Definition
The act of closure or being closed
A static morphological tooth contact
relationship
Includes all factors concerned with the
development and stability of the masticatory
system and the use of teeth in oral motor
behavior
Includes the integrated system of functional
units involving teeth, joints and muscles of
the head and neck
Each tooth occludes with 2 teeth of the opposing
jaw
Exceptions
Mandibular central incisor
Maxillary second molar
Occlusion is supported and made more efficient
after eruption of first permanent molars
Interdental spacing is important for future
sufficiency of space in permanent teeth
Probability of crowding in permanent teeth is
related to the amount of interdental spacing in
primary dentition
Factors influencing the effect of terminal
plane relationship on Angle’s molar
relationship
Differential growth of the jaw
Forward growth of the mandible
Sufficient Leeway space to accommodate a
mesial shift of the permanent molars
Leeway space is the amount of space gained
by the difference in the mesiodistal diameter
between deciduous molars and premolars
Class I
Class II
Class III
Overjet
Reverse overjet
Overbite
Balanced occlusion
Bilateral contacts in all functional excursions
Prevent tipping of the denture bases
Not necessarily existing in natural dentition
because each tooth is a separate unit
Intercuspal position
Centric occlusion
Concepts developed in relation to
orthodontics, complete dentures and full
mouth rehabilitation
None are completely applicable to natural
dentition
Terminal plane relationship
Flush
56% - Class I Angle’s molar relationship
44% - Class II Angle’s molar relationship
Distal step
Class II Angle’s molar relationship
Mesial step
A greater probability for Class I Angle’s
molar relationship
A lesser probability for Class III Angle’s
molar relationship
Anteroposterior relationship
Incisors: Class I, II, III
Canine: Class I, II, III
Molars: Angle’s Class I, II, III
Faciolingual relationship
Premolars
Molars
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Class I
Class II Angle’s Class I
Class III Angle’s Class II
Angle’s Class III

Curve of Spee
Curve of Wilson
Sphere of Monson

Mandibular arch is wider than

With the exception of mandibular
maxillary arch
incisors and maxillary third molars,
Each tooth must be placed at the
each tooth contacts two antagonist
angle that best withstands the line of
teeth in the opposing arch
forces brought against it during
Loss of one tooth keeps the adjacent
function
tooth in contact with opposing
If the tooth is placed at a
antagonist
disadvantage, its longevity may be at
Mesial or distal drifting into the
risk
space disturbs occlusal contact with
Anterior teeth are placed at a
antagonist teeth

Lingual cusp tips of maxillary posterior Lateral

make contact with opposing fossae and Working side
marginal ridges of mandibular posterior Non-working side
teeth In complete dentures
Buccal cusp tips of mandibular posterior Balancing side
make contact with opposing fossae and Non-balancing side
marginal ridges of maxillary posterior Movement in TMJ
teeth Tooth guidance
Lingual cusps of maxillary posterior teeth Group function
and buccal cusps of mandibular posterior Canine guidance
teeth are called “supporting cusps” Protrusive
Areas of occlusal contact that a Incisal guidance
supporting cusp make with opposing teeth Retrusive
in centric occlusion are “centric stops” The most retrusive position is the centric
The tip of that cusp is also a centric stop occlusion in complete dentures

2
‫بسم الله الرحمن الرحيم‬
We will start to talk about an important topic which is the OCCLUSION

SLIDE 2
[Occlusion]

• Definition

 The act of closure or being closed

Approximate or occlude of 2 jaws together that’s what do we mean
by OCCLUSION

 A static morphological tooth contact relationship.

Notice it’s Static
The relationship between upper & lower teeth then they are in
contact

 Includes all factors concerned with the

development and stability of the masticatory
system and the use of teeth in oral motor
behavior.
So this definition or fact is more appropriate, because it’s including
some …

 Includes the integrated system of functional units

involving teeth, joints and muscles of the head
and neck.
This what we covered in the oral physiology when we talked about
the
Dynamic Part of Occlusion. Se I won’t concentrate about it here
Because it’s more related to Physiology.

SLIDE 3
[Concepts of Occlusion]
We have some concepts of occlusion we’ll actually discusses here

 Balanced Occlusion.

