OCCLUSION IN FPD

PRESENTED BY:DR FEMITHA SYED GUIDED BY:DR INDU RAJ

JUNIOR RESIDENT HOD

DEPT OF PROSTHODONTICS,GDC KOTTAYAM

 INTRODUCTION

 The study of occlusion is an important aspect of dentistry.

 
 Occlusion is the integrated relationship of the tooth, periodontium, TMJ and
neuromusculature, and not merely the interdigitation of teeth.

 It is important to know what constitutes normal occlusion in order to be able

to recognize abnormal occlusion
Occlusion

 the act or process of closure or of being closed or shutoff

 the static relationship between the incising or masticating surfaces

of the maxillary or mandibular teeth or tooth analogues.(GPT 9)

Ramfjord and Ash- “multifactorial functional relationship
between the teeth and other components of the masticatory
system as well as with other areas of the head and neck that
directly or indirectly relate to function, parafunction or
dysfunction of the masticatory system.”

Hobo(1978)Ideal occlusion can be defined as an occlusion which is

compatible with stomatognathic system providing efficient
mastication and good esthetics without creating physiologic
abnormalities.
 Articulation
The static and
dynamic contact
relationship between
the occlusal surfaces
of the teeth during
function.(GPT 9)

FUNCTIONAL ARTICULATION is defined as the occlusal

contacts of the maxillary and the mandibular teeth during
mastication and deglutition.
 The contact of the maxillary and mandibular teeth in various
functional (mandibular) movements is an important
relationship that should NOT be traumatic to the supporting
tissues and should allow an even load distribution
throughout the dental arch.
CENTRIC RELATION/TERMINAL HINGE
POSITION (THP)

 a maxillomandibular relationship, independent of tooth contact

,in which the condyles articulate in the anterior-superior position
against the posterior slope of the articular eminences ;in this
position ,the mandible is restricted to a purely rotary movement
;from this physiologic,unstrained maxillomandibuar relationship
the patient can make vertical ,lateral or protrusive movements ;it is
a clinically useful ,repeatable reference position(GPT 9)
•This position is independent of tooth contact.
•bone to bone relation
•This position is clinically discernible when the
mandible is directed superior and anteriorly.
• It is restricted to a purely rotary movement
about the transverse horizontal axis (GPT-5)
MAXIMAL INTERCUSPAL POSITION
(MIP)

 The complete intercuspation of the opposing teeth independent of condylar

position, sometimes referred to as the best fit of the teeth regardless of the

condylar position, (GPT 9)

 tooth to tooth relation

CENTRIC OCCLUSION

 The occlusion of opposing teeth when the mandible is in

centric relation. This may or may not coincide with the
maximal intercuspal position.(GPT 9)
clear from the definitions When fixed and removable prosthesis are
that in natural dentition, MI fabricated with existing natural teeth
position need not coincide
with CR.

Prosthesis made to coincide with the

MI position is made to coincide
with CR only when there are existing normal MI position, if
insufficient occlusal contacts sufficient natural teeth are present to
existing to guide the occlusion
guide the occlusion.

 different from complete dentures where MI position is given at CR

Development of concept of occlusion

Three periods:
 1. Fictional period (prior to 1900)
 2. Hypothetical period (1900-1930)
 3. Factual period (1930 to present)
Concepts of occlusion

 Gnathology
 Transographics
 Cranial orthopedics
 Lauritzen
 Guichet
 Posselt
 Gerber
 Biological occlusion
 Panky-mann-schuyler philosophy
CLASSIFICATION OF OCCLUSION

For many years, the standard classification for occlusion has

Angle’s classification of malocclusion been Angle`s classification of malocclusion.

Dawson's classification Analysis of any occlusion requires careful inspection of

MIP in relation to both the position and condition of the
TMJs.
 Type I: Maximal intercuspation is in harmony with centric relation.

Type IA: Maximal intercuspation occurs in

harmony with adapted centric posture
 Type II: Condyles must displace from a verifiable centric relation
for maximum intercuspation to occur.

Type II‑A: Condyles must displace from an

adapted centric posture for maximum
intercuspation to occur.
 Type III: Centric relation cannot be
verified.

