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Occlusion: 1. Terms, Mandibular Movement and the Factors of Occlusion

Article  in  Dental update · October 2003

DOI: 10.12968/denu.2003.30.7.359 · Source: PubMed

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 R E S T O R A T I V ER EDS ETNO TR IASTTI RV YE D E N T I S T RY

Occlusion: 1.Terms, Mandibular

Movement and the Factors of
Occlusion
ALEX MILOSEVIC
position in the glenoid fossae.
Abstract: This short series of three papers will review the relationship between l The terminal hinge axis is the
mandibular movement and tooth morphology during function and dysfunction. ICP,
horizontal axis between the
RCP and long centric are discussed as is a description of mandibular excursions. Incisal
guidance, condylar guidance, sagittal curve of Spee and lateral curve of Monson are condyles during rotation with a
inter-linked to illustrate how these factors of occlusion influence occlusal anatomy. ‘terminal arc of closure’ at the
mandibular incisors of up to 25 mm.
Dent Update 2003; 30: 359-361 The end point of this rotation is
RCP. (Further mandibular opening
Clinical Relevance: Explanation of the various movements and terms will will result in translation of the
hopefully help the dentist understand their relevance and importance. Gaining and
maintaining harmony within the stomato-gnathic system is a desired objective in much
condyles down the articular
restorative dentistry. The topic of occlusion is not especially difficult to understand nor eminence to a maximum interincisal
complex. opening up to 50 mm).

ICP and RCP are regarded as

‘European’ terms having North

T he term ‘occlusion’ is vague and

probably has a different meaning
for prosthodontists, periodontists,
orthodontists and oral surgeons. It has
been defined as the relation of the
maxillary and mandibular teeth when in
functional contact during activity of
the mandible (Dorland, 1985).1 This
definition is somewhat narrow and
excludes parafunctional relationships,
temporomandibular joint and muscle
function, occlusal trauma and
periodontal reaction. It may be better to
define occlusion as an integral (but not
necessarily central) part within the
stomato-gnathic system (SGS) that
relates teeth, not only to other teeth,
but, importantly, to the other
components of the SGS during normal
function, parafunction and
Alex Milosevic PhD, BDS, FDS RCS, DRD
RCS(Edin.), Consultant and Honorary Senior
Lecturer in Restorative Dentistry, Liverpool
University Dental Hospital, Pembroke Place,
Liverpool L3 5PS.
dysfunction. The SGS, therefore,
combines the TMJ, muscles,
periodontium and teeth into one
functional unit. A problem in any one
sub-unit may affect another.
This series of papers aims to explain
the fundamental principles required to
promote a practical understanding of
mandibular movement, related
terminology, how to carry out an
occlusal analysis and adjustment, and
how to use articulators in crown and
bridgework.
The starting point for any study of
occlusion is Inter Cuspal Position (ICP)
and Retruded Contact Position (RCP)
and the relationship between them.
l Inter Cuspal Position is defined as
the mandibular position when
maximum interdigitation
(intercuspation) occurs.
l Retruded Contact Position may be
defined as the initial tooth contact
upon closure when the condyles
have purely rotated whilst in their
most superior unrestrained
American equivalents in Centric
Occlusion and Centric Relation,
respectively. The author prefers ICP
and RCP as they are more intuitive and
descriptive.
Mesial drift, toothwear, post-
extraction tilt and drift, restorations in
supra- or infra-occlusion all potentially
lead to alteration in intercuspation. ICP
is, therefore, a habitual position that
can change throughout life. Because
RCP relies on anatomical positions, it is
constant and thus more reproducible.
Head posture, however, does influence
the maxillo-mandibular relationship.
In 90% of the population, ICP and
RCP are not coincident as the former is,
on average, 1 mm anterior to RCP. Try
curling your tongue to the back of the
palate and close together. Most readers
will find this position strange. A short
anterior slide into ICP will give the
reader the ‘feel’ for this ‘area of
freedom’. Long centric or freedom from
centric is a concept that was not
intended to reproduce the slide
between RCP and ICP but, in effect, it

