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OCCLUSION, OCCLUSION, ARTICULATORS, FACEBOWARTICULATORS, FACEBOW
Dr Zuryati AbDr Zuryati Ab--GhaniGhaniBDS, Grad Dip BDS, Grad Dip ClinClin Dent, FRACDS, Dent, FRACDS,
D D ClinClin Dent (Dent (ProsthodonticsProsthodontics))11.02.0811.02.08
CONTENTCONTENT
INTRODUCTIONINTRODUCTION--OCCLUSIONOCCLUSIONOCCLUSIONOCCLUSION--DEFINITIONSDEFINITIONSPOSSELTPOSSELT’’S BORDER MOVEMENTSS BORDER MOVEMENTSARTICULATORS +FACEBOW RECORDARTICULATORS +FACEBOW RECORD
INTRODUCTIONINTRODUCTION
OCCLUSIONOCCLUSIONDynamic biological Dynamic biological relaitonshiprelaitonship of of components of the components of the masticatorymasticatory system system that control tooth contacts during that control tooth contacts during function and dysfunctionfunction and dysfunction
It is the integrated action of the jaw It is the integrated action of the jaw muscles, TMJ and teethmuscles, TMJ and teeth
OcclusionOcclusion
Important to the provision of Important to the provision of comprehensive patient care.comprehensive patient care.
Relevant to all disciplines in dentistryRelevant to all disciplines in dentistry
Restorative dentistry and Restorative dentistry and prosthodonticsprosthodontics: : tooth restoration requires recognition of the tooth restoration requires recognition of the importance of importance of occlusalocclusal form and tooth form and tooth contact patterns at an appropriate OVD, for contact patterns at an appropriate OVD, for optimizing jaw functionoptimizing jaw function
An understanding of the importance of An understanding of the importance of the occlusion is paramount for the occlusion is paramount for enhancing jaw function, defining lower enhancing jaw function, defining lower face height and aesthetic needs, as face height and aesthetic needs, as key issues in optimizing oral health.key issues in optimizing oral health.
OCCLUSIONOCCLUSION--DEFINITIONSDEFINITIONS
Contact between cusps, Contact between cusps, fossafossa, marginal ridges of, marginal ridges ofopposing teethopposing teeth
Position of the jaw when teeth are in ICPosition of the jaw when teeth are in IC
Contact of teeth with maximum clenchingContact of teeth with maximum clenching
IntercuspalIntercuspal contactcontact (IC)(IC)
IntercuspalIntercuspal position (ICP)position (ICP)
Maximum Maximum intercuspationintercuspation (MI)(MI)
The tooth contact position when the jaw The tooth contact position when the jaw is in centric relationis in centric relation
CO may or may not be the same tooth CO may or may not be the same tooth contact R/S as ICPcontact R/S as ICP
Tooth contact (CO) when the jaw is in Tooth contact (CO) when the jaw is in CR may be more CR may be more retrudedretruded than at ICPthan at ICP
Centric occlusion (CO)Centric occlusion (CO)
The position of the jaw when the The position of the jaw when the condylescondyles are in a physiologically are in a physiologically acceptable guided position for the acceptable guided position for the recording of transfer recordrecording of transfer record
The contact position of the teeth when The contact position of the teeth when the jaw is in RPthe jaw is in RP
RetrudedRetruded jaw position (RP)jaw position (RP)
RetrudedRetruded contact position (RCP)contact position (RCP)
The The maxillomandibularmaxillomandibular relationship in which relationship in which the the condylescondyles articulate with the thinnest articulate with the thinnest avascularavascular portion of their respective discs portion of their respective discs with the complex in the anteriorwith the complex in the anterior--superior superior position against the slopes of the position against the slopes of the articulararticulareminence.eminence.