 Type IV: The occlusal relationship is in

active stage of progressive disorder because
of pathologically unstable TMJs
COMPONENTS OF OCCLUSION

The various elements that are involved in occlusion, such as

 TMJ
 Associated musculature
 Teeth ;their contacting surfaces and
 Investing tissues and or the denture supporting structures.
 ANATOMY OF TMJ

 It is a compound type of ginglymo-arthroidal synovial joint.

 The disc consists of three regions of which center portion is thinnest

and devoid of nerves and blood vessels

 The posterior portion of the disc it attached to loose connective tissue

which is vascularized and innervated called the retro discal tissue
MANDIBULAR MUSCULATURE

 These are essentially the muscles which hold

the mandible in space during function.
Mandibular Movements

 Mandibular movements occur around three axes

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

 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)

 lateral excursion
 The center for this rotation is a vertical axis extending
through the rotating or working-side condyle.
 Sagittal Axis

 occurs when mandible moves to working side, the condyle on

the opposite side (Non working side) travels forward and
downwards simultaneously.
 ENVELOPE OF MOTION

 When we combine the border movements of the three planes, we

get a 3 dimensional space within which mandibular movements is
possible.

 described by POSSELT in 1952.

Mandibular Movements

 With the condylar rotation and translation, the mandible is capable

of performing the following movements:
 1-Opening
 2-Protrusive
 3-Lateral Excursions: right and left
 Opening Movement

condyle rotates in its Pure rotation occurs MANDIBLE

place, in the only till the condyles OPENS
terminal hinge start to translate moving
position. out of its centricity
 pure rotation ends, the condyle begins to
translate, against the walls of the glenoid
fossa

till maximum
opening arc of opening
position changing MANDIBLE
FURTHER OPENS
Protrusive Movement

Condyles follow the form slide downwards and

of the superior wall of the forwards as the mandible
glenoid fossa moves in protrusion

 separation of the posterior teeth, a state known as Disclusion

Ideally, the anterior segment of the mandible will travel a

path guided by contacts between the anterior teeth, with
complete disocclusion of posterior teeth
 Lateral Excursion Movement

 mandible is capable of moving towards both the right

and left sides

 Working side - the side to which the mandible

moves during function, also called as
laterotrusive
 
 Non-working side – that side of the mandible
which moves medially or towards the tongue
during function, also called mediotursive
 Balancing Side Working Side
Condyle has downward path Condyle pivots

Balancing side. Working side.

Condyle has downward path. Condyle pivots.

Mandible &TMJ
A8

Movement direction
 Bennet movement- The bodily shift of the mandible in the direction of the
working side was first described by Bennett.

 The presence of the immediate or early lateral translation side shift has been
reported in 86% of the condyles studied.
 
 Following the immediate lateral translation, there is a further gradual shifting
of the mandible or progressive lateral translation, -“progressive side shift” or
“Bennett side shift”.
 Determinants of Occlusion

[Link]
Determinants of
Occlusion:
The effect of anatomy of
the TMJ on the
mandibular movements
and tooth morphology
[Link]
Determinants
of Occlusion:
The effect of
occlusion on
mandibular
movements and
tooth
morphology
Posterior Determinants of Occlusion
As the condyle moves out of centric relation, it descends along
the articular eminence of the mandibular fossa.
The arc at which it moves inferiorly as the mandible is being
protruded depends on the steepness of the articular eminence.
If very steep- condyle describes a steep vertically inclined path
If flatter-condyle will take a less vertically inclined path
Angle at which condyle moves away from horizontal reference
plane-condylar guidance angle
 
 The two TMJs provide the guidance for the posterior portion of the
mandible and are largely responsible for determining the character of
mandibular movement posteriorly.

 The condylar guidance is considered to be a fixed factor, since in the

healthy patient it is unalterable.
 
