This lecture will continue the last lopic which is MASTICATION AND DYNAMICS OF OCCLUSION starting with slide

15, Occlusion. #slide Occlusion So, today we will learn about the occlusion of upper and lower teeth, please pay attention of this slide because in the final exam, therell be a lot of questions regarding this slide.Upper and lower jaw are articulated by TMJ. TMJ is the articulation between mandible and the cranium, but the articulation between upper and lower teeth is just by occlusion. We have the topic that we call the envelop of motion of the mandible. Imagine that i put a small pencil on the incisal edges of someones lower incisor and put a paper on sagittal plane, then i ask the person to make the different mandibular movement, the pencil started to draw based on moving the mandible in different movement (opening, closing , backward, forward) .If the person do the maximum possible location of the mandible in each of these movement, this will produce this envelop of motion in the sagittal plane. The envelope of motion will discuss the detail of the mandibular movement. Okay, lets discuss about the lines that are made by movement of the mandible. Now, when your teeth are put together after swallowing, your teeth are in contact, molars are against molar, this is called the centric occlusion. This means when your teeth are against each other in many differet ways, you can for example, bite your teeth edge to edge , you can bite your teeth when your lower teeth are forward or backward. So you have many number of possibilities for you to put your lower teeth against upper teeth, but of course, theres only one centric occlusion , which is the maximum cotact of upper and lower teeth. Please look at the picture.

FIGURE 1 Look at this picture, now were in number 2 (centric occlusion) , the maxilla and mandible are in the maximum contact. At this position, the cusps of the lower teeth exists in the fossae of upper teeth, and the cusps of the upper teeth are in the fossae of lower teeth, this is called maximum intercuspation . Maximum contact is when the cusps exist in the fossae between two cusps. So you put your teeth like this ok, when the cusps are digitating, this is maximum contact/maximum intercuspation/centric occlusion . Now I will ask you after you put your mandible in the centric occlusion, I want you to protrude (move mandible forward) but not to open your mouth/mandible. The thing that will happen, as you remember in dental anatomy we said, the upper incisors overlap with lower incisors. Now when you try to move your mandible forward without opening, the incisors edge of the lower incisors will slide until they reach edge to edge (this is incase for class 1 relationship incisor edge is located at the lingual fossa). As you move your mandible, your mandible will depress a little bit. Why the mandible will be depressed? Because the incisor slides downward against

the lingual surface of the upper incisor, thats why this will undergo some depression on the mandible until the incisor reach edge to edge. This moment that I describe is this part when moving from the centric occlusion to edge to edge contact. The mandible has to be depressed because of 2 things : 1 the incisal guidance. Why? because the mandible is guided by the incisal surface of the upper

teeth.

2 - Mandible condyle when you move your mandible forward. The condyle is located at the glenoid fossa. When you move your mandible, the condyle will also slope against the sloping part of the articular eminence. So the mandible will move slightly downward.

Thats why this area (3) wont look horizontal like this, it tend to look like oblique (refer Figure 1). Now at this stage your mandible is meeting edge to edge, but the molars are not in contact with each other. Molar will be in maximum contact during centric occlusion/maximum intercuspation. Next, I will ask you to move your mandible forward. You can usally move your mandible for 2-3mm beyond being contact. And this point here represents the maximum forward position or the maximum protrusion of the mandible (refer figure 1). You can try this by yourself, notice that your mandible will drop a little bit, contact at edge to edge and mandible continue to move straight/slightly horizontal until the mandible reach the maximum protrusion. Now from that position, I will ask you to open your mouth wide. Before you open wide, the condyle are also located at the maximum forward position. So the condyle are located not by the end of the fossa but slightly at the articular eminence. Now from this position please open to the maximum. You will open from this point (4) down until this point (5) here representing the maximum opening point (refer to figure 1). Now lets move back to centric occlusion, we have to do the same but backward. Meng So protrusion and retrosion . Why the maximum backward position or maximum retrosion position is located slightly lower than central occlusion position? Because the cusps are going to..the cusp are (cant understand) retrude to it fossa like if you move backward, the cusp will move incline against the sloping area of the fossa. Your mandible will drop a little bit. What happened if I ask you from that position, to open you mandible? You are not going to open your mandible like this. You are going to open your mandible in two stages. The first stage is where the condyle are rotating ??? From this point to this point. During this area the condyle are only rotating around an axis passing through them (speaking Arabic). But beyond that you cant open the mandible further without translating the condyle forward (speaking Arabic). They have to slide normally (speaking Arabic). This is important to protect the vital structure. What happening if you continue to open your mandible without having your mandible sliding, you were actually compressed the vital structure of the neck which are present in carotid sheath particularly the internal carotid artery and internal jugular vein.

