Introduction to Occlusion

Continued
Fundamentals of Occlusion & Articulation
Characteristics of an Ideal Occlusion Part II
Basic Structure of the TMJ
Two TMJ: When one moves, the other must move as well.
Sagittal View of Normal TMJ
You cannot successfully
treat dysfunction unless
you understand function.
J.P. Okeson
Normal TMJ Anatomy
The Temporomandibular Joint
Basic Structures
Condyle
Anatomic variations
guide mandibular
movement
Retrodiscal tissue
elasticity
Highly innervated
and vascular
Loading is painful
Trauma can cause
inflammation

TMJ Structures - Sagittal View
The Temporomandibular Disc

Fibrous connective
tissue
Interface between
bones, somewhat
pliable
Bi-concave shape
Collateral ligaments
No Innervation
No Vascularization

Two Accessory Ligaments:
Stylomandibular & Sphenomandibular Ligaments
The stylomandibular ligament limits excessive protrusive movement of the mandible
The sphenomandibular ligament plays a minimal role in limiting mandibular movement
Capsular Ligament
Sagittal View Temporomandibular Ligament
Rotational Movement Limits
Posterior Movement Limits
Limitation of Movement with TM Ligament
Designed to limit the pure hinge axis rotation movement. Full length occurs at
15-20 mm of opening, which has a pivot point at which translation commences.
Anterior View of TMJ
Articular Surface of the Condyle
Sagittal View Articular Disc & Fossa
Terminology Describing Tooth
Position:
MAXIMUM INTERCUSPATION
a.k.a. centric occlusion
(CO)
Habitual occlusion, habitual
centric
Maximum intercuspation
describes an occlusal
relationship
Teeth are contacting in a
position that the patient
finds the most comfortable
Easily achievable, but not
always reproducible, by the
patient

MAXIMUM INTERCUSPATION
What is considered Ideal?

Angle Class I: 1
st
Molars
and Canines
relationship
Adequate Overlap
Long axis of teeth
Simultaneous contact
Posterior tooth
dominance
Anterior tooth
passive contact
Multiple contacts on all
teeth adequately
distributes forces
An occlusal position
If CR and MI do not
coincide, the patient will
have a slide
Most patients have
some degree of a slide
into maximum
intercuspation
(approximately 1-2 mm)
MI is simultaneous
contact
Forces concentrated on
long axis
Posterior contacts
should dominate
Maximum Intercuspation
Term Describing Mandibular
Position
CENTRIC RELATION
Centric Relation
A condylar position
Superior and Anterior
Thin portion of disc
Describes the most
stable position of the
condyle
Superior and anterior
position of the mandible
with the disc properly
interposed


An ideal occlusion
Basic Premises:

When the mandible closes,

1. There is an ideal way for the teeth to contact
2. There is an ideal place for the condyle and
disc to be situated.

In an Ideal Occlusion, CR and MI
Occur Simultaneously.
The condyle seats in CR simultaneous with the
teeth occluding in MI. No slide occurs.
Characteristics of an Ideal Occlusion
Slide from CR to MI
Only 15% of the
population have no CR to
MI discrepancy
After the first contact in CR
(usually on 2 or more
posterior teeth), the
patient continues to close,
and the teeth come
together more completely
(MI). The condyles must
move out of their most
ideal position when the
teeth come fully together.
Terms for Describing Eccentric
Movements of the Mandible
In an ideal occlusion, protrusive
movement is guided by anterior teeth.
Early lateral movements are ideally canine-guided.
Terms for Describing Eccentric
Movements of the Mandible
Lateral movements-
moving the
mandible to the left
or to the right.
Shown is a left lateral movement
Terms for Describing Eccentric
Movements of the Mandible
Lateral movements-

During a left lateral
movement, the left
side of the arch is
considered to be the
working side.
Shown is a left lateral movement
Terms for Describing Eccentric
Movements of the Mandible
Lateral movements-

During a left lateral
movement, the right side
is considered to be the
balancing side or non-
working side.
Shown is a left lateral movement
Terms for Describing Eccentric
Movements of the Mandible

Lateral movements are guided by either:
group function
(secondary choice)
canine guidance (ideal)
Summary of Characteristics of an
Ideal Occlusion
CR and MI occur simultaneously
All teeth contact simultaneously
All occlusal forces are longitudinal
Posterior tooth contacts dominate
Eccentric movements are anterior-
guided
No cross-over contacts on posterior
teeth

Summary of Criteria for an
Optimal Functional Occlusion

Condylar position- Centric relation
Tooth position- Maximum intercuspation
Protrusive movements are guided by
anterior teeth
Lateral movements are canine guided.
Axial loading of occlusal forces
In MI, posterior tooth contacts dominate.
During crossover, guidance is smoothly
transferred to the incisors.
The End