 Bilateral contacts in all functional excursions.

Means when we have the mandible against the maxilla & the teeth
are in contact, teeth remain in contact.

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So, for example: if you are closing your mandible against the
maxilla & you want to move the mandible 5 mm to the right or to
the left, ofcourse the teeth will be in contact at the side that you
move the teeth to, but we also need the teeth to be in contact at
the other side. So, Balanced Occlusion means whatever you
actually occlude your mandible or whatever the position of teeth of
the mandible, the teeth remain in contact.

Q: Is Balanced Occlusion happening in people

with teeth?
NO, let’s take an example; the dentate person (like you) if he try to
bite the mandible against the maxilla & try to move his mandible
5mm to the right or to the left, the teeth of the other side (the
opposite side) won’t be in contact, this is important.
[Balanced Occlusion doesn’t happening in reality]
But we need it in cretin Situations.

Q: Why we don’t need Balanced Occlusion in

dentate people?
Simply, because each tooth of our teeth act as a single unit, each
tooth has its own PDL & it’s connect to the bone.
But imagine person with Upper & Lower Dentures, now if this person
bite on centric occlusion & I ask him to move his mandible & remain
in contact with the maxilla for 5 mm to the right, if he actually don’t
have Balanced Occlusion, there will be a space in the other side (the
Left Side) because the denture is considered as a single unit,
complete unit not as the real teeth which each one of them act as a
single unit, so when there is a space in the other side, the denture
will falls down.
So, Balanced Occlusion is needed when we construct upper &
lower complete dentures.

 Prevent tipping of the denture bases.

It’s preventing denture’s movement.

 Not necessarily existing in natural dentition

because each tooth is a separate unit.
 Intercuspal position.
It’s the position where the cusps of the lower teeth are located in
the fossae & marginal ridges of the upper teeth (opposing teeth).
That mean when you close your mandible against the maxilla, the
cusps of the lower teeth is present in the fossae & marginal ridges
of the upper teeth.
Remember we have the preperioceptor all the time guides the
mandible to its right position [The Intercuspal position].

So, for example, when I ask you to close your mandible, you close it
in the centric occlusion without a problem. You don’t think about it,

4
because you have a preperioceptor in the PDL which all the time
send information to the telling it about the position of the mandible
& this actually leads the mandible to its correct
relationship to the maxilla with biting.

 Centric Occlusion.
It’s a state where the teeth are in inercuspal position and the
condoyles are located in a specific location in the glenoid fossa.
So, the centric occlusion isn’t necessarily related to the teeth only,
the Intercuspal position: it’s the position of the mandible to the
maxilla or the maxilla to the mandible when the teeth are in
maximum contact.

The CENTRIC OCCLUSION isn’t only describes the relationship

between the Upper & Lower teeth, but it also illustrates the
relationship between Upper & Lower part of TMJ.

Concepts developed in relation to orthodontics, complete

dentures and full mouth rehabilitation.

Q: When do we need the OCCLUSION?

We need it in orthodontics & in complete & partial constrictions.

 None are completely applicable to natural dentition.

This concept which is discussing especially BALANCED
OCCLUSION isn’t necessarily applicable to the natural dentition.
When you have all the teeth in your mouth, you don’t have a
problem.
All of them are functional, so any movement of the mandible won’t
lead to dislocation of the teeth of the other side, because as we said
each tooth is hold in the bone separately as a one unit.

SLIDE 4
[Overview of Primary Occlusion]
 Each tooth occludes with 2 teeth of the opposing jaw.
This a general rule.
So, any primary tooth should be occluding to 2 teeth in the
opposing jaw, but we have exceptions:

 Exceptions:
 Mandibular central incisor.

5
It makes contact with the maxillary central, because it’s smaller in
size than the maxillary one.
 Maxillary second molar.
It makes occlude with the mandibular second molar only.

 Occlusion is supported and made more efficient after

eruption of first permanent molars.
The occlusion of primary teeth remains premature until the eruption
of permanent first molar; they are stabilizing the primary
epithelium.