 Protrusive condylar path can be steep or shallow.
 If protrusive condylar path is steep, cusp height must be longer &
vice versa.
 If immediate lateral translation is great, then cusp height must be
shorter & vice versa.
Effect of distance from working condyle on ridge
and groove direction
 Effects are observed on the occlusal surface of a
mandibular molar and premolar with the paths traced by
the palatal cusps of the respective maxillary teeth
 The working path(laterotrusive) traced in a lingual
direction
 Nonworking path(mediotrusive)-distofacial direction

Nearer the tooth to the working side condyle-smaller the

angle between working and non working paths
Effect of intercondylar distance on ridge and
groove direction

 Greater the intercondylar distance-smaller

angle between laterotrusive and
mediotrusive pathway
Anterior Determinants of Occlusion:

 Overlap of the Anterior Teeth- Incisal guidance (overbite & overjet)

 Occlusal Plane
 Curve of Spee
 Facial Position of Teeth-distance from mid [Link]
 The track of incisal edges of mandibular to maxillary anterior teeth
from maximum intercuspation to edge to edge occlusion is called
as protrusive incisal path.

 Angle formed between protrusive incisal path & horizontal

reference plane is called as protrusive incisal path inclination.
 The steepness of the lingual surfaces determines the amount of
vertical movement of the mandible.
 If the surfaces are very steep, the anterior aspect of the mandible
describes a steep incline path.
 If the anterior teeth have little vertical overlap, they provide little
vertical guidance during mandibular movements.
 The anterior guidance is considered to be a variable rather than a
fixed factor
 It ranges from 50 to 70 degree.

 In healthy occlusion, anterior guidance is 5 to 10

degree steeper than condylar path in sagittal plane.

 Therefore when mandible moves protrusively, anterior

teeth guide mandible downward to create disocclusion
in posterior teeth.
 Anterior guidance affects the occlusal
morphology of posterior teeth.

 Greater the vertical overlap of anterior

teeth, longer is posterior cusp height.

 Greater the horizontal overlap of anterior

teeth, shorter is posterior cusp height.
By increasing anterior guidance to compensate for inadequate condylar
guidance, it possible to increase cusp height.

If protrusive condylar inclination is shallow, requiring short posterior

cusps, cusps may be lengthened by making the anterior guidance steeper

Increasing anterior guidance will permit the lengthening of cusps that

would otherwise have to be shorter in presence of pronounced immediate
lateral translation.
Effect of plane of occlusion on cusp height
 More parallel the plane of occlusion to condylar guidance-
shorter the posterior cusps

Effect of curve of spee on cusp height

Longer radius flatter plane of occulssion

greater the angle at which mandibular posterior teeth

move away from maxillary posterior teeth taller
cusps

Shorter radius acute plane of occlusion

smaller angle of mandibular posterior tooth movement

flatter teeth
Facial position of teeth-Effect of distance from midsagittal
plane on ridge and groove direction

 Further the distance from midsagittal plane increased

angle between latertotrusive and mediotrusive pathway
Effect of the determinants on tooth
morphology
Effect of the determinants on tooth
morphology
 Criteria for optimum functional occlusion

 Described as even and simultaneous contact of all

possible teeth when the mandibular condyles are in
their most superoanterior position, resting against the
posterior slopes of the articular eminences, with the
discs properly interposed.
Optimal functional tooth contacts

1)Direction of force
If a tooth is contacted such that the resultant forces are directed
through long axis (vertically),the periodontal ligaments is quite
efficient in accepting the forces and breakdown is less likely.
Cusp tip contact flat surface:
 The resultant force is directed vertically
through long axis of teeth.
 This type of force is well accepted by
periodontal ligament.

When opposing teeth contact on inclines

 the direction of force is not through the
long axis of teeth.
 Instead tipping forces are created that tend
to cause compression (A) of certain areas
of periodontal ligament and elongation
(B) of other areas .
 The process of directing occlusal forces
through the long axis is known as Axial
Loading .
 It can achieved in two methods :

1)Through the development of contacts on

either cusp tips or relatively flat surfaces
that are perpendicular to the long axis of
the tooth.
2) The other method is Tripodization
 It is logical to see but difficult to accomplish
(Burch1980)
 requires each cusp contacting an opposing fossae to be
developed-Such that it produces three contacts
surrounding the actual tip.
2) Amount of force
 The lever system of the mandible can be compared to a
nutcracker This demonstrates that greater forces can be
applied to an object as its position nears the fulcrum.
 Whereas the fulcrum of the nutcracker is fixed, the fulcrum
(the TMJ) of the masticatory system is free to move.

 As a result, when heavy forces are applied to an object on the

posterior teeth, the mandible is capable of shifting downward
and forward to obtain the occlusal relationship that best
completes the desired task.

