Occlusion / Orthodontic Courses by Indian Dental Academy

OCCLUSION
IN
OPERATIVE DENTISTRY

INDIAN DENTAL ACADEMY

Leader in continuing dental education
www.indiandentalacademy.com

CONTENTS
INTRODUCTION
GENERAL DESCRIPTION
GOALS FOR COMPLETE DENTISTRY
RESPONSE TO HIGH RESTORATION
OCCLUSAL DISEASE
TMJ
MASTICATORY MUSCULATURE
MANDIBULAR MOVEMENT
POSSELT'S MOTION
OCCLUSAL SCHEMES
CENTRIC OCCLUSION
CENTRIC RELATION
DETERMINING CENTRIC RELATION
LOAD TESTING OF TMJS
RECORDING CENTRIC RELATION
CLASSIFICATION OF OCCLUSION
DETERMINANTS OF OCCLUSION
THE PLANE OF OCCLUSION
POSTERIOR OCCLUSION
ROLE OF CONTACT AREAS
ROLE OF CONTOUR
ROLE OF MARGINAL RIDGES
SIGNS OF INSTABILITY OF OCCLUSION
REQUIREMENTS FOR EQILIBRIUM OF
THE MASTICATORY SYTEM
REQUIREMENTS FOR OCCLUSAL
STABILITY
OCCLUSAL EQUILIBRATION
VERIFICATION OF COMPLETION
COMPUTER ASSISTED DYNAMIC
OCCLUSAL ANALYSIS
DENTITION OCCLUSAL EXAMINATION
TREATMENT PLANNING
CONFORMATIVE APPROACH
CONCLUSION
REFERENCES
INTRODUCTION
Occlusion literally means closing.
When the jaws are closed and teeth are in contact, this
is termed as static occlusion.
However, occlusion mainly occurs as momentary
contacts during mandibular movements and is termed
as Dynamic occlusion.
The contact of teeth in opposing dental arches, when
they are in contact (static) and during various jaw
movements (dynamic) STURDEVANT.
GENERAL DESCRIPTION
Blunt, rounded or pointed projections of the
crowns of the tooth - Cusps
Cusps are separated by distinct Developmental
grooves
The facial cusps are separated from lingual cusps
by a deep groove - central groove
If a tooth has multiple facial or lingual cusps, the
cusps are separated by facial or lingual
Developmental grooves
Depressions between the cusps - Fossae
Grooves having noncoalesced enamel Fissures
Noncoalesced enamel at the deepest point of a
fossa - Pit
Operative Dentistry follows the concept of functional
or physiologic occlusion.

The functional occlusion is one which can function
efficiently without pain & remains in a state of health
regardless of the relationship between the maxillary
and mandibular teeth.

A dental examination is complete if it identifies all
factors that are capable of causing or contributing to
deterioration of oral health or function.
GOALS FOR COMPLETE
DENTISRTY
Freedom from disease in all masticatory system
structures
Maintaining healthy periodontium
Stable TMJs
Stable occlusion
Maintaining healthy teeth
Optimum esthetics
RESPONSE TO HIGH RESTORATION
Tooth ache
Tooth tender on biting
Tooth wear
Spastic masticatory muscles
Muscle tension headache
Condyle / disk derangement
Degenerative arthritic changes in the TMJs
OCCLUSAL DISEASE
Occlusal disease is deformation or disturbance of
function of any structures within the masticatory system
that are in disequilibrium with a harmonious
interrelationship between the TMJs, the masticatory
musculature & the occluding surfaces of the teeth
Abrasion : wear due to friction between a tooth and an
exogenous agent
Erosion : tooth surface loss due to chemical or
electrochemical action
Abfraction : stress induced non-carious cervical lesion.
ATTRITIONAL WEAR
Attrition : wear due to tooth-to-tooth friction
Mostly in the lower anterior teeth
Causes :
1. Deflective incline interferences of
posterior teeth to centric relation
forward slide of mandible during
closure collision of lower anteriors with upper
anteriors.