 Interdental spacing is important for future sufficiency

of space in permanent teeth.
If you examine the primary teeth of your little brothers & sisters,
you will find spaces between them.
The importance of these spaces is for permanent teeth to be
erupting normally.

 Probability of crowding in permanent teeth is related

to the amount of interdental spacing in primary
dentition.

SLIDE 5
[Primary Molar relationship]
Here we are talking about the relationship between the last
deciduous molars.
(Which are the second maxillary & mandibular deciduous molars).
There is a relationship between the ends of the distal parts of these
molar.

 Terminal Plane Relationship.

It’s also called Terminal Plane Relationship.

 Flush:
When the distal surface of the maxillary second deciduous molar is
in lined with the distal surface of the mandibular second deciduous
molar making one straight line - like (Case A) in the picture
below - this is called Flush Relationship.

Sometimes the distal end of the mandibular second located distal to

the distal end of the maxillary second molar; making what is called
Mesial Step.
- like (Case C) in the picture below - .

While in case of what the distal end of the maxillary second is

masial to the distal

6
end of the mandibular second making the Distal Step, is
considered as Case B.
- look at the picture below - .

 56% - Class I Angle’s molar relationship.

Now when we have flush terminal relationships like Case A in the
picture below, in 56% this will lead to Class I Angle’s molar
relationship.

 44% - Class II Angle’s molar relationship.

While it’s only in 44% will lead to Class II Angle’s molar
relationship.

 Distal step.
When we have a distal step like in Case B, this will lead in all the
cases to the
Class II Angle’s molar relationship.
Notice in the picture (Case B), if the permanent molars getting
erupt here , the Upper molar will be anterior to the lower, so it will
be Class II Angle’s molar relationship.

 Mesial step.
Like Case C we have:
 A greater probability for Class I Angle’s
molar relationship.

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  A lesser probability for Class III Angle’s
molar relationship

SLIDE 6
[Primary Molar Relationship]
 Factors influencing the effect of terminal plane
relationship on Angle’s molar relationship.
Means what are the Factors that determine the flush
terminal relationship will be for example Class I, II, and III
Angle’s Molar Relationship?
The factors include:

 Differential growth of the jaw.

The difference of the growth between the Upper & Lower Jaws.

8
If for example we have a growth in the lower jaw more than the
upper jaw & for that it may have class III.

 Forward growth of the Mandible.

All the time the Mandible grows forward more than the Maxilla.

 Sufficient Leeway space to accommodate a mesial

shift of the permanent molars.

• Leeway space is the amount of space gained by the

difference in the mesiodistal diameter between
deciduous molars and premolars.
You know the premolars will replace the deciduous molars, & their
sizes MesioDistaly aren’t equal, they are less in size MesioDistaly
than deciduous molars (Deciduous Molars are bigger than
Premolars); this difference is called Leeway Space.
So when these premolars getting erupt in these spaces which are
larger in size than their sizes, this will lead the Maxillary Permanent
Molar to be erupt more anterior or accommodate this space
because its size is large.
It’s also important to know that this Leeway Space is more in the
Mandible than in the Maxilla, so for this reason the Lower Molars
erupting more mesial to the Upper molars, that’s really which
makes the Class I Angle’s molar relationship.

SLIDE 7
[Permanent Occlusion]
 AnteroPosterior Relationship.

 Incisors: Class I, II, III

 Canine: Class I, II, III
 Molars: Angle’s Class I, II, III

We don’t have only AnteroPosterior Relationship; not

necessarily all the time AnteroPosterio, we also have:

 Faciolingual relationship.

 Premolars
 Molars

SLIDE 8
[Incisal Relationship]
 Class I: [Normal Case]:

9
It’s when the incisal edge of the Lower incisors is just located in the
lingual fossa of the Upper Incisor.

 Class II:
It’s when the Mandibular Incisor is slightly lower to its normal
position.
When the Lower Incisors edges lay Posterior to the Cingulum
plateau of the Upper Incisors .Increase in the Overjet.
Which divides into 2 divisions?

Division 1:
In this case the upper incisor will be Proclained (moving more
anterior).
Here the Overjet will be More than normal case.

