Fundamentals Of

Occlusion
Fahim Vohra
SDS 333
Fundamentals Of Fixed Prosthodontics
Chap 2, Pg 11-23.
 Outline
• Definitions
• Mandibular movement
• Normal vs Pathological Occlusion
• Occlusal Interferences
• Schemes of Occlusion
• Determinants of Occlusion
The Temporo-Mandibular Joints
 Why Is Occlusion Important ?
• Assist in diagnosis
• Planning in restorative care
To minimize failure
Ensure predictable outcome by minimising loads on teeth

Managing the environment so that we get the minimal amount

of surprises (Similar to wearing a car seatbelt), the less the
patient has to adapt the better.
 Definitions

OCCLUSION

A relationship between the masticatory surfaces of the

maxillary and mandibular teeth

The relationship between tooth contacts and mandibular

movements
 Centric Occlusion
Relationship of the mandible to the maxilla when the
teeth are in maximum occlusal contact, irrespective of
the position or alignment of the condyle-disk assemblies.

The relationship between the maxilla and mandible

when the teeth are maximally meshed with the
mandible in its most cranial position
 Centric Relation
A relationship of the mandible to the skull where the
condyle is in an anteriorly, superiorly braced position
along the articular eminence of the glenoid fossa, with
the articular disc interposed between the Condyle and
eminence.
 Mandibular Movements
• Mandibular movements occur around three axes

a) Horizontal axis
b) Vertical axis
c) Sagittal axis
 Horizontal Axis (Rotation)

This movement occurs in the sagittal plane when the

mandible in centric relation makes a purely rotational
opening and closing border movement around the
transverse horizontal axis, which extends through both
condyles.
 Vertical axis (Rotation)

This movement occurs in the horizontal plane when the

mandible moves into a lateral excursion. The center for
this rotation is a vertical axis extending through the
rotating or working-side condyle.
Working side
• The side towards which the mandible moves during excursion
OR Mandible moving toward the cheek
• Working side condyle pivots within the socket and is better
supported.

Balancing side (Non working side)

• The side opposite to the direction in which the mandible
moves OR Mandible moving toward the tongue
• Balancing side condyle has a downward orbiting path and is
more prone to injury or damage.
 Balancing Side Working Side
Condyle has downward path Condyle pivots

Movement direction
Mandible and TMJ
 Sagittal Axis

This movement occurs when mandible moves to working side,

the condyle on the opposite side (Non working side) travels
forward and downwards simultaneously. When viewed in the
frontal plane, this produces a downward arc on the non working
side, rotating about an anteroposterior (sagittal) axis passing
through the other condyle
 Pure Hinge Movement
It occurs as the result of the condyles rotating in the
lower compartments of the temporomandibular joints
within a 10- to 13-degree arc, which creates a 20- to
25-mm separation of the anterior teeth
 Translation Movement
• Occurs when the mandible moves forward (protrusion)
• Teeth, condyles, and rami, all move in the same direction and
to the same degree.
• Occurs within the superior cavity of the joint
 Maximum Opening
(Translation & Rotation)

Occurs in the upper compartment of the joint as the mandible

drops down farther . Then the horizontal axis of rotation shifts to
the area of the mandibular foramen, as the condyles translate
forward and downward while continuing to rotate.
 Protrusive Position
When the mandible slides forward so that the
maxillary and mandibular anterior teeth are in
an end-to-end relationship, it is in a protrusive
position.
 Bennett Movement
It is defined as “the bodily lateral movement/
lateral shift of mandible resulting from
movements of condyles along lateral inclines of
mandibular fossa during lateral jaw movement”
Dr Norman Bennett
 Bennett Angle
The angle formed between the sagittal plane and the
average path of advancing condyle as viewed in the
horizontal plane during lateral mandibular movements.
Average range is 7.5-12.8 degree

BSC WSC

Bennett angle

Sagittal plane
Posterior Determinant of Occlusion
TMJ – Temporomandibular Joint
Bony surfaces

The dentist has no control on the

posterior determinants i.e. TMJ
Anterior Determinant of Occlusion
Teeth
• Incisors
• Canines
• Premolars
• Molars
 Anterior Determinants Of Occlusion
Posterior teeth
Provide vertical stops
Guide mandible to CO