2. Improper restorations on anterior teeth
3. Direct interference of the anterior teeth to complete
closure in centric relation
SPLAYED TEETH
Forward movement of upper anteriors
Cause :
Improperly contoured restorations that
are too thick on the lingual of upper
anteriors or overcontoured lower
restorations.
SENSITIVE TEETH TOOTH
Cause : occlusal overload

pulp hyperemia / noncarious cervical cracks
SPLIT TEETH / FRACTURED CUSPS
Cause : interference of cusp incline with
strong occlusal force
PAINFUL MUSCULATURE
Cause :
Deflective occlusal interference

Disharmony between the occlusion &TMJs

TMJ
All occlusal analysis starts at the TMJ

As the TMJ is a stress bearing joint, all of the
articular surfaces of the condyle, the fossa & the
eminence are covered with avascular layers of
dense fibrous connective tissue
TMJ is nourished by synovial fluids that lubricate the
joint for smooth gliding function
UNDERSTANDING CONDYLE DISK
ALIGNMENT
Medial & lateral
Diskal ligament
Posterior ligament
Superior elastic
stratum
Superior lateral
Pterygoid muscle
The axial rotation occurs around a
true hinge axis when the condyles
are fully seated.
Rotation around a fixed horizontal
axis seems improbable because of
angulation of the condylles in
relation to the horizontal axis
The condyles serve as bilateral
fulcrum for the mandible & so the
joints are always subjected to
compressive forces whenever the
elevator muscles contract.
MASTICATORY MUSCULATURE
Muscles of mastication : Masseter
Temporalis
Lateral /
External pterygoid
Medial / Internal pterygoid

Centric relation (CR) is the position of the mandible when the
condyles are positioned superiorly in the fossae in healthy
TMJs.
This position is independent of tooth contacts.
Rotation with the condyles positioned in CR is termed terminal
hinge (TH) movement.
TH is used in dentistry as a reference movement for
construction of restorations.
Initial contact between teeth during a TH closure provides a
reference point, termed centric occlusion (CO).
Many patients have a small slide from CO to MI, typically in a
forward and superior direction.

MANDIBULAR MOVEMENT
Maximum rotational opening in TH is 25 mm
measured between the incisal edges of the
anterior teeth

Simultaneous, direct anterior movement of
both condyles, or mandibular forward
thrusting, is termed protrusion.
The mandible can protrude approximately 10
mm.
complex motion combines rotation and
translation in a single movement.
Most mandibular movement during speech,
chewing, and swallowing consists of both
rotation and translation.
Maximum opening is approximately 50 mm.
Lateral movement is often described with respect to only one
side of the mandible for the purpose of defining the relative
motion of the mandibular to the maxillary teeth.
Mandibular pathways directed away from the midline are
termed working (laterotrusion & function), and
mandibular pathways directed toward the midline are termed
nonworking (mediotrusion, nonfunction & balancing).
Lateral movement is approximately 10 mm.
Bennet movement :
The rotation of the working side condyle in its
articular fossa results in a slight lateral movement of
the condyle. This lateral movement of
the condyle averages 1 mm in
extent and is termed the Bennet
movement or the immediate
side shift.
This movement may be straight lateral,
lateral and anterior; lateral and distal;
lateral and superior or lateral and inferior.
Bennet angle:
The mean angle formed by the sagittal plane and
the path of the non-working condyle as viewed in the
horizontal plane is termed the Bennet angle.