Division 2:
While here the upper incisor will be Retroclined.
Here the Overjet will be ZERO.

 Class III:
Where the Lower Incisors edges lie anterior to the cingulum
plateau of the Upper Incisors, the Overjet is reduced or reversed.

 Overjet:
: is the Horizontal Space between the incisal edges of the Upper
& Lower
Incisors.

 Reverse Overjet
When Overjet is reversed & the Lower Incisors become anterior
to the Upper Incisors.

 Overbite:
It’s the Vertical Space between the incisal edges of the Upper &
Lower Incisors.

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SLIDE 10
[Canine Relationship]

 Class I:
It’s when the tip of the Upper Canine is just in the Embrasure
position between the lower canine & the Lower First Premolar.

 Class II
It’s when the tip of the upper canine is Anterior to the
Normal Position which is in Class I.

 Class III:
It’s when the tip of the upper canine is Posterior to
that of the Class I.

SLIDE 11
[Molars Relationship]

 Angle’s Class I.
It’s when the tip of the MesioBucchal cusp of the Maxillary first
molar located exactly opposite to the MesioBucchal groove of the
Mandibular first molar.

 Angle’s Class II:

It’s when the tip of the MesioBucchal cusp of the maxillary first
molar is located Anterior to the Normal Position which is in class
I, (Protruding Case)

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  Angle’s Class III:
While in this case if you notice, the tip of the MesioBucchal cusp
goes Posterior to that of the class I & become in the embrasure
site which is in between the lower first & second molars. And notice
here the tip of the upper canine takes place where the upper molar
should be located, (Retruding Case).

Protruding Case: is when the Upper Molar Protrude (Become

Anterior) to its normal position.

Retrudind Case: is when the Upper Molar Retrudes (Become

Posterior) to its normal position.

Not necessarily you should see same relationship of the incisors as

well, sometimes you may found Class I Angle’s Molar relationship &
at the same time Class II incisal relationship, but whenever have a
sever class II Angle’s Molar relationship you should see a sever
Class II incisal relationship, because sometimes the cause of Class II
in incisal relationship is (Thumb Suckling).

SLIDE 12
[Arch Occlusal Relationship]

So we are discussed the AnterioPosterior relationship

between the Upper & Lower teeth, we also we have a
relationship related to Lower teeth whish is
(FacioLingual or BucchoLingual <MesioLateral>
relationship).
Like for example, what is the relationship between the
Upper & Lower Molars in the FacioLingual dimension
(Coronal Section)?

12
Now if you look to the drawing no. 5 which is illustrate the
Normal Relationship between the Upper & Lower First
premolars, notice that the Bucchal Cusp of the lower first
premolar is in between the 2 cusps (Bucchal & Lingual
cusps) of the upper premolar.

Regarding the molars, notice that in the drawing no. 6, the

MesioBucchal cusp of the lower first molar located
between the 2 cusps (MesioBucchal & DistoBucchal) of
the upper first molar & this is the Natural Relationship.
This makes some categorization of the cusps; that’s mean
based on these relationships; we divide the cusps into 2
Categories:

1- Functional Cusp.
Which are the cusps that are related to the opposing teeth
or which are important in contact.

2- Non – Functional Cusp

Which are the cusps that are without contact.

Let’s take for example the tooth which is in (drawing no.

5) Premolars Relationship. Here we have 1 bucchal
cusp & 1 lingual cusp.

Which one of these cusps is in occlusion?

The Bucchal Cusp
So, we need the bucchal cusp of the lower premolar as the
Functional Cusp.

13
Regarding the upper molars (drawing no. 6)
Which the cusp is in contact?
The Lingual Cusp.

So, this is actually important (the Lingual cusp of the

Upper Molar & the Bucchal cusp of the Lower
Molar), because let’s suppose we want to make a Filling
to supports the heavy load & this filling is made on the
Supporting Cusp (for example, the bucchal cusp), I
have to know that this Bucchal Cusp is under the load, so
this filling need to be very hard. But if I want to make a
small filling on the lingual cusp of the lower molar, I have
to know this cusp is Non – functional Cusp. It’s not in
contact, it doesn’t have a pressure on it, and so it doesn’t
matter if I put a filling less in hardness.
So all the time we have to put very strong filling or
restorations at the areas of the Functional Cusp or the
areas of Occlusion.
Because not all parts of the tooth make the
occlusion.