Anterior teeth
Guide mandible in protrusive, retrusive and lateral
excursions

The closer the tooth located to a determinant , more it

will be influenced by it.
 Occlusal Interferences
• Interferences are undesirable occlusal contacts that may
produce mandibular deviation during closure to maximum
intercuspation or may hinder smooth passage to and from the
intercuspal position .
• These can be of following types

a) Centric
b) Working
c) Non working
d) Protrusive
 Centric Interferences
It is a premature contact that occurs when the mandible
closes with the condyles in their optimum position in the
glenoid fossae (CR) . It will cause deflection of the
mandible in a posterior, anterior, and/or lateral direction
 Working Side Interference
It occurs when there is contact between the maxillary
and mandibular posterior teeth on the same side of the
arches as the direction in which the mandible has
moved. If that contact is heavy enough to dis-occlude
anterior teeth, it is an interference .
 Non-Working Side Interference
• It is an occlusal contact between maxillary and mandibular
teeth on the side of the arches opposite the direction in which
the mandible has moved in a lateral excursion .
• It has the potential for damaging the teeth, PDL, MOM and
TMJ due to changes in the mandibular leverage, the
placement of forces outside the long axes of teeth and
disruption of normal muscle function.
 Protrusive Interference
• It is a premature contact occurring between the mesial
aspects of mandibular posterior teeth and the distal aspects
of maxillary posterior teeth .
• The proximity of the teeth to the muscles and the oblique
forces make them potentially destructive.
• They also interfere with the patient's ability to incise properly
Ideal vs Pathologic
Occlusion
 Ideal Occlusion
An ideal occlusion should provide comfort and function in
a predictable way.

1) Ideal occlusion at tooth level

Cusp tip to fossa or cusp to marginal ridge contact – i.e no incline
contacts

2) Ideal occlusion at articulatory system level

Posterior stability, Anterior guidance, Lack of posterior
interferences.

3) Ideal occlusion at patient level

Within the adaptability of the rest of the articulatory system.
 Features Of Ideal Occlusion
A) Anterior Guidance:

• In lateral excursions of the mandible, working-side

contacts (preferably on the canines) disocclude or
separate the nonworking teeth instantly.

• In protrusive excursions, anterior tooth contacts

will disocclude the posterior teeth.
Protrusive Guidance

Excursive Guidance
 Features Of Ideal Occlusion
B) Posterior stability:

Enough posterior teeth in each arch with solid and stable

contacts in appropriate positions to evenly distribute loads and
to allow the mandible to close in a reproducible CO. Posterior
teeth contact more heavily than anterior teeth

It is enhanced by tall cusp – deep fossa

Maintains teeth position

CO or ICP is easily reproduced
Increased masticatory function

Signs of lack of PS, drifting, fremitus, fractured rest, mobility & wear
Lack Of Posterior Stability
 Features Of Ideal Occlusion

C) Absence of posterior interferences

The non-working
side
 Features Of Ideal Occlusion

D) Centric Occlusion is achieved at centric

relation position

E) Occlusal loads are axially transmitted through

the teeth
 Organization Of Occlusion
• There are three recognized concepts that
describe how teeth should contact in various
mandibular positions

1. Bilateral balanced occlusion

2. Unilateral Balanced occlusion
(Group function)
3. Mutually protected occlusion
(Canine protected)
 Bilateral Balanced Occlusion
• It dictates that a maximum number of teeth
should contact in all excursive positions of the
mandible.
• Use for complete denture occlusal scheme as
contacts on non-working side prevent tipping
of the denture
• Not used for fixed prosthodontics, as very
difficult to achieve
 Unilateral Balanced Occlusion
• Also called group function
• It requires teeth on the working side to be in
contact in lateral excursion and teeth on the
non-working side are free of any contact.
• Avoids destructive , oblique forces on the non-
working side.
• Prevents wear of maxillary palatal and
mandibular buccal cusps
 Mutually Protected Occlusion
• Also called canine protected occlusion
• Anterior teeth overlap prevents the posterior teeth
from making any contact on either the working or
the nonworking sides during mandibular excursions.
• Anterior teeth bear all the load and the posterior
teeth are dis-occluded during excursions. Protecting
the posterior teeth
• In CO, posterior teeth direct forces through their long
axis and anterior teeth are slightly in or out of
contact. Protecting the anterior teeth.
 Guidance
Describes the influenced path the mandible
takes as a result of the contacting surfaces
of the teeth. Depending on the contact and
shape of the teeth they should be in
harmony
 Protrusive Guidance
Influenced path the mandible takes as a
result of a forward thrust
 Lateral Guidance
• Canine
• Describes the way in which lateral
excursions are affected by tooth to tooth
contacts involving the canine teeth only
resulting in disclusion of the posterior teeth
 Lateral Guidance

• Group function
• When lateral
excursions are
guided by more
than one tooth
other than the
canines
 Hanau’s Quint

By modifying the following five factors, a scheme of occlusion can

be developed that will suit a particular patient best.