POSSELT'S MOTION
In 1952, Posselt described the capacity of motion of the mandible. The resultant
diagram has been termed Posselt's motion (known as the Envelope of
motion).
The path of the mandible during its movement in each of the possible three
directions (sagittal, horizontal & vertical) is described to points beyond which
the mandible is not capable of further movement.
These points are defined as the border limitation of mandibular movements, and
moving the mandible to these points is therefore called border movements of
the mandible.
Centric relation
Centric occlusion
Protrusion
Hinge movement
(terminal arc of opening)
max. jaw opening
OCCLUSAL SCHEMES
Three basic schemes of occlusion : Balanced
occlusion
Canine protected occlusion
Group function occlusion

It is defined as the simultaneous, bilateral contacting of
maxillary and mandibular teeth in anterior & posterior
occlusal areas in centric and eccentric positions
This concept was applied to restoration of natural
dentition by Mc Collum & Schuyler et.al.,
Seen in case of advanced attrition case
In natural teeth, balancing side contacts are inappropriate
and potentially harmful as they constitute premature
contacts and were proposed to cause occlusal wear, pdl
breakdown, & TMJ disturbances.
BALANCED OCCLUSION
As the muscles move the mandible to the
working side, the tip or the distobuccal
incline of the lower working side canine
glides down the palatal incline of the
upper working side canine.
This causes the mandible to move laterally, forwards and
to open. This is termed Canine guidance & the concept of
occlusion as Canine protected occlusion
On a canine guided working movement the premolars &
molars on the working side become separated as the mandible
moves away from centric occlusion.
All the teeth on the non-working side also become separated
as the mandible moves away from centric occlusion.
CANINE PROTECTED OCCLUSION
There is simultaneous gliding contact of teeth on
the lateral & protrusive side during lateral &
protrusive movement.
Group function is seen on all the working side
teeth.
The incisal edges of the' mandibular anterior teeth
glide down the palatal surfaces of the maxillary
anterior teeth.
UNILATERAL BALANCED / GROUP FUNCTION
OCCLUSION
The buccal inclines of the buccal cusps of the mandibular premolars and
molars glide against the palatal inclines of the buccal cusps of the maxillary
premolars and molars.
Tooth guided working guidance continues until the guiding teeth on the
working side meet in an edge to edge relation.
Further movement towards the working side is guided by contact of the
upper and lower incisors. This is termed 'cross over'.
CENTRIC OCCLUSION
It is the position of maximum intercuspation of
teeth which is in harmony with the neuromuscular
mechanism.
This is not the most retruded position of the
mandible
Centric occlusal contacts should be checked in both functional &
non-functional occlusion.

Functional occlusion occurs in the segments of arch toward which the
mandible moves & is divided into lateral functional & protrusive functional
occlusion

Lateral functional occlusion is predominantly guided by canines but
involves sharing of contact by other posterior teeth in the functional working
segment
Facial range Mn Facial cusps moving facially & distally across
the lingual inclines of Mx Facial cusps
Lingual range Mx Palatal cusps moving across the
facial inclines of Mn lingual cusps

In Protrusive functional occlusion, all Mn anterior teeth will contact along
the palatal inclines of Mx anterior teeth with the disclussion of posterior
teeth
Non functional occlusion or balancing contacts are undesirable in the natural
dentition.
Non functional occlusion is divided into lateral non-functional & protrusive
non-functional occlusion

In lateral non-functional occlusion,
the Mn facial cusps on the non-functioning side move obliquely, lingually &
mesially towards the Mx palatal cusps along their facial inclines

Protrusive non-functional occlusion occurs in facial & lingual range
The facial range of Protrusive non-functional occlusion occurs when the
mesial cusp ridges of Mn facial cusps contact the distal slopes of triangular
ridges of Mx facial cusps
The lingual range of Protrusive non-functional contact occurs when the distal
cusp ridges of Mx palatal cusps contact the mesial slopes of triangular ridges
of Mn lingual cusps.
POTENTIAL CONTACT AREAS OF
OCCLUSAL SURFACES
MAXILLARY
POSTERIOR
MANDIBULAR
POSTERIOR
ZONE 1 Facial range in Lateral
functional contact
Lingual inclines of facial
cusps
Facial inclines of facial
cusps
ZONE 2 Facial range in Centric
contact
Central groove area Facial cusp tips
ZONE 3 Lateral non-functional
contact
Facial inclines of palatal
cusps
Lingual inclines of facial
cusps
ZONE 4 Lingual range in Centric
contact
Lingual cusp tips Central groove area