SLIDE 13
[Curves of Occlusion]

 Curve of Spee
As you see if you put the teeth together, their
Occlusal surface are not actually Flat, that’s
mean if you bring the lower jaw & try to put it
with the upper one, you will be not able to fit
all the teeth in the Flat Surface, because not all the teeth
is organized to fit into the flat surface. See here in the
picture if you join a line from the tip of the canine to the
last cusp here which is the DB cusp of the Mandibular
Third Molar & let the line to pass throw the cusps of all
teeth, this line tend to curve & this curvature called Curve
of Spee.

14
Curve of Spee:
Defines as the Imaginary Line passing from the cusp tip
of the Mandibular Canine to the cusp tip of the DB
cusp of the Mandibular Third molar.

If you continue the curvature of this curve this line should

pass throw the Head of Condyles & this is very
important, because when you bite if the teeth
arrangement is flat, all the teeth were touching a flat
plane, so you will be not able to bite; because actually the
mandible rotating around the condyle. So if you have a
flat teeth upper & lower you will not be able to bite them
together, because the posterior teeth will touch together
& the anterior ones will remain without contact, with this
curvature all the teeth will be in contact this is the
AnterioPosterior curvature, this is a Carve of Spee

 Curve of Wilson.
Which is describes the MesioLateral
curvature, this picture is a coronal section &
here we find this curvature, lets imagine that
this curvature passes throw mandibular first
molar from B cusp then L cusp, then L cusp & B cusp
from the other side, this curve is called Curve of Wilson.

Curve of Wilson:
Is define as the Imaginary Line passing throw the B & L
cusps of the right side of the posterior teeth then it
continues to the L & B cusps of the crown of the
posterior teeth of the other side (Any Posterior Teeth).

 Sphere of Monson
If you bring the Curve of Spee & Curve of Wilson
together you get a sphere called Sphere of Wilson.
Here this is the mandible & see all the teeth are touching
the sphere.

15
The center of this sphere is in the Glabella which is the
area between the eyebrows & it’s an elevating ridge
(Between Superciliary Ridge).

SLIDE 14
[Inclinations & Angulations of the Roots of
the teeth]
If you notice here in the molars, the long axis of the two
occluding molar are not vertical, & as you see here the
long axis of the upper first molar is tip Outward that’s
mean the upper molar is not existing vertical in the jaw,
while in the lower molar it’s also not vertical but it’s tip
Inward.
Because of our teeth are not meeting cusp to cusp, we
always have inclination, the upper molar incline Outward
while the lower molar incline Inward, but if they are
vertical, if the relationship between them is vertical, there
will be imbalanced when we are apply the force from the
maxilla to the mandible or from the mandible to the
maxilla, this will lead to inclination of the teeth in a non
functional way. But if we inclines the teeth slightly and in
a correct way, there will be a stabilization between them,
so because of the functional cusps (Bucchal Cusps) of
the lower molars are located between the two cusps of the
upper molars, you should actually make the long axis of
the molars not vertically oriented, & this makes the arch
of the mandible wider than the arch of the maxilla.

 Mandibular arch is wider than maxillary arch.

 Each tooth must be placed at the angle that
best withstands the line of forces brought
against it during function.

16
The teeth are not vertically located in the jaw, & this
makes the stabilization between the upper & lower teeth.

 If the tooth is placed at a disadvantage, its

longevity may be at risk.
If one of our teeth -for example- is erupt in wrongly way, &
its angle is not appropriate for its function, so the life time
in our mouth or the longevity will be at risk.

 Anterior teeth are placed at a disadvantage.