1. Condylar guidance
2. Incisal guidance
3. Occlusal plane orientation
4. Compensating curves
5. Height of the Cusp

Except for the condylar guidance, all other factors can be modified during the
fabrication of a prosthesis and the anterior guidance plays a predominant role.
 Anterior Guidance
• Guidance produced by the teeth themselves and not the
temporomandibular joint (can be on any tooth)

• The influence of contacting surfaces of anterior teeth on

mandibular movements.

• The influence of contacting surfaces of the guide pin and

anterior guide table on articulator movements.

• The fabrication of a relationship of the anterior teeth

preventing the posterior tooth contact in all eccentric
mandibular movements.
 Effects Of Anatomic
Determinants Of Occlusion
 Protrusive Incisal Path

The track of the incisal edges of

the mandibular teeth from
maximum intercuspation to
edge-to-edge occlusion.
 Protrusive Incisal Path Angle

The angle formed by the protrusive incisal path and the horizontal
reference plane is the protrusive incisal path inclination. It
ranges from 50 – 70 degrees and is often 5-10º steeper than
the sagittal condylar guidance.
 Incisal Guide Angle
The angle formed with the horizontal
plane of occlusion and a line in the
sagittal plane between the incisal
edges of maxillary & mandibular
central incisors when the teeth are in
maximum intercuspation.

The angle formed in the sagittal plane

between the horizontal plane and the
slope of the incisal guide table.
 Importance of Anterior Guidance

Opening and closing of the mandible is simply a rotation of the

condyles in the articular fossae.
 Importance of Anterior Guidance

As anterior guidance is normally steeper than the condylar guidance, the

anterior teeth guide the mandible downwards during protrusive or lateral
movement
and ..
 Importance of Anterior Guidance

(during protrusive movement)

.. produces dis-occlusion or separation of the posterior teeth.
Importance of Anterior Guidance
(during lateral movement)
 Importance of Anterior Guidance
Anterior guidance is linked to the combination of
horizontal & vertical overlap of the anterior teeth
and
can affect the occlusal surface morphology of
the posterior teeth.
 Inter-relationship with Vertical & Horizontal Overlap of the
Anterior teeth

Anterior guidance can be made steeper by either increasing the vertical

overlap (overbite) ‘A-B’, or by reducing the horizontal overlap (over
jet) ‘C-A’ of the anterior teeth.
Anterior guidance can be made shallow by either decreasing the overbite
‘B-A’ or increasing the over jet ‘A-C’ of the ant. teeth.
Condylar Guidance & Posterior tooth Morphology
(without considering the role of A.G.)

Shallow condylar guidance normally requires shallow cusp

angle or short cusp height and steeper condylar guidance
requires steep cusp angle or longer cusp height.
 Condylar side-shift & Posterior tooth Morphology
(without considering the role of A.G.)

‘side shift +’ ‘No side shift’

Similarly, in the presence of an immediate lateral side shift during lateral
movement (Bennett’s movement) the cusp height and cusp angle
should be shallow.
Influence of Anterior Guidance on
Posterior tooth Morphology
 Influence A.G. on Posterior tooth Morphology
(Effect of Overbite)

Greater overbite produces more Less overbite – less disocclusion –

disocclusion hence permits longer shorter Cusp height.
cusp height
 Influence of A.G. on Posterior tooth Morphology
(Effect of Over jet)

Greater over jet necessitates shorter Less over jet allows for long
cusp height. cusp height.
 Influence of A.G. on Posterior tooth Morphology

Summarizing,

greater anterior guidance allows posterior teeth to have

longer cusp height
&
smaller anterior guidance requires posterior teeth to have
shorter cusp height.
 Influence of A.G. on Posterior tooth Morphology

By increasing the anterior guidance angle to compensate for

inadequate or shallow condylar guidance, it is possible to
increase the cusp height of the posterior teeth.
Influence of A.G. on Posterior tooth Morphology

Similarly, increasing the anterior guidance will permit

lengthening of the cusp that otherwise have to be shorter in
the presence of pronounced immediate lateral translation of
the condyles.
THANK YOU