Dental Update – September 2003 359

R E S T O R AT I V E
Working side Non-working side
A occur.
Mandibular
position in ICP
RLE
Mandibular position in RLE
Figure 1. Right lateral excursion (RLE) viewed in
the horizontal plane. A = Lateral shift or
Immediate Side Shift in mm. B = Bennett Angle or
Progressive Side Shift in degrees.
does. The ‘freedom’ relates to an ability
to close the mandible into RCP, or
slightly anterior to it, without altering
the vertical dimension at the anterior
teeth. In practice this means moving
the palatal inclines of the upper anterior
teeth forwards to facilitate unrestricted
jaw closure into either RCP or ICP. ICP
and RCP are coincident in 10% of the
population and in patients who have
undergone therapeutic reorganization
of their dentition. This is termed Point
Centric and involves restoration of
teeth to interdigitate in RCP. Which
occlusal scheme is best remains
debatable as they all have well
respected advocates: freedom of centric
(Beyron, 19692; Ramfjord & Ash,
19833); long centric (Dawson, 19894);
point centric (Stuart & Stallard, 19605).
LATERAL MOVEMENT
Working Side
Lateral mandibular movement is guided
by condyle-fossa relationships and
tooth relationships. During canine
guidance the palatal surface provides
guidance which may disclude all the
other teeth on the side to which the
mandible has moved (the working side).
Alternatively, multiple working side
contacts may be present, called group
function, or a combination of initial
group function with canine rise towards
360
D E N T I S T RY
the end of the lateral exclusion can
B Non-working Side
The side away from which the mandible
has moved is termed the non-working
side but NOT the balancing side.
Balancing side contacts are used in
complete denture construction to gain
balanced articulation and improve
denture stability during excursive
movements. Balance is a prosthetic
term in edentulous cases whereas non-
working side contacts occur in dentate
subjects. Non-working contacts may
become interferences should any of the
previous situations exist as for the
RCP–ICP slide and/or:
l Palatal cusps fracture;
l Increased tooth mobility occurs
with a healthy periodontium (1°
Trauma from occlusion);
l Increasing tooth mobility occurs
with pre-existing chronic adult
periodontitis (2° Trauma from
occlusion);
l Pain or pulpal necrosis is located
to one or two teeth with no other
obvious cause, e.g. caries.
It should be remembered that many
individuals adapt to developmental
malocclusions and deranged
occlusions such that a non-working
contact is not necessarily an
interference. Despite this, the non-
working contact can result in alteration
in mandibular leverage and non-axial
forces. Providing there are no signs or
symptoms of disorder/disease, then a
watchful eye is acceptable.
Bennett Shift or Movement =
Lateral Shift = Immediate Side
Shift
These terms have caused great
confusion to dentists, perhaps because
all the terms describe the same thing.
Lateral Shift is the most descriptive
term as it relates to the lateral
movement of the working side
condyle.6 It may move outwards
(laterally) and upwards (superiorly),
backwards (distally) or downwards
(inferiorly).
The next effect consists mainly of
rotation round the vertical axis of the
working condyle with concomitant
lateral translation (Figure 1). The
average lateral movement is 1 mm.
There is, therefore, a bodily shift of the
mandible to the working side.
Unfortunately, the American literature
also calls this shift laterotrusion.
Bennett Angle = Progressive
Side Shift
The Bennett angle refers to the angle,
in the horizontal plane, between the
sagittal plane and the downward,
inward and forward path of the non-
working condyle. The mean Bennett
angle is 7.5°. It is important to realize
that this is viewed in the horizontal
plane. The degree of forward and
downward translation of the non-
working condyle, when viewed in the
sagittal plane, is greater than for a
protrusive movement. This angle
between the translating pathway in
protrusion and that of the non-working
condyle has been called Fischer’s
angle.
PROTRUSIVE GUIDANCE
This is a combination of anterior or
incisal guidance and condylar
guidance. Protrusion is the anterior
movement of the mandible. An
edentulous individual can protrude his/
her mandible. During protrusive
guidance, in Class 1 relation, the incisal
edges are guided by the palatal aspects
a b
Figure 2. (a) Steep anterior guidance increases
likelihood of posterior disclusion. (b) Shallow
anterior guidance with greater risk of posterior
contacts.
Dental Update – September 2003