 This shifting of the condyles creates an unstable mandibular

position.
 Additional muscle groups such as the inferior and superior lateral pterygoid
muscles and the temporal muscles are then called on to stabilize the
mandible.
 

 The damaging horizontal forces of eccentric movement must be directed to

the anterior teeth, which are position farthest from the fulcrum and the force
vectors, since the amount of force that can be applied to the anterior teeth is
less than that which can be applied to the posterior teeth the likelihood of
breakdown is minimized.
 
 3) Postural considerations and functional tooth contacts:

 The postural position of the mandible during inactivity.

 Itis generally 2-4mm below the intercuspal position ,influenced to some degree
by head position.

 patientreclined in a dental chair- the mandibular postural position and resultant

occlusal condition may be slightly posteriorly oriented.

 alertfeeding position -mandible assumes a slightly anterior postural position,

activity of the elevator muscles will result in heavier anterior tooth contacts.
 When this occurs, the anterior contact must be reduced until the posterior teeth
again contact more heavily in normal closure.
 Summary of optimal functional occlusion

1. In closure, condyles are in most superoanterior position against the discs on

posterior slopes eminence of glenoid fossae.

2. Posterior teeth are in solid & even contacts, anterior teeth are in slightly lighter
contact.

3. All tooth contacts provide axial loading of occlusal forces.

4. In lateral excursions, working side contacts disocclude or separate
the non working side instantly.

[Link] protrusive excursions, anterior tooth contacts will disocclude the

posterior teeth.

[Link] upright posture, posterior teeth contact more heavily than do

anterior teeth
 60
Organization of occlussion

Three occlusal concepts have been established throughout clinical trials and
conceptual theories(Pameijer 1983; Santos 1985; Hobo et al.1989)

– Bilaterally Balanced Occlusion

These can be
- Unilaterally Balanced Occlusion
categorized as

- Mutually protected Occlusion

• However, since restorative treatment requirements vary, the clinician should understand
possible combinations of occlusal schemes and their advantages, disadvantages, and indications .
 61
Bilaterally Balanced Occlusion
 BILATERAL BALANCED OCCLUSION

 Bilateral, Simultaneous, Anterior and Posterior

Occlusal Contact of Maxillary and Mandibular Teeth
in Centric and Eccentric Position
 The concept of balanced occlusion credited to
Ferdinand Graf Spee
 earliest proposed theories
 earlier applied to natural dentition, now limited to
complete denture
w NW
 there was a high rate of failure in fixed prosthodontics

 Failure was due to Increased occlusal wear,

Increased/accelerated periodontal breakdown, TMJ and
neuromuscular disturbances
The Demise of Balanced Occlusion in
restoring natural dentition

 Clyde Schuyler(1929) believed in harmony between centric relation

and centric occlusion and said that such arrangements would result in
high efficiency in mastication

 But he recognized the essential differences between edentulous and

dentulous conditions.

 This concept was referred to as Functionalism

 By 1953 he began to observe failure of natural dentition restored
with balance .

 He said that he failed to see the value of nonfunctional contacts

 His observations and suggestions effectively signaled the end of

BALANCE as a acceptable treatment approach for the dentulous
patient
Stuart and Stallard (1960)noted that balanced occlusion in reconstructed natural
dentitions :

 Often required injudicious increase in occlusal vertical dimension to achieve

balance.

 Often led to instability of occlusion.

 Frequently showed increased wear of teeth and restorations

 Provided poor group usage of teeth.

 Extraordinary technical demands

 Esthetic character of the restored occlusions was not satisfactory .

 67
Unilaterally Balanced Occlusion
 UNILATERAL BALANCED
OCCLUSION/ GROUP FUNCTION

 The most desirable group function consists of canine, premolar and

mesiobuccal cusp of first molar

 Horizontal pressures during lateral movements are distributed to one

half of the arch on the working side.

 This scheme eliminates cross tooth and cross arch balance seen with
balanced occlusion
 Advantages:

 Group function of the teeth on the working side distributes the occlusal
load

 The absence of contact on the nonworking side prevents those from getting
subjected to destructive, obliquely directed forces found in nonworking
interferences.