This position is independent of tooth contactThis position is independent of tooth contact
Centric relation (CR)Centric relation (CR)
TMJTMJ-- CondyleCondyle at CRat CR
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
www.baileydds.comwww.baileydds.com
Summary of definitionsSummary of definitions
ICP, CR, RP
IC, CO, RCP
Position of the jaw when an individual is Position of the jaw when an individual is sitting or standing upright when relaxed and sitting or standing upright when relaxed and alertalert
A free way space or speaking space is presentA free way space or speaking space is present
The vertical height of lower third of the face The vertical height of lower third of the face when teeth contact in ICPwhen teeth contact in ICP
Postural jaw position (PJP)Postural jaw position (PJP)
OcclusalOcclusal vertical dimension (OVD)vertical dimension (OVD)
Lateral jaw positionsLateral jaw positions
The side of the jaw that moves towards midlineThe side of the jaw that moves towards midlineThe side opposite the chewing sideThe side opposite the chewing side
The side of the jaw that moves laterally The side of the jaw that moves laterally away from the midline away from the midline Chewing side (where the chewing occurs)Chewing side (where the chewing occurs)
Canine guidanceCanine guidanceGroup functionGroup function
Non working/balancingNon working/balancing
Working sideWorking side
BennetBennet movementmovement: The bodily lateral : The bodily lateral movement of the mandible resulting from movement of the mandible resulting from the movements of the the movements of the condylescondyles along the along the lateral inclines along the lateral inclines along the mandibularmandibular fossafossa
BennetBennet AngleAngle: Angle formed by movement of : Angle formed by movement of balancing balancing condylecondyle with with sagittalsagittal plane during plane during lateral jaw movementlateral jaw movement
POSSELTPOSSELT’’S BORDER S BORDER MOVEMENTMOVEMENT
PosseltPosselt (1952) described the full range (1952) described the full range of jaw movement in 3 planes by of jaw movement in 3 planes by tracing the path of lower incisor teeth tracing the path of lower incisor teeth as the jaw is guided through the as the jaw is guided through the border pathsborder paths
POSSELTPOSSELT’’S BORDER MOVEMENTSS BORDER MOVEMENTS
Sagittal view Frontal view
Horizontal view IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
ARTICULATORSARTICULATORS
A hinged mechanical device to which A hinged mechanical device to which maxillary and mandible casts are maxillary and mandible casts are attached, attached, to reproduce relationship of to reproduce relationship of patientpatient’’s maxilla to mandibles maxilla to mandible in ICP in ICP and for lateral and protrusive jaw and for lateral and protrusive jaw movementsmovements
Uses of articulatorsUses of articulators
Study the way teeth occlude for Study the way teeth occlude for diagnosis and treatment planningdiagnosis and treatment planningAllow formation of Allow formation of occlusalocclusal surfaces surfaces during lab preparation and adjustment during lab preparation and adjustment of fixed and removable prostheses and of fixed and removable prostheses and indirect dental restorationsindirect dental restorations
TYPES OF ARTICULATORSTYPES OF ARTICULATORS
SIMPLE HINGESIMPLE HINGEAVERAGE VALUE (PLANEAVERAGE VALUE (PLANE--LINE)LINE)SEMI ADJUSTABLESEMI ADJUSTABLEFULLY ADJUSTABLEFULLY ADJUSTABLE
SIMPLE HINGESIMPLE HINGE
Single hinge movement onlySingle hinge movement onlyNo lateral movementNo lateral movementSmaller than patientSmaller than patient’’s jawss jawsVery limited value in restorative Very limited value in restorative dentistry and dentistry and prosthodonticsprosthodontics but may but may allow preliminary evaluation of static allow preliminary evaluation of static tooth arrangement on study caststooth arrangement on study casts
SIMPLE HINGESIMPLE HINGE
AVERAGE VALUEAVERAGE VALUE
CondylarCondylar angle fixed at 30angle fixed at 30°°No provision of adjustment for lateral No provision of adjustment for lateral mandibularmandibular shiftshiftAdjustable Adjustable incisalincisal guidanceguidanceConsidered sufficient for reproducing ICP on Considered sufficient for reproducing ICP on study castsstudy castsProduce an approximation of Produce an approximation of condylarcondylarmovements and used to design and prepare movements and used to design and prepare complete dentures and simple restorationscomplete dentures and simple restorations
AVERAGE VALUE (PLANEAVERAGE VALUE (PLANE--LINE)LINE)
Allow adjustment of Allow adjustment of condylarcondylar inclination and inclination and BennetBennet angleangleIntercondylarIntercondylar width fixed at 110mmwidth fixed at 110mmCondylarCondylar and and BennetBennet angle are obtained angle are obtained from protrusive and lateral from protrusive and lateral occlusalocclusal records records or are set an average valuesor are set an average valuesIncisalIncisal guidance are made by reference to guidance are made by reference to the O/B and O/J of anterior teeth, or if the the O/B and O/J of anterior teeth, or if the teeth are lost, an average value can be set.teeth are lost, an average value can be set.
