Optimum occlusion

By/
Rana Helmy Abd El-baky

Prof Dr/ Heba Ahmed Adawy

Ass prof/ Nehad Abd El-mawgod
 Normal occlusion, ideal occlusion, and optimum occlusion are terms
commonly used in dentistry to describe different relationships between the
upper and lower teeth and the way they fit together.
Here's an overview of each term:
1. Normal Occlusion:

refers to the alignment and relationship of the upper and lower teeth that
are considered within the acceptable range of variation for a healthy
individual. It is also known as "physiological occlusion" or "natural
occlusion." In normal occlusion, the upper and lower teeth fit together
harmoniously, allowing for efficient chewing, proper speech, and a stable
bite. There may be slight variations in tooth alignment and contact points,
but overall, the occlusion is considered functional and healthy
2. Ideal Occlusion:
also known as "ideal bite" or "ideal dental occlusion," represents the theoretical concept of
an ideal tooth alignment and occlusal relationship. It is often used as a reference or goal for
dental treatment planning. In ideal occlusion, the upper and lower teeth are aligned in such a
way that they achieve the best esthetics, function, and stability. The dental arches are well-
balanced, and the individual teeth exhibit proper alignment, interdigitation, and contact
points. However, achieving ideal occlusion may not be possible or necessary for every
individual due to factors like skeletal discrepancies, tooth size discrepancies, or pre-existing
dental conditions.
3. Optimum Occlusion:
Optimum occlusion refers to a functional and stable occlusal relationship customized and
optimized for an individual patient based on their specific dental and skeletal characteristics.
It considers factors such as the patient's facial profile, tooth size, jaw relationships, and
functional requirements. Optimum occlusion may not necessarily coincide with the
theoretical ideal occlusion, but it aims to achieve the best possible occlusal outcome for the
individual patient. Achieving optimum occlusion involves careful diagnosis, treatment
planning, and consideration of the patient's oral health needs and treatment [Link]
characteristics of optimum occlusion:

Stability Bilateral Anterior Vertical Freeway

Balance Guidance Dimension Space
1. Stability

Optimum occlusion provides stability and balance during various

functional movements of the jaw, such as biting, chewing, and speaking.
The teeth should come into contact evenly and harmoniously, distributing
the forces exerted during these activities.
 some factors to achieve stability in occlusion:
1. Balanced Occlusal Contacts:
• The first significant concept developed to describe optimal functional
occlusion was called balanced occlusion.
• Bilateral and balancing tooth contacts during all lateral and protrusive
movements.

• where the teeth come together harmoniously during biting and chewing, this
means that the forces exerted on the teeth are distributed evenly across the
dental arches, minimizing the risk of excessive stress on individual teeth or
supporting structures.
2. Muscle and Joint Balance:

• Muscles of mastication function more harmoniously and with less intensity

when the condyles are in a Centric Relation.
• Positional stability is determined by the muscles that pull across the joint and
prevent dislocation of the articular surfaces.
• The directional forces of these muscles determine the optimal stable joint
position, these three muscle groups( elevator, masseters, and temporal) are
primarily responsible for joint position and stability.
• The most stable joint position, therefore, exists when the condyles are in their
most superoanterior position in the articular fossae, resting against the
posterior slopes of the articular with the discs properly interposed.
• This is the position the condyles assume when of the elevator muscles are
activated with no occlusal influences.
• Effective functioning while minimizing damage to any components of the
masticatory system.
• Establish an occlusal condition that can accept heavy forces with a minimal
likelihood of damage and at the same time be functionally efficient.
• An optimal occlusal condition during mandibular closure would be provided
by even and simultaneous contact of all possible teeth.
• Furnishes maximum stability for the mandible while minimizing the force
placed on each tooth during function.
• Therefore the criteria for optimal functional occlusion developed to this point
are described as even and simultaneous contact of all possible teeth when the
mandibular condyles are in their most superoanterior position.
• Muscle imbalances or temporomandibular joint (TMJ) disorders can affect
occlusal stability.

• Addressing any underlying muscle or joint issues through physical therapy,

muscle relaxation techniques, or TMJ treatment can help restore stability to
the occlusion.
3. Proper Vertical Dimension:

• The vertical dimension of occlusion plays a crucial role in occlusal

stability. When the vertical dimension is properly established, it
allows for optimal coordination between the teeth, muscles, and
TMJ.

• Factors such as tooth wear, tooth loss, and changes in the position
of the TMJ can influence the vertical dimension. Ensuring an
appropriate vertical dimension is maintained helps promote
stability in occlusion.
4. Adequate Bone and Periodontal Support:

The stability of occlusion is also dependent on the health and support of the
surrounding bone and periodontal tissues. good oral hygiene, addressing
periodontal disease, and managing bone loss through appropriate
Maintenance treatments contribute to the stability of the occlusion.
[Link] Balance

Bilateral balance in optimum occlusion refers to the even distribution of forces

between the right and left sides of the dental arches during biting and chewing. It
means that the upper and lower teeth on both sides of the mouth come into
simultaneous and harmonious contact, allowing for efficient and stable function.