 It also saves centric holding cusps that is mandibular buccal cusps and
maxillary palatal cusps from excessive wear
 Group function was felt to be goal for occlusal adjustments and
has easy application
 In the presence of anterior teeth bone loss or missing canines,
mouth should be restored to group function
 Due to these factors, this concept had broad support from Pankey , Mann and
Schyluer(1960) Ramjford, Ash(1966), POSSELT(1968), and LAURITZEN(1974).

 It has been adapted by PANKEY and MANN for complete mouth rehabilitation

 Group Function Occlusion doesn’t have the harmful effects as seen with Balanced
Occlusion and is not as difficult to fabricate as a Mutually Protected Occlusion.
 Characteristics of Group Function Given by
BEYRON (1954)

 Teeth should receive stress along the tooth long axis

 Total stress should be distributed among the tooth segment in lateral movement
 No interferences occur from closure into intercuspal position
 Keep proper interocclusal clearance
 Teeth contact in lateral movement without interferences
 He felt that no single occlusion could serve as a general basis of every individual
 It was suggested that some Freedom of movement in an
anteroposterior direction should be allowed. This evolved into:

Theory of Long centric

 Maximum intercuspation and centric relation are not coincident but

flat areas on the depth of the fossae, on which opposing cusps occlude,
will allow for a certain degree of freedom in both centric and eccentric
movements without the guiding influences of occlusal inclines
 Long centric is 0.5mm to 1.5 mm free space between maximum
intercuspation and centric relation position, without changing vertical
dimension of occlusion
Advantages:

 Freedom to close the mandible in centric relation or slightly anterior to it

without varying vertical dimension.
 If no freedom in centric, the lower incisors may strike the lingual inclines of
upper incisors in a manner that has a tendency to wedge the upper teeth
labially .
 It is this wedging effect that causes most of the instability in occlusions not
provided with a long centric
 Three dimensional aspect of Freedom in Centric Concept.

 There may be freedom in Mesial (M), Distal (D), Lateral (L) and
Median (Md) directions from a centric contact

(a) Locked in occlusion

(b) Freedom in centric occlusion

BRITISH DENTAL JOURNAL, VOLUME 191, NO. 5, SEPTEMBER 8 2001

MUTUALLY PROTECTED OCCLUSION
 MUTUALLY PROTECTED OCCLUSION

 Posterior teeth function most effectively in stopping the mandible

during closure whereas anterior teeth function most effectively in
guiding the mandible during eccentric movements.

 It is apparent that the posterior teeth should contact slightly more

heavily than anterior teeth in centric relation.

.
Stuart(1960) found patients over 60 yrs old without attrition and studied their occlusion:

 He observed that molars did not contact during eccentric movements but in maximum
intercuspation they contacted
 The molars were said to be responsible for bearing the vertical occlusal loads

Stallard(1961) found that anterior teeth protect the posterior teeth and the posterior teeth protect
the anterior.

 The concept of mutually protected teeth was based on this observation

 The centric stops on the posterior teeth also help to prevent excess stress loading transferred
to TMJ

 The incisors protect the canine and posterior teeth during Protrusion
Lucia in 1961 described the Advantages of mutually protected occlusion

 Minimum amount of tooth contact is involved –therefore better penetration of

food

 A cusp to fossa relationship produces an interlocking of upper and lower

components- giving a maximum support in centric relation in all directions

 The force is clearly closer to the long axis of each tooth

 The arrangement of the marginal, transverse and oblique ridges have a shearing
action -make a more efficient chewing apparatus
 CANINE PROTECTED OCCLUSION

 began in 1919 with the work of Nagao.

 This was reinforced by Shaw in 1924

 gained most of it’s concepts after the extensive work of D’Amico in 1958.
 This theory suggests that the only tooth contact in all positions of
the mandible except CR should be between maxillary cuspids and
mandibular cuspids.
 Thus he called canine as NATURE’S STRESS BREAKER.
WHY CANINE??

