area of two opposing teeth.
• It is also called as tooth to two teeth occlusion or cusp
embrassure occlusal pattern.
TYPES OF CUSPS
Centric (Function) Cusps Non Centric (Non-Function) Cusps

•Palatal of uppers + Buccal of lowers. •Buccal of uppers + lingual of lowers.
• Called STAMP CUSPS: • Called SHEAR CUSPS:

because they stamp in the opposing because they shear the food.
fossae.
• The shear cusp constitutes the remaining
• Constitutes about 60% of the bucco- 40%.
lingual dimension of a molar.
DURING THE 1970’S, ANDREWS SIX KEYS TO NORMAL OCCLUSION CAME
FORWARD AFTER STUDYING MODELS OF 120 PATIENTS WITH IDEAL
OCCLUSION.
ANDREWS CONSIDERED THE PRESENCE OF THESE FEATURES

ESSENTIAL TO ACHIEVE AN OPTIMAL OCCLUSION.
Crown Angulation (Tip)
Key Key
1 2
Key Crown Inclination (Torgue)

3
Molar
Relationship
Key
Rotation 4 Tight Contacts
Key
5 Key Curve of Spee
6
1. Molar inter-arch relationship:
1-The MB cusp of upper 6 should occlude
in the groove between M & MB cusps of lower 6.
2-The ML cusp of upper 6 should occlude

in the central fossa of lower 6.
3-The crown of upper 6 must be angulated

so that the distal MR Occludes with the mesial MR of
lower 7.
2- Mesio-distal crown angulation:
-Long axis of the clinical crown:
A line passes along the long axis of the

crown through the most prominent part in
the center of the labial or buccal surface.
For the occlusion to be considered normal, the gingival part of the

long axis of the crown must be distal to the occlusal part of the line
.
3. Labio-lingual crown inclination:
crown inclination ( Torque )
It is determined from a mesial or distal view.
The resulting angle between a line perpendicular

to the occlusal plane & a line that is tangent to the
middle of the labial or buccal clinical crown.
The upper incisors usually have +ve torque;

The lower incisors usually have slight –ve torque.
From the canines distally, the torque becomes –ve.
Anterior teeth ???
4
Absence of
Rotated posterior teeth occupy
more space in the dental arch
Rotation
5
Tight contacts
There should be tight contact
between adjacent teeth.
6
Curve of Spee
A normal occlusal plane should be
flat.
STATIC
OCCLUSION
Cusp fossa pattern of occlusion
• It produces an interdigitative relation of cusps and

fossa of one tooth with cusps and fossa of only one
opposing tooth.
• This arrangement is also called as tooth to one tooth
occlusion.
1- Cusp-Ridge Pattern of occlusion:
One stamp cusp fits in a fossa & another stamp cusp of

the same tooth fits into the embrasure area of two of the
opposing teeth.
Called “tooth-to-two-tooth” occlusion or
“cusp-embrasure” occlusal pattern.
2- Cusp-Fossa Pattern of occlusion:
Most or all stamp cusps fit into fossae.

Producing interdigitive relation of the cusps &
fossae of one tooth with the cusps & fossae of only
one opposing tooth.
Called “tooth-to-one-tooth” occlusion.
“ A TRIPODE IS THE MOST STABLE SYSTEM IN MECHANICS”
Cusp-Fossa vs. Cusp-Marginal Ridge
1- Giving maximum support in centric occlusion.
?
2- The forces are closer to the long axis of each tooth, giving a more
efficient chewing apparatus.
3- The occlusal forces are along the long axis of teeth: less tipping.
4- There is elimination of food impaction between marginal ridges.
5- The teeth are more stable, with more stable occlusion.
6- lesser wear of the cusp tips; because the cusps make their contact with
their ridges not their tips.
DYNAMIC OCCLUSION
There are 3 recognized occlusal concepts that describe the manner in
which teeth should & should not contact in the various
functional & excursive positions of the mandible:
Bilaterally Unilaterally Mutually

blanced occlusion balanced occlusion protected occlusion
1. Bilateral balanced occlusion
• All teeth in contact
“ in centric & all eccentric mandibular movements “.
• There is cross-mouth & cross-tooth contacts.
• In 5% only of population.
• Only used with complete removable dentures as it
aids in denture stability
( cross tooth & cross arch stability ).
• In natural dentition & fixed prosthodontics:
- it is very hard to accomplich.
- causes high occlusal wear , pdl breakdown,
neuro-muscular disturbances.
2. Unilateral balanced occlusion (group function)
• 20-25%
• On the working side …. canine & post caine teeth are in contact,
• while on the non-working side …. no contacts exist between teeth.
• Advantageous if pdl support of canine is compromised.
3. Canine guided (mutually protected)
• 60-70%
• Posterior teeth are in contact in centric position.
• Anterior teeth guide the mandible in protrusive
movements.
• Canines guide the mandible in lateral movements.
• i.e.: posterior teeth are separated & not in contact
in ALL eccentric movements.
Organic occlusion
 Given by stallard and stuart