So what happen after that this now represent the beginning of the slightly movement of the condyle, until the maximum opening. This is what happening in the movement of mandible. This line represent the limit of mandible, of course you can move the mandible within this shape, you can move the mandible anywhere, but this line represent the maximum of the movement of the mandible. (speaking Arabic)

This line represent the outermost movement of the mandible let say but the mandible can move anywhere within the cingulum fossa. At rest, are the teeth in occlusion? No. (speaking Arabic)When you are at rest, the lower teeth are central from upper teeth to 2-4mm. So this point here represent rest. When you eat your mandible of course moves.

Bushra Let reapete them quickly..centric occlusion (Incisal guidence),edge to edge, maximum forward position (reverse overjet),opening of mandible from maximum forward position,maximum retrusion,rotation of the condyle,sliding of the condyle,maximum opening,rest position(chewing cycle)..please refer to figure 1 So this is the envelope of motion of mandible. Occlusion means teeth are in contact position. Centric occlusion (CO) equal intercuspal position (ICP). ICP means that the position of mandible,,when the cusps of lower teeth are in the maximum contact with the cusps and fossae of the upper teeth. Sometimes u can put your teeth together lightly and u clench them..this is called the position where teeth are in light contact..but sometime u can put them together and bite forcefully,this is called intercuspal clenching position. What is the difference between intercuspal position and intercuspal clenching position? In respect to mandible,nothing happen. It is in the same position but the muscle of mastication will be contracted in the clenching position and muscle of mastication will be in minimal contraction in normal intercuspal clenching position.. this is the case where the mandible is in the maximum contact with the maxilla

Centric occlusion(CO),the head of the condyle are located at the upper most position in the glenoid fossa. CO in compelete denture, is not the same as CO in people with teeth.why?? As I discuss last lecture,the periodontal ligament of lower teeth,they have the receptors called proprioceptors. These receptors are important to send information to the brain about the position of the mandible..becasue of that,u can easily bite your mandible exactly against maxilla in the position u want. In the situation of people who have complete denture, the proprioceptor will be lost. So, theres no repector that will send to the brain about the position of the mandible. As a result, old people who have lost their teeth are not able to bite exactly everytime in the same position People who were in denture the most RETRUDED position become the centric occlusion. Why?

Just imagine that I ask a blind man to put this remote control in the basket. This basket is free from any attachment. It is free. It is difficult right? but, If I put the basket on the wall like this, it is easier right? This is the same in complete denture situation. In this old people in denture, u want a position that has a reference. So the reference will be the most PROTRUDED position. Not the centric occlusion. Why? Because centric occlusion is not the maximum position. Centric occlusion met the maximum position which is the most RETRUDED is the maximum position for this old people. Thats why this will be easier for them when we told them, whenever you want to bite, put your mandible to the back, where there is the maximum and then bite. By this he is able all the time to bite without any problem. Then if u make the centric occlusion of people with teeth the same as centric occlusion with people in denture, believe or not in many of the cases, this old people will suffer from lack of occlusion because they are not able to bite everytime in the in the same bite. Now, intercuspal position (ICP) and intercuspal clenching position (ICCP) are both static position where the mandible is not moving during this position. We have example on median occlusal position. Light tooth contact positon reached in a normal chewing cycle. Whenever you eate in the tooth cycle, you move your mandible downward and upward, in a circular motion. When you reached up, you dont bite your teeth together. This is call the median occlusal position which is one position on the cycle of chewing which is the most upward position on the chewing cycle. It is close to centric occlusion but not the centric occlusion. We have different position ICCP and we have incisal clenching position. You can put incisal together edge to edgeand clech. But this is not normal.no one can do that otherwise you can injured your teeth. Its is called bruxism. Bruxism is characterized by the grinding action of the teeth and typically includes the clenching of the jaw. There is also a simple form of clenching or sometime clenching in its centric position. Centric position clench on centric ______. Acentric position is to clench on another position like incisal clenching or the lateral clenching. These are very harmful to teeth and also TMJ. Also some people have lateral clenching, they put their teeth laterally and then clench. This extreme movement cause serious injury to the temperomandibular joint. these people are normally not aware of having this problem because this occur while they are asleep but they wake up in the morning suffering for pain in the muscle of mastication. And usually if left untreated they will have problems with TMJ sometimes it requires surgery. Lets talk about the rest position when the deep are held slightly separate. The mandible is held on the sling of medial pterygoid and the masseter. TMJ is not loaded. Is the masseter muscle

contracted? some people say yes some say no. thats why the evidence is conflicting. Now the space left in rest position, space between upper and lower teeth is called freeway space or interdental space or the speech space because this is the space that allows you to speak. Upper and lower jaw are connected in articulation through teeth. We have in periodontal ligament, propioreceptor or articular receptor . These monitor load upon the articulating surface. When you bite, what you do actually you reduce the amount of biting? The prioreceptor also are connected to pressure receptors found in apical area of periodontic ligament