ZONE 5 Lingual range in Lateral
functional contact
Lingual inclines of palatal
cusps
Facial inclines of lingual
cusps
CENTRIC RELATION
Centric Relation Is the relationship of
the mandible to the maxilla when the
properly aligned condyle-disc
assemblies are in the most superior
position against the eminentiae
irrespective of vertical dimension or
tooth position
Centric relation refers to both position
& condition of the condyle-disk
assemblies.
The condyles can freely rotate on a fixed axis in centric
relation upto 20 mm of jaw opening with out moving out of
fully seated position in their respective fossa.
Centric relation is an interference-free occlusion.
The rotating condyles are free to move
down & up the eminence to & from
centric relation, permitting the jaw to
open or close at any position from centric
relation to most protruded.
PROCEDURE BILATERAL MANIPULATION
1 . Recline the patient all
the way back
DETERMINING CENTRIC RELATION /
ADAPTED CENTRIC POSTURE
the way back
2 . Head stabilization
the way back
3 . Stretch the neck by lifting
the patients chin
the way back
the patients chin
4 . Place the four fingers on
lower border of the mandible
the way back
the patients chin
5 . Bring the thumbs together
to form a c with each hand
the way back
the patients chin
5 . Bring the thumbs together
to form a c with each hand
6 . With a very gentle touch,
manipulate the jaw so it
slowly hinges open and
closed.
DIRECTLY FABRICATED
ANTERIOR DEPROGRAMMING
DEVICE
DIRECTLY FABRICATED
DEVICE
THE PANKEY JIG
Dr. Keith Thornton
DIRECTLY FABRICATED
DEVICE
THE PANKEY JIG
Dr. Keith Thornton
THE BEST-BITE APPLIANCE
DIRECTLY FABRICATED
DEVICE
THE PANKEY JIG
Dr. Keith Thornton
THE LUCIA JIG
Lucia, Dr.Peter Neff
DIRECTLY FABRICATED
DEVICE
THE PANKEY JIG
Dr. Keith Thornton
THE LUCIA JIG
Lucia, Dr.Peter Neff
Leaf Gauge
Dr.Hart
LOAD TESTING OF TMJS
Not done to force the condyle into centric relation
done to check centric relation
Done in increments
Any sign of pain condyle on affected side is not
fully seated
Reasons for tenderness : Intracapsular disorder
Occlusal interferences
Mistakes done during load testing :
Applying too much pressure too soon
Not applying enough upward loading force
RECORDING CENTRIC RELATION
CRITERIA FOR ACCURACY IN MAKING AN
INTEROCCLUSAL BITE RECORD

The bite record must not cause any movement of teeth or
displacement of soft tissue.
It must be possible to verify the accuracy of the interocclusal
record in the mouth
The bite record must fit the casts as accurately as it fits the
mouth
It must be possible to verify the accuracy of the bite record
on the casts.
The bite record must not distort during storage or
transportation to the laboratory
WAX BITE RECORD
Most popular method.
Delar wax thick at front
Technique :

WAX BITE RECORD
Technique :

WAX BITE RECORD
Technique :

WAX BITE RECORD
Technique :

WAX BITE RECORD
Technique :

ANTERIOR STOP TECHNIQUE
ANTERIOR STOP TECHNIQUE
CLASSIFICATION OF OCCLUSIONS
ANGLES CLASSIFICATION

In normal Class I occlusion, the mandibular facial
cusp contacts the maxillary premolar mesial
marginal ridge and the maxillary premolar lingual
cusp contacts the mandibular distal marginal
ridge. Because only one antagonist is contacted,
this is termed a tooth-to-tooth relationship.
The most stable relationship results from the
contact of the supporting cusp tips against the two
marginal ridges, termed a tooth-to-two-tooth
contact.
In Class II occlusion, each supporting cusp tip
will occlude in a stable relationship with the
opposing mesial or distal fossa; this relationship is
a cusp fossa contact.
INTERARCH TOOTH RELATIONSHIPS
DAWSONS CLASSIFICATION
Type I : Maximal intercuspation is in harmony with centric relation
Centric relation is verifiable with the teeth separated.
Jaw can close to maximal intercuspation without premature
tooth contacts