 Long roots
 Good crown to root ratio
 Surrounded by dense compact bone which tolerates forces better.
 Location is far from the TMJ thus receiving less stress .
 It has many receptors in the periodontal ligament so it controls lateral
pressure by directing vertical masticatory movements.
 D’Amico also claimed that proprioceptors of the periodontal ligament
associated with the canine teeth are far more responsive than those of
any other teeth
 Another advantage is it appears that fewer muscles are active when
canines contact during eccentric movements than when posterior teeth
contact.
Nature's Biofeedback Mechanism:
 There is a biofeedback mechanism that comes into play.
 When the canines touch, nerves send a message back to the brain which
in turn sends a message to the muscles that close the jaw and then the
muscles relax.
 When you take away that canine protection, the muscles stay active.
 That's when you can get clenching, grinding of the teeth, joint pain,
fracturing of teeth, excessive wear of the enamel on top of the tooth,
erosion of the root surface (abfractions), and gingival recession.

 In many patients, canines however are not in proper position to accept

horizontal forces.

 The most favorable alternative to canine guidance is group function.

Limitations:

 Controversy arises whether or not the canine should be the only tooth to bear
the pressures during lateral excursion

 Missing canine and prosthetic canine

 If periodontium is compromised .

 Class 2 or 3

 Cross bite
Dawson (1974) stated that,

 “When canines cannot be used, lateral movements have posterior dïsclusion guided by
anterior teeth on the working side, instead of canine alone”
 He called this “Anterior Group Function”

Dawson presented his Theory Of Nutcracker

 The farther the nut (anterior teeth) was from the fulcrum (condyles), the lesser would be the
force exerted on the nut.

 The more anterior the initial tooth contact, Class III lever, longer the lever arm and hence the
force exerted by the musculature will be less effective, therefore the load placed on the teeth
will also be small.
 Stuart and Stallard (1961) modified features of mutually protected occlusion
and coined the term “ORGANIC OCCLUSION” in which Centric relation
and maximum intercuspal position coincide.
 The aim of the Organized Occlusion is to relate the teeth to be in harmony
with the muscles and joints in function.
 The muscles and joints should determine the mandibular position of occlusion
without tooth guidance.
Organic occlusion features by
THOMPSON (1967) are:
 CRP and MIP are coincident
 Posterior teeth are in a cusp fossa relation, one tooth to one tooth
contact
 Each functional cusp contacts the occlusal fossa at three points
 In protrusion maxillary incisors guide the mandible and disocclude the
posteriors
 In lateral movements – lingual surface of maxillary canine glides along
the distal inclines of mandibular canine and mesial ridge of 1st
premolar cusp
 BIOLOGIC OR PHYSIOLOGIC OCCLUSION:

 It is defined as an occlusion in which a functional equilibrium or state of

homeostasis exist between all tissues of masticatory system.

 A physiologic occlusion implies a balance between occlusal stress and

tissue resistance .

 The biologic processes and local environmental factors are in balance.

 92
RESTORING DIFFERENT COMBINATIONS

Prosthesis Position Articulator and Occlusal

ICP/CR records morphology
Single crown ICP Simple hinge Conform to
occlusal
Morphology
FPD- one ICP Semiadjustable “
quadrant /anterior
guidance
Several Long centric Fully Group function is
quadrants adjustable/ant desired/cusp to
guidance and fossa
condylar
guidance
 93
Normal vs Pathologic occlusion
slightly more than
10% of the majority of the population, maximum
population complete In the absence
intercuspation deflect mandible away
harmony between of symptoms
teeth and TMJ
from its optimum position.

physiologic or normal
a normal occlusion
turns pathologic and
[Link] function of the manifest as
neuromuscular system that avoid Muscle hypertonicity
premature contacts Muscle fatigue
[Link] will be within Muscle spasm
most people’s physiologic Chronic head ache Muscle
capacity tenderness
TMJ dysfunction.
Signs & symptoms :

Following symptoms can help to confirm the diagnosis –

1. Teeth- hyper mobility,open contacts,abnormal wear

2. Periodontium-widened pdl space,isolated/circumferential periodontal

defects

3. Musculature-acute/chronic muscular pain,trismus

4. TMJ-pain,clicking or popping sound,unilateral clicking with midline

deviation

5. MPDS
 Patient adaptability

 Most of the patients are able to adapt small occlusal

deficiencies without exhibiting acute symptoms.