UR6
LR6
Right Lateral Excursion Non-working side contact
Figure 3. The greater the Curve of Monson
(medio-lateral curve), the greater risk of a non-
working contact, as palatal cusps ‘hang down’.
of the upper incisors and, ideally, there
should be posterior disclusion. The
envelope of movement of the
mandibular incisor from rest through
RCP, ICP protrusion and maximal
opening was traced by Posselt.7 Incisal
guidance provides the anterior guiding
component of protrusion and condylar
guidance the distal guiding component.
The condyles rotate and translate down
the articular eminence to maintain
maxillomandibular separation in the
posterior region. The average
protrusive condylar angle is 45° with a
range of 30–60°.
The incisal guidance angle is shown
in Figure 2. The steeper the palatal
incline, the greater the incisal angle and
the greater likelihood for posterior
disclusion. In a Class II Division II
incisal relation, disclusion of the molars
will rapidly occur in either protrusion or
lateral excursion. Although steep
anterior guidance may seem preferable,
this must be weighed against the
possibility of overloaded teeth with the
associated risk of tooth or restoration
fracture and a reduced area of freedom
between RCP and ICP.
Ideal anterior guidance can be
developed in provisional crowns and
bridges by adding or grinding palatal
acrylic in order to obtain acceptable
aesthetics and phonetics, absence of
discomfort within the teeth and
elsewhere in the stomato-gnathic
system, no loosening or fracture of the
provisional restorations and finally, of
course, posterior disclusion. All the
anterior teeth do not need to contact
on protrusion and with lower labial
segment crowding this may not be
possible. Guidance on a single tooth,
however, especially a lateral, should be
Dental Update – September 2003
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R E S T O R AT I V E
avoided. It is probably impossible to
gain posterior disclusion in incisal
edge-to-edge and Class III
UL6
relationships.
LL6
THE FACTORS OF
OCCLUSION
The clinical significance and inter-
relationship of the previously
discussed factors may not be apparent.
Cusp height, fossa depth, ridge and
groove direction in both natural and
restored dentitions are determined by
these factors of occlusion.
Occlusal determinants are:
l Incisal guidance;
l Condylar guidance;
l Sagittal or mesio-distal curve
(Curve of Spee in prosthodontics);
l Curve of Wilson or medio-lateral
curvature (Curve of Monson in
prosthodontics);
l Lateral or Bennett shift.
In an individual with a reduced
overbite, there exists a greater potential
for cuspal contacts during protrusive
movement should there be a co-existent
steep sagittal curve. In this situation,
shorter, flatter cusps would reduce the
potential for posterior interferences. As
this curvature becomes flatter, this
potential reduces. The flat occlusal
plane is safe with respect to cuspal
clashes when coupled with some incisal
or canine guidance. Anterior Open Bite
with symptoms of stomato-gnathic
dysfunction pose a particular problem
as it is unlikely that posterior
disclusion is achievable without
recourse to orthognathic surgery.
The posterior determinant of cusp
height and fossa depth is the condylar
guidance angle. Steep anterior and
condylar guidances are theoretically
harmonious and tend to provide
disclusion allowing for steeper cuspal
anatomy. Shallow condylar guidance,
even with a good overbite, can thus
still result in cuspal contacts nearer the
back of the mouth.
The influence of lateral shift on cusp
height is more difficult to describe.
Consider the medial movement of the
D E N T I S T RY
non-working side during a lateral shift.
(Remember lateral shift related to the
outward movement of the working
side). As the non-working mandibular
buccal cusps move across the
opposing maxillary palatal cusps, there
is the risk of non-working contacts in
situations with a marked curve of
Monson (Figure 3). In a steep curve of
Monson, the palatal cusps ‘hang
down’. It would be advantageous if
these cusps were shorter and flatter in
this occlusal scheme or if there existed
steep canine guidance (on the working
side), in combination with an above
average Bennett angle, in order to
guide the mandible downwards away
from the opposing teeth on the non-
working side.
The next paper in this series will
discuss how to carry out an occlusal
analysis and adjustment.
R EFERENCES
1. Dorland’s Illustrated Medical, 20th ed. Philadelphia:
W.B.Saunders Co., 1985.
2. Beyron H. Optimal occlusion. Dent Clinic N Am
1969; 13: 537–554.
3. Ramfjord SP, Ash MM. Occlusion, 3rd ed.
Philadelphia: Saunders, 1983.
4. Dawson PE. Evaluation, Diagnosis and Treatment of
Occlusal Problems, 2nd ed. St Louis: CV Mosby
Co., 1989; pp.264–273.
5. Stuart CE, Stallard H. Principles involved in
restoring natural occlusion to teeth. J Prosthet
Dent 1960; 10: 304–313.
6. Bennett NG. A contribution to the study of the
movements of the mandible. J Prosthet. Dent 1958;
8: 41–54.
7. Posselt U. Studies in the mobility of the human
mandible. Acta Odontol Scand 1952; 10: Suppl. 10.
JULY/AUGUST
CPD Answers
1. A, B, C, D 6. B, C
2. A, B, C 7. B, C
3. B, D 8. A, B
4. A, B, C 9. B, C, D
5. B, C, D 10. A, C
361