Type IA : Maximal intercuspation occurs in harmony with adapted
centric posture
Adapted condition to Intracapsular deformation
TMJs can accept loading with no discomfort

TYPE II : Condyles must displace from a verifiable centric relation for
maximum intercuspation to occur

TYPE IIA : Condyles must displace from an adapted centric posture
for maximum intercuspation to occur
The source of pain will be in muscle or in interfering tooth
The occlusal therapy goal is to achieve Type I or IA

TYPE III: Centric relation can not be verified
TMJs cannot accept loading without tenderness
Focus should be on correcting the TMD before occlusal
treatment can be finalised
The occlusal therapy goal is to achieve Type I or IA

TYPE IV : The occlusal relationship is in an active stage of progressive
disorder because of pathologically unstable TMJs
Actively progressive disorder of the TMJs
Signs : progressive anterior open bite
progressive asymmetry
progressive mandibular retrusion
The goal is to stop the progression of the TMJs defprmation

DETERMINANTS OF OCCLUSION
FIRST DETERMINANT OF OCCLUSION : Condylar
path
SECOND DETERMINANT OF OCCLUSION : Anterior
guidance

In a perfected occlusion, the combination of both
Condylar guidance & Anterior teeth guidance
determines the path that the mandible follows in
function.
CONDYLAR GUIDANCE
It refers to the path that the horizontal rotational axis of
the condyles travel during normal mandibular opening.
It includes : Translation of condyles
Bennett shift
Inter-condylar distance

Both the condyles translate simultaneously along their
eminences in protrusive functional movement.
In lateral functional movements, the condyles on non-
functional side translates forward along the eminence
while the condyle on working side rotates in its fossa.
TRANSLATION OF CONDYLES
Bennett shift is the lateral bodily shift of the
mandible towards the working side in function.
The amount of lateral shift influences the pattern
of tooth contact during lateral movement.

The inter-condylar distance affects the path of
lateral functional movement of mandible since it
determines the location of vertical axis of rotation
in relation to mandibular arch.
The farther the condyles are from midsaggital
plane, the more anterior is the path of lateral
excursion and vice versa.
INTER-CONDYLAR DISTANCE
BENNETT SHIFT
In Restorative treatment, restriction of the envelope
of function is the most problematic.
Restorations must be in hormany with the envelope
of function
Incisal edges too far
back
Incisal edges too far
forward

When restoring upper anterior teeth, the lingual
contours must be in harmony with the envelope of
function from centric relation contact to incisal edge
positions.
ANTERIOR GUIDANCE
Lower incisal edges
definite labio-incisal line angle
Determination of horizontal
Position for upper incisal edges
Determination of horizontal
position for lower incisal
edges
Exact position & contour of incisal
edge
Determination of contour of the anterior
guidance
THE PLANE OF OCCLUSION
It is an imaginary surface that theoretically touches
the incisal edges of the incisors and the tips of the
occluding surfaces of the posterior teeth.
The curvatures of posterior plane of occlusion are
divided into : Curve of Spee
Curve of Wilson
CURVE OF SPEE
Antreroposterior curvature of the occlusal surface,
beginning at the tip of lower canine & following
the buccal cusp tips of bicuspids & molars
and continuing to the anterior border of
ramus
If the curved line continues further back, it would
follow an arc through the condyle, with a 4 inch
radius
The curve results from variations in axial alignment
of the lower teeth parallel with its arc of closure.
This requires the last molar to be
inclined at the greatest angle & the forward tooth to
be at the least angle
It is designed to permit protrusive disclusion of the
posteriorteeth