SEMI ADJUSTABLESEMI ADJUSTABLE
Recommended for most dental Recommended for most dental restorationsrestorationsMore accurate than average valueMore accurate than average valueAllows increase of OVD by raising the Allows increase of OVD by raising the height of articulator pinheight of articulator pinArcon/nonArcon/non--arconarcon: the choice is : the choice is operator preferenceoperator preference
SEMI ADJUSTABLESEMI ADJUSTABLE
ArconArconFossaFossa box in the upper box in the upper membermemberCondylarCondylar sphere in the sphere in the Lower memberLower memberDuplicates arrangement Duplicates arrangement of TMJof TMJ
NonNon––arconarconCondylarCondylar ball is attached ball is attached to upper memberto upper memberSlot mechanism attached Slot mechanism attached to lower memberto lower member
SEMI ADJUSTABLESEMI ADJUSTABLE
SEMI ADJUSTABLESEMI ADJUSTABLE--ARCONARCON
Stratos
SEMI ADJUSTABLESEMI ADJUSTABLE--NON NON ARCONARCON
Dentatus Condylar guidance
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
FULLY ADJUSTABLEFULLY ADJUSTABLE
ComplexComplexDesigned to duplicate TMJ featuresDesigned to duplicate TMJ featuresCondylarCondylar settings may be determined settings may be determined by by pantograohicpantograohic and stereographic and stereographic recordsrecords
FULLY ADJUSTABLEFULLY ADJUSTABLE
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
ARCON TYPE
FACEBOWFACEBOW
An instrument that An instrument that records the records the relationship of the maxilla to the hinge relationship of the maxilla to the hinge axis of rotationaxis of rotation of the mandibleof the mandibleIt allows the maxillary cast to be It allows the maxillary cast to be placed in an equivalent relationship on placed in an equivalent relationship on the articulatorthe articulator
FACEBOWFACEBOW
In order to identify true hinge axis, hinge In order to identify true hinge axis, hinge axis locator and hinge axis face bow are axis locator and hinge axis face bow are necessarynecessaryFacebowsFacebows are commonly used with an are commonly used with an arbitrary hinge axis that is located 13mm arbitrary hinge axis that is located 13mm along a line drawn from the upper aspect of along a line drawn from the upper aspect of the superior border of the tragus of the ear the superior border of the tragus of the ear to the outer to the outer canthuscanthus of the eyeof the eyeOther arbitrary point of reference of the Other arbitrary point of reference of the TMJTMJ--external ear canal.external ear canal.
FACEBOWFACEBOW
Allows transfer of Allows transfer of intercondylarintercondylar distancedistanceIn dentate patients, the In dentate patients, the facebowfacebow fork is fork is used to locate the used to locate the occlusalocclusal and and incisalincisalsurfaces of the maxillary teeth. Wax surfaces of the maxillary teeth. Wax impression compound attached to the fork impression compound attached to the fork must locate the tooth cuspmust locate the tooth cuspIn edentulous patients, the fork is attached In edentulous patients, the fork is attached to a maxillary to a maxillary occlusalocclusal rimrim
FACEBOWFACEBOW
FACEBOWFACEBOW
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger..
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
Maxillary cast mounted using facebow record-Slidematic facebow with Denar articulator-
IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger, 2004, 2004
SummarySummary
Remember and understand occlusionRemember and understand occlusion--definitionsdefinitionsFunction and types of articulatorsFunction and types of articulatorsFunction of a Function of a facebowfacebow
ReferencesReferences
OcclusalOcclusal and clinical practice. An Evidenceand clinical practice. An Evidence--based based approach. approach. IvenIven KlinebergKlineberg, Rob , Rob JaggerJagger. Elsevier . Elsevier Limited, London, 2004Limited, London, 2004Textbook of Textbook of ProsthodonticsProsthodontics. Deepak . Deepak NallaswamyNallaswamy. . JaypeeJaypee brothers medical publishers (p) LTD. 2003brothers medical publishers (p) LTD. 2003Management of Management of TemporomandibularTemporomandibular Disorders and Disorders and Occlusion. Jeffrey P Occlusion. Jeffrey P OkesonOkeson. 5. 5thth Edition, Mosby Edition, Mosby Inc., St Louis, 2003Inc., St Louis, 2003www.uic.edu.comwww.uic.edu.comwww.myotronics.comwww.myotronics.comwww.baileydds.comwww.baileydds.com
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