 In protrusive movement two or more mandibular anterior teeth
occlude with maxillary incisors.
 All mandibular teeth occlude simultaneously with maxillary
teeth in centric relation.
 Maxillary palatal cusp occlude in fossa of each mandibular
opponent. Mandibular buccal cusp occlude in fossa of each
maxillary opponent.
 The mandibular anterior teeth relate to lingual surface of
maxillary anterior teeth as stamp cusps into fossa.
 In lateral closure only canines on the working side occlude.
 In lateroprotrusive closure, the lateral incisor may share closure
contacts with canines.
 The stamp cusps of premolars and molars occlude with opposing
fossa with 3 point contact in centric relation.
DIAGNOSIS OF PATIENTS WITH
PROBLEMS RELATED TO OCCLUSION
Most common signs
05 Ear pain & headache

04 Muscle & TMJ pain
03 Tooth mobility
02 Pulpitis
01 Tooth wear
History Taking
Clinical Examination
1- Muscle examination
2- Maximal inter-incisal distance
a. Maximum comfortable mouth opening.
b. Maximum mouth opening.
c. Examining for lateral movement of the mandible.
3- T.M.J
TMJ dysfunction:
- Joint sounds
- Joint restrictions
Our Target (selective
adjustment treatment)
From 3 to 4 contact points on
1 molars.
From 2 to 3 contact points on

2 premolars.
Very light or no contact on anterior teeth

3 in centric contact
Occlusal adjustments
Adjustment of occlusion can be done by-
 Selective reshaping of ridges of cusps.

 Changes can be made at angles of marginal ridge.
 Reduction of cusp height can be done.
 Reduction of sulcus by reducing angles of triangular and
oblique ridges.
While reduction do not create flat areas, always maintain

rounded contours polished surface of cusps and ridges.
All eccentric interferences should be removed first then
only centric relation interferences should be removed.
Eliminate contact on any posterior incline that
mark in lateral or protrusive excursive
movements.
T-SCAN
Advantages:
1- Reproducible marks.
2- Easier & more convenient in patient education.
3- Facilitates communication between dental staff.

Finally ………………..
Occlusal Principles
affect ……
Posterior Survival of
Anterior General tooth-borne &
masticatory Phonetics implant-borne
esthetics function health prosthesis.
Occlusion influences the ability of an individual
To chew & swallow effectively & thus influences
10
60
A person’s diet.
occlusion may also influence an individual’s

susceptibility to sleep apnea if it’s associated
with restricted airway, linking it to an increased
risk of CV. diseases.

Determinants of Occlusion

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Determinants of Occlusion

By Associate prof. Manal Rafei Hassan

3- Patient’s occlusal scheme.

HARMONY IS THE KEY WORD

The mandible is a U shaped

The head is covered with

 Distance between the rotational center of one

• Comfortable and stable TMJs: the jaw joints must be

 Greater the vertical

 Greater the horizontal

 Position of teeth in relation to

 The more plane of occlusion

• Development of occlusion can result in fitting one

Centric (Function) Cusps Non Centric (Non-Function) Cusps

• Called STAMP CUSPS: • Called SHEAR CUSPS:

ANDREWS CONSIDERED THE PRESENCE OF THESE FEATURES

Key Crown Inclination (Torgue)

2-The ML cusp of upper 6 should occlude

3-The crown of upper 6 must be angulated

-Long axis of the clinical crown:

A line passes along the long axis of the

For the occlusion to be considered normal, the gingival part of the

It is determined from a mesial or distal view.

The resulting angle between a line perpendicular

The upper incisors usually have +ve torque;

• It produces an interdigitative relation of cusps and

One stamp cusp fits in a fossa & another stamp cusp of

2- Cusp-Fossa Pattern of occlusion:

Most or all stamp cusps fit into fossae.

4- There is elimination of food impaction between marginal ridges.

5- The teeth are more stable, with more stable occlusion.

Bilaterally Unilaterally Mutually

 Given by stallard and stuart

05 Ear pain & headache

From 2 to 3 contact points on

Very light or no contact on anterior teeth

Adjustment of occlusion can be done by-

 Selective reshaping of ridges of cusps.

While reduction do not create flat areas, always maintain

2- Easier & more convenient in patient education.

3- Facilitates communication between dental staff.

occlusion may also influence an individual’s

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