CURVE OF WILSON
Mediolateral curve that contacts the buccal &
lingual cusp tips on each side of the teeth.
Alignment of posterior teeth to parallel the
direction of loading from the internal
pterygoid muscle results in curve of wilson
Results from inward inclination of lower
posterior teeth & outward inclination of upper
posterior teeth
The inward inclination of lower occlusal table
is designed for direct access from the lingual,
with no blockage by lower lingual cusps
The outward inclination of upper occlusal
table provides access from the buccal for the
food to be tossed directly onto occlusal table
by the action of buccinator
When the curve of wilson is made too flat, ease of
masticatory function may be impaired because of
increased activity required to get the food onto
the occlusal table.

The design of lower posterior teeth moving
downward before they shifting medially is made
possible by the curve of wilson.

POSTERIOR OCCLUSION
Posterior teeth (cusp characteristics):
For teeth to remain stable there must be certain barriers against
their displacement. These barriers are provided by the vertical
overlaps of the teeth (occlusoapically by the opposing teeth)
and mesio-distally by the contact areas.

This is achieved by a
Holding cusps/supporting cusps/stamp cusp/centric cusps
Non-holding cusps/non-centric/non-supporting cusps

During fabrication of restorations
it is important that supporting cusps do
not contact the opposing teeth in
manners that result in lateral
deflection; rather contacts should be on
smoothly concave fossae so that forces
are directed approximately parallel to
the long axis of the teeth.
Supporting cusps : these cusps contact the opposing teeth
along the central fossa occlusal line. For upper posterior teeth
in normal occlusion, these supporting cusps are usually the
lingual cusps occluding in opposing fossae while for lower
posterior teeth, they are usually the buccal cusps.
Non-supporting cusps /Guiding cusps:
These cusps do not contact the tooth and are usually
located in the embrasures or developmental grooves of
opposing teeth

They have sharper cusp ridges and form a separation
between the soft tissues and occlusal table.

Posterior Tooth Contacts :
In idealized occlusal designed for restorative dentistry, the
posterior teeth should contact only in MI.
Forceful contact or collisions of individual posterior tooth
cusps during chewing and clenching may lead to patient
discomfort or damage to the teeth.
During chewing the working-side closures start from a
lateral position and are directed medially to MI.
Test movements are used by dentists to assess the occlusal
contacts on the working side; for convenience, these
movements are started in MI and move laterally.
Thus the working-side test movement follows the same
pathway as the working-side chewing closure but occurs
in the opposite direction.
The preferred occlusal relationship for restorative purposes
is to limit the working-side contact to the canine teeth.
Tooth contact posterior to the canine on the working side
may occur naturally in worn dentitions.
Multiple tooth contacts during lateral jaw movement are
termed group function.
Group function occurs naturally in a worn dentition;
however, group function can be a therapeutic goal when the
bony support of the canine teeth is compromised by
periodontal disease.
During chewing closures, the mandibular teeth on the
nonworking side close from a medial and anterior position
and approach MI by moving laterally and posteriorly.
Avoidance of contacts on the nonworking side is an
important goal for restorative procedures on the molar teeth.
ROLE OF CONTACT AREAS
A break in continuity of the line of contact areas throws
additional responsibility on the PDL & alveolar bone.
Creating a contact that is too broad, bucco-lingually or
occluso-gingivally in addition to changing the tooth
anatomy will change the anatomy of the inter dental col.
The broadened contact produces an inter-dental area that
the patient is less able to clean i.e. increases the area
susceptible to future decay.
Creating a contact that is too narrow bucco-lingually or
occluso-gingivally leads to greater susceptibility for
microbial plaque accumulation & predisposes to the
periodontal and caries problems.
All tooth crowns exhibit contours in the form of convexities
and concavities which should be reproduced in a restoration.
The concavities occlusal to the height of contour, whether
they occur on anterior or posterior teeth are involved in the
occlusal static and dynamic relations as they determine the
pathways for mandibular teeth into and out of centric
occlusion.
Deficient or mislocated concavities will lead to premature
contacts during mandibular movements, which could inhibit
the physiologic capabilities of these movements.
Excessive concavities can invite extrusion, rotation or
tilting of occluding cuspal elements into non-physiologic
relations with opposing teeth.