Optimum occlusion refers to the ideal alignment and contact between the upper and
lower teeth when the jaws come together.
 To achieve bilateral balance, several factors need to be considered:

1. Dental occlusion analysis: An initial step is to perform a

thorough analysis of the dental occlusion. This involves evaluating the
relationship between the upper and lower teeth, tooth alignment, and the
way the teeth come together during various movements.
2. Occlusal splints: In some cases, occlusal splints or bite guards may be
used to achieve bilateral balance. These removable appliances are custom-made
to fit over the teeth and help in redistributing the forces evenly during biting
and chewing. They can be adjusted to optimize the occlusion and achieve
bilateral balance.
3. Comprehensive treatment: Achieving bilateral balance may require
comprehensive orthodontic or prosthodontic treatment. This could involve
realigning the teeth through orthodontic braces, replacing missing teeth with
dental implants or bridges, or using other restorative methods to establish
proper occlusion.
4. Functional Movements: Bilateral balance is important not only during
static biting but also during functional movements such as lateral excursions
(side-to-side movements) and protrusive movements (forward movements).
These movements should maintain the bilateral balance between the upper
and lower teeth, ensuring efficient and comfortable function.
5. Occlusal Interferences: Occlusal interferences refer to any premature
contacts or disturbances in the bite that disrupt the bilateral balance. These
interferences can cause excessive forces on specific teeth or interfere with the
smooth movement of the jaw. Identifying and addressing occlusal
interferences is important for achieving and maintaining bilateral balance in
occlusion.
6. Canine Guidance:

• Canine guidance is an important component of bilateral balance in

occlusion. It refers to the functional guidance provided by the canines
(the pointy teeth) during lateral excursions or sideways movements.
• Canine guidance helps protect the posterior teeth from excessive forces
and ensures balanced occlusal contacts during these functional
movements.
• As it is the longest and largest root and therefore the best crown/root
ratio.
• Surrounded by dense compact bone, which tolerates the forces better
than the medullary bone found around posterior teeth.
• Another advantage of the canines centers on sensory input and the
resultant effect on the muscles of mastication.
• Fewer muscles are active when canines make contact during eccentric
movements than when posterior teeth come into contact.
• Decrease forces on the dental and joint structures.
7. Occlusal Scheme: Bilateral balance is a fundamental aspect of occlusal
schemes or occlusal relationships. There are different occlusal schemes, such as
Angle's Class I, II, and III, which describe the relationship between the upper and
lower teeth. In an ideal occlusal scheme, the occlusion is balanced bilaterally,
allowing for efficient and stable function.
3. Anterior Guidance:

Optimum occlusion typically includes a smooth and functional anterior

guidance. This means that the front teeth (incisors) should guide the
movements of the lower jaw during protrusive (forward) and lateral
(sideways) movements. The guidance provided by the incisors helps in proper
chewing and protects the posterior teeth from excessive forces
• When the mandible moves forward into protrusive contact, damaging
horizontal forces can be applied to the teeth
• During protrusion, the anterior and not the posterior teeth should come
into contact
 To achieve anterior guidance, several factors
need to be considered:

1. Analysis of tooth alignment: The alignment of the front teeth is crucial

for achieving proper anterior guidance. The dental professional will evaluate
the position, angulation, and inclination of the upper and lower front teeth to
ensure they are properly aligned.
2. Evaluation of incisal edges:

• The incisal edges, which are the biting edges of the front teeth, need to
be carefully assessed. The dental professional will examine the
relationship between the upper and lower incisal edges to determine if
there are any discrepancies or irregularities that may affect anterior
guidance.

• Anterior teeth, unlike posterior teeth, are in proper position to accept the
forces of eccentric mandibular movements
3. Occlusal adjustments: Occlusal adjustments may be necessary to achieve
proper anterior guidance. This involves making selective modifications to the
biting surfaces of the teeth, particularly the front teeth, to ensure they come
into contact harmoniously and functionally. The adjustments can be done
through reshaping the tooth surfaces or using restorative techniques such as
veneers or crowns to alter the incisal edges.
4. Phonetics and aesthetics: Achieving proper anterior guidance also
involves considering factors such as phonetics (speech) and aesthetics. The
dental professional will assess how the teeth come together during speech
sounds and evaluate the overall appearance of the front teeth to ensure they
function properly and look natural.
5. Protrusive Movements:

Protrusive movements occur when the lower jaw moves forward, such as
during swallowing or certain speech sounds. During these movements, the
front teeth, specifically the upper and lower incisors, should come into
contact in a smooth and coordinated manner. This contact provides guidance
and stability to the jaw during forward movements.
6. Group Function or Canine Guidance: There are two main concepts
associated with anterior guidance: group function and canine guidance.
Group function occurs when the contact and guidance during protrusive
movements involve multiple teeth, including the canines, premolars, and
molars. Canine guidance, on the other hand, emphasizes the guidance
provided primarily by the canines during protrusion, with minimal
involvement of the posterior teeth.
4. Vertical Dimension:

The vertical dimension of occlusion is the space between the upper and
lower teeth when the jaws are in a resting position. In optimum occlusion,
the vertical dimension should be stable and provide proper support for the
facial muscles and jaw joints. Excessive vertical dimension or insufficient
vertical dimension can lead to various functional and aesthetic problems
1. Rest Position: The vertical dimension of optimum occlusion is often
established based on the rest position of the jaw. In the rest position, the
muscles that control jaw closure are relaxed, and the teeth are not in contact.
This position serves as a reference point for determining the appropriate
vertical dimension of occlusion.
2. Masticatory System: The vertical dimension of occlusion is intimately
connected to the entire masticatory system, which includes the teeth,
muscles, and temporomandibular joints (TMJ). When the vertical dimension
is properly balanced, it allows for efficient and comfortable chewing,
speaking, and swallowing.
3. Occlusal Vertical Dimension: The occlusal vertical dimension (OVD) specifically refers
to the vertical dimension when the teeth are in maximum intercuspation or centric
occlusion. It is the distance between the biting surfaces of the upper and lower teeth when
the jaws are closed together in their proper alignment. The OVD is influenced by factors
such as tooth wear, tooth loss, and changes in the position of the TMJ.
4. Denture Construction:

• The vertical dimension of occlusion is particularly important in the

construction of complete dentures.

• When fabricating dentures, the vertical dimension needs to be carefully

determined to ensure proper esthetics, function, and stability. Incorrect
vertical dimensions in dentures can lead to discomfort, speech difficulties,
and compromised chewing ability.
5. Temporomandibular Joint (TMJ) Health:

• The vertical dimension of occlusion can impact the health and stability
of the TMJ. When the vertical dimension is properly maintained, it
helps promote a balanced load distribution and reduces strain on the
TMJ structures.

• Imbalances in the vertical dimension can contribute to TMJ disorders

and associated symptoms.
6. Individual Variations:

• The vertical dimension of optimum occlusion can vary among individuals

based on factors such as facial morphology, tooth size, and skeletal
characteristics.

• It is important to consider these individual variations in determining the

ideal vertical dimension for each person.
5. Freeway Space
The freeway space, also known as the freeway gap, is an important concept
in the field of occlusion and refers to the space between the upper and lower
teeth when the jaw is in a relaxed, physiologic position, often referred to as
the freeway space of optimum occlusion.
1. Resting Position: The freeway space is assessed when the jaw is in a
resting or physiologic position, with the muscles that control jaw closure in a
relaxed state. This position is different from the position of maximum
intercuspation or centric occlusion, where the teeth are in full contact.
2. Muscular Balance:

• The freeway space is a natural occurrence that exists to provide room for
the jaw muscles and other soft tissues to function without interference. It
allows for movement and accommodates the functional and dynamic
aspects of the masticatory system.

• So reflects the balance and equilibrium of the muscles that control the
resting position of the jaw. When the jaw is in the relaxed position, the
muscles are in a state of balance, and the freeway space represents the
natural resting space between the teeth.
3. Importance in Prosthodontics: The freeway space is particularly
relevant in prosthodontics when planning and fabricating dental prostheses,
such as complete dentures. Adequate freeway space needs to be maintained to
allow for proper function, stability, and comfort of the dentures.
 SUMMARY OF OPTIMAL FUNCTIONAL OCCLUSION

• When the mouth closes, the condyles are in their most superoanterior
position (musculoskeletally stable), resting against the posterior slopes of
the articular eminences with the discs properly interposed. In this
position, there is even and simultaneous contact of all posterior teeth.

• The anterior teeth also come into contact but more lightly than the
posterior teeth.
 All tooth contacts provide axial loading of occlusal forces.
 When the mandible moves into laterotrusive positions, there are adequate
tooth-guided contacts on the laterotrusive (working) side to disocclude
the mediotrusive (nonworking) side immediately.
 The most desirable guidance is provided by the canines (canine
guidance).
 When the mandible moves into a protrusive position, there are adequate
tooth-guided contacts on the anterior teeth to disocclude all posterior
teeth immediately.
References :

1. POPA1A, Sever Toma; POPESCU2B, Sanda Mihaela; CONSTANTINESCU3C,

Marian-Vladimir. Occlusal equilibration between option and clinical realty.
2. SOLOW, Roger A. Clinical protocol for occlusal adjustment: Rationale and
application. CRANIO®, 2018, 36.3: 195-206.
3. Ignatius, Ancy V.; Garlapati, Komali1,; Chaitanya, Nallan CSK1; Saba, Asra1;
Kandi, Pallavi; Reddy, Chelluri Shreya1. T-Scan Guided Occlusal Equilibration as an
Effective Treatment in the Management of Symptomatic Temporomandibular
Disorders: An Open Clinical Trial. Journal of Indian Academy of Oral Medicine and
Radiology 34(1):p 53-59, Jan–Mar 2022. | DOI: 10.4103/jiaomr.jiaomr_300_21.
4. Marcel Le Gall. Clinic of Occlusal Balancing. 2020. ⟨hal-02429906⟩.
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