 Lowered threshold :Patients with a low pain

threshold do not present much difficulty in diagnosis.
They readily identify every pain.
Raised threshold :

 Individualswho have adapted to existing malocclusion may be

comfortable with their dentition, although numbers of signs are
evident.
 Even in the absence of pain however, occlusal treatments may
be advised to prevent or minimize wear on the teeth and damage
to the musculature or TMJs.
 97
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.

 Four types of interferences:

 98
Centric Interference

 Mandible is closed in centric relation until initial tooth Maxillary mesial-

facing cusp incline
contact occurs. and mandibular distal
facing inclines

 If increasing the closing forces deflects the mandible,

premature contact or interference exists.

 Leads to deflection of the mandible, can be in a

posterior, anterior and/or lateral directions.
 99
Working Interference

 Occurs when there is contact between the maxillary and

mandibular posterior teeth on the working side and this
causes anterior teeth to disocclude.

Maxillary palatal
facing cusp incline and
mandibular facial
facing cusp inclines
 100
Non-Working Interference

 Occurs when there is contact between the maxillary and

mandibular posterior teeth on the non- working side when the
mandible moves in lateral excursions.

 Destructive in nature.

Maxillary facial facing cusp

inclines and mandibular
lingual facing cusp inclines
 101
Protrusive Interference

• Occurs when distal facing inclines of maxillary posterior

teeth contacts the mesial facing inclines of mandibular
posterior teeth during protrusive movement.

• These are destructions forces

 102
Occlusal Interferences

 Interferences may lead to pathologic occlusion and should be

assessed and corrected if needed, with the aid of mounted
diagnostic casts before prosthetic rehabilitation is commenced.
 Review of literature

 The influence of the incisal path on any tooth path was consistently greater than that of the condylar path.

 The condylar path had a greater influence on the paths of posterior teeth than on the paths of anterior teeth,
especially in the female subjects.

 The influence of the condylar path on the molar paths was twice as great in the female than that in the male
subjects.

 It was concluded that the influence of the incisal and condylar guidance on the protrusive movement path varies
according to the kind of tooth and the gender of the subject.
 In this study, 14% of the subjects exhibited canine protection, 16% a pattern called progressive
disclusion, 46% group function, and 24% a different disclusion pattern on each side.

 The teeth of mouths having canine-protected occlusions had significantly lower mean periodontal
disease index scores than the teeth of mouths having progressive disclusion or group function.
 The most commonly evaluated lateral occlusion schemes were canine-guided occlusion (CGO) and
group function occlusion (GFO).

 CGO was associated with narrower mastication and less EMG activity of the masticatory muscles
during clenching.

 GFO was associated with wider mandibular movement and quicker mastication.

 During mastication, there was no difference in EMG activity between the 2 lateral occlusion schemes.

 Furthermore, the long-term studies indicated that there is no difference between the 2 schemes in
patient comfort and restoration longevity.
 2021 The Journal of Indian Prosthodontic Society

 This study aimed to evaluate the combined influence of condylar and incisal
guidance in canine-guided and group function occlusal schemes

 Conclusions: Within the limitations of the present study, condylar guidance was similar
in subjects with both schemes of occlusion, whereas steeper incisal guidance was
noticed in canine-guided individuals as compared to group function.
Conclusion

 Unfortunately the occlusion of teeth is frequently overlooked or

taken for granted in providing restorative treatment to the patient .
 The perfection of skills required to provide sophisticated treatment
of complex occlusal problems may take years to aquire.
 How ever the minimum expectation of the competent practioner is
the ability to diagnose and treat simple occlusal disharmony.
 The practioner must be able to produce restoration that will avoid
creation of iaotrogenic occlusal disease
References

1. Fundamentals of fixed prosthodontics. Shillingburg HT 2nd edition.

2. Evaluation, diagnosis and treatment of occlusal problems. Peter E. Dawson , 2 nd
edition
3. Contemporary fixed prosthodontics. Rosenstial Land Fujimoto, 3rd edition
4. Management of temperomandibular disorders and occlusion. Okeson JP,4 th edition
5. A study of anterior guidance. Knap FJ, Donegan SJ. JOP 1995;4:226-232.
6. Occlusion for fixed prosthodontics:
7. A historical perspective of the gnathological [Link] H. Pokorny,JPD 2008
8. Occlusion series in BDJ, 2001;191:6-7