ROLE OF CONTOUR
A marginal ridge should always be formed in two planes bucco-
lingually, meeting at a very obtuse angle. This feature is essential when
an opposing functional cusp occludes with the marginal ridge.
A marginal ridge with these specifications is essential for;
1. The balance of the teeth in the arch.
2. Prevention of food impaction proximally.
3. Protection of the periodontium.
4. Prevention of recurrent and contact decay.
5. For helping in efficient mastication.

ROLE OF MARGINAL RIDGES
SIGNS OF INSTABILITY OF OCCLUSIION
Excessive wear
Hypermobility of one or more teeth
Migration of one or more teeth Horizontal shifting
Intrusion

Supraeruption
REQUIREMENTS FOR EQILIBRIUM OF THE
MASTICATORY SYTEM
Stable TMJs even when loaded
Anterior guidance in harmony with functional
movements of the mandible
Noninterference of posterior teeth
in centric occlusion
posterior disclusion when
condyle leaves CR
All teeth in vertical harmony with the masticatory
muscles
All teeth in horizontal harmony with the neutral
zone
REQUIREMENTS FOR OCCLUSAL STABILITY
Stable stops on all teeth when the condyles are in centric relation
Anterior guidance in harmony with the border movement of the
envelope of function
Disclusion of all posterior teeth in protrusive movements
Disclusion of all posterior teeth in nonworking side
Noninterference of all posterior teeth on working side, with either the
lateral anterior guidance or the border movements of the condyle.
In lateral movements, supporting cusps preferably should have slight
freedom in centric and occlude in a valley like space on opposing
teeth (in grooves or embrasures), to facilitate non interfering passage
of cusps.
During protrusive movements, there should not be any tooth contact
posteriorly.
OCCLUSAL EQUILIBRATION
Reduction of all contacting tooth surfaces that
interfere with the completely seated condylar
position i.e., centric relation
Selective reduction of tooth structure that interferes
with lateral excursions
Elimination of the posterior tooth structure that
interferes with protrusive excursions.
Harmonization of the anterior guidance
VERIFICATION OF COMPLETION
Clench test :
Clenching the tooth together & squeezing firmly.
Reasons for discomfort : incomplete elimination of
occlusal interferences on the posterior teeth

COMPUTER ASSISTED DYNAMIC
OCCLUSAL ANALYSIS
T scan
Developed by Maness.
Sensor unit that records occlusal contacts on a thin
mylar film & relays the information to a computer
The occlusal contacts on teeth can be located by marking
them with articulating paper or ribbon held by Millers
forceps.
Shim stock or Mylar strips are also helpful in identifying the
presence of occlusal contacts.

DENTITION OCCLUSAL EXAMINATION
The examination of the occlusion is performed in three steps:
1. First, the teeth need to be dry and one of the easiest ways
of doing this is to ask the patient to close onto folded tissue
paper held by Miller forceps.

2. Mark-up the patient's dynamic
occlusion, by asking the patient to slide
his/her teeth from side-to-side whilst
holding the articulating paper (Blue paper)
between them.
3. The final stage requires changing the
colour of the paper (Red) and asking the
patient to tap his/her teeth' together into a
normal bite. This will mark the static
occlusion.

Before initiating treatment the practitioner must decide
whether to provide restorations within the existing occlusal
scheme or to change it deliberately.
Conformative approach is defined as the provision of
restorations in harmony with the existing jaw relationships.
It is the principle of providing a new restoration that does
not alter the patients occlusion
Majority of restorations follow this principle.
The provision of new restorations to a different occlusion
which is defined before the work is started: i.e. to visualize
the end before starting is defined as the re-organized
approach.
TREATMENT PLANNING
CONFORMATIVE APPROACH
When considering the provision of simple restorative
dentistry to the conformative approach, no matter
what type of occlusal restoration is being provided
the sequence is always the same - THE EDEC
PRINCIPLE.

The EDEC Principle is useful in relation to:
- Direct restorations
- Indirect restorations

TECHNIQUE
1. Examine:
Examine the static and dynamic occlusions before
picking up a handpiece.
Mark them pre operatively on teeth, as explained
earlier.
Malpositioned opposing supporting cusps, ridges or
fossae may be recontoured in order to achieve optimal
occlusal contacts in the restored tooth.
Plunger cusps and over erupted teeth are to be
reduced.
In anterior restorations, the scheme of incisal
guidance must be examined and understood prior to
tooth preparation.
Also, an assessment of periodontal condition must be
made.

THE EDEC PRINCIPLE FOR DI RECT
RESTORATI ONS
2. Design:
Always visualize the design of the cavity
preparation. This is better done after a simple
occlusal examination .
The existing occlusal marks will either be
preserved by being avoided in the preparation,
or they will be involved in the design, but never
end preparation margins at these points.
3. Execution:
The execution of the restoration must be to the design (form) of
the preparation that the dentist will have decided before starting
to cut.
Controlled interproximal cutting and care in restoring axial tooth
contour to avoid overcontouring is essential.
Carving of restorations must be harmonious to occlusion and
should not introduce premature contacts.
4. Check:
Finally, check the occlusion of the
restoration, that it does not prevent all the
other teeth from touching in exactly the
same way as they did before. This is either
done by;
This is done by reversing the colour of the
paper or foils used pre-operatively and
using the preoperative marks as a reference.

The dentist not only has to examine the occlusion in
Indirect restorations but the results of that examination
have to be accurately recorded and that record has to be
transferred to the technician.
The EDEC principle followed for indirect restorations

THE EDEC PRINCIPLE FOR
I NDI RECT RESTORATI ONS
1. Examine:
The examination of the patients pre-existing occlusion is carried
out in exactly the same way as described for the direct restoration.
There is a need for this information to be transferred accurately
to the laboratory technician; hence a record must be made.
The methods of recording interocclusal records include:
Two dimensional bite records Intra oral photographs,
written records, and/or Occlusal Sketching
Three dimensional bite records Bite registration
materials such as hard wax, acrylic resin, elastomers etc
A combination of both.
2. Design:
Clinically the cavity preparation is designed in exactly the
same way as for a direct restoration.
The fundamental difference is that , the technician is going to
make the restoration.

3. Execute:
From an occlusal point of view one of the most significant
considerations is the provision of a temporary restoration
which duplicates the patient's occlusion and is going to
maintain it for the duration of the laboratory phase.
For this the temporary restoration should:
be a good fit, so that it is not going to move on the tooth;
provide the correct occlusion, so that the prepared tooth
maintains its relationships;
be in the same spatial relationship with adjacent and
opposing teeth.
4. Check:
The occlusion of the restoration should be as ideal
as possible (preferably not on an incline) and should
not prevent all the other teeth from touching in
exactly the same way as they did before. This needs
to be checked before and after cementation.

Occlusion is fundamental to the practice of dentistry, in
providing a biologically functional restoration and for
comprehensive patient care.
A dental restoration after being attached to the tooth
becomes one of the essential components of the
stomatognathic system. Hence, any restoration (from
intracoronal direct restoration to complex crown and
bridge work) must be planned to conform to the existing
occlusal pattern and not to disturb it
CONCLUSION
WHEELERS Dental Anatomy, Physiology & Occlusion
7
th
edition
PETER E. DAWSON Functional Occlusion

STURDEVANTS Art & Science of Operative Dentistry
5
th
edition

M.A. MARZOUK Operative Dentistry modern theory and
practice

S J Davies

et.al., - Occlusion: Good occlusal practice in simple
restorative dentistry.
British Dental Journal (2001) 191, 365 - 381

REFERENCES

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