That’s mean is their position, their angulations is
not appropriate, their forces isn’t actually enough
to keep them in its position.
All the time the anterior teeth are not put exactly as
molars, the molars are more stable than the Anterior teeth
all the time tipped forward, but what’s actually stabilize
that is the force of the Lips, Lips all the time apply force
on the anterior teeth to inhibit them to do profanation,
let’s assume theoretically cutting the upper & lower lips,
after some years we will find anterior teeth getting
exposed, pronounced anteriorly.
So those people who have Incompliant Lips (lips which
don’t meet, away from each other), always we see their
anterior teeth to be Proclined.

SLIDE 15
[Antagonist]

17
  With the exception of mandibular incisors and
maxillary third molars, each tooth contacts two
antagonist teeth in the opposing arch.
As we said before in the deciduous teeth each tooth
should has a contact with 2 teeth, also here the
permanent teeth follow the same rule. Let’s take an
example; the Lower First Premolar normally should be
contact to 2 teeth which are (the Maxillary canine & First
premolar). Except the Mandibular central incisor which
make a contact with the maxillary central & the maxillary
third molar.
This rule is applied in Normal Class I relationship, while in
the case of the Class II relationship the situation is
different & the exception will be the mandibular third
molar not maxillary one.
As the general rule: If you extract the lower third molar,
you also should extract an upper third molar why?
Because the upper third molar has only one antagonist
(which is the lower third molar that will be extract) & this
antagonist is loss, so there will be a supraeruption of the
upper third which leads to imbalanced in the occlusion, so
we should extract the upper third as well, & this in the
normal case only in the Class I relationship. While in Class
II the opposite is true, the lower third molar which is make
the occlusion, so in this case if we extract the upper
molar, we should extract the lower also. But if we extract
the lower, we will not need to extract the upper because
the antagonist is lost & the upper is still in contact with
the mandibular second molar.

 Loss of one tooth keeps the adjacent tooth in

contact with opposing antagonist.
While each tooth has 2 antagonists, so if you lose one
tooth, the other one will be in contact.

 Mesial or distal drifting into the space disturbs

occlusal contact with antagonist teeth.
If we have tooth with 2 antagonists & one of these
antagonists get extracted, the tooth will be still in
occlusion because it still have the other antagonist tooth,
but if we need to extract the tooth which anterior or

18
posterior to it, this will lead to Mesial or Distal drifting &
this will disturbs the occlusion.
So as the rule in dentistry: If you extract your tooth don’t
be late, run to the nearest dentist and replace it. 

SLIDE 16
[Centric Spots]

 Lingual cusp tips of maxillary posterior make

contact with opposing fossae and marginal
ridges of mandibular posterior teeth.

 Buccal cusp tips of mandibular posterior make

contact with opposing fossae and marginal
ridges of maxillary posterior teeth.

 Lingual cusps of maxillary posterior teeth and

buccal cusps of mandibular posterior teeth are
called “supporting cusps”.

 Areas of occlusal contact that a supporting

cusp makes with opposing teeth in centric
occlusion are “centric stops”.
Not all the surface of the tooth are in contact with the
antagonist tooth, only a small areas which are called
Centric Stops.

 The tip of that cusp is also a centric stop.

Always the tip of cusp (if this cusp is a supporting cusp
only) considered as a Centric Stop, also the bottom of
the fossa & the marginal ridges are considered as a
Centric Stop.

 Knowledge of centric stops is important in

restorative dentistry.
All the time you should know the area of a Centric Stops
because these are the areas which caries the whole load.

19
SLIDE 17
[Movement Away from the Centric Occlusion]

 Lateral
If you move the mandible laterally, we called the side
where you move your mandible to it, the Working Side &
the other side is called the Non – Working Side.

 Working side.
It’s the side which where the mandible is moving to.

 Non-working side.
It’s the opposite side to the Working Side.

 In complete dentures.

 Balancing side.
In the Complete Dentures instead of saying Working
Side, we said Balancing Side.
 Non-balancing side.
Here (in Complete Denture) the Non – Working Side
should have contacting teeth & that’s what we call it
Balanced Occlusion, but as we said in the Dentate
People in the normal dentition there will be no need to
have the contact between teeth.

 Movement in TMJ.
When you move the mandible to the right side (for
example), the TMJ in the opposite side will move forward &
the TMJ which is in the same side will be constant.
 Tooth guidance.
When you move a group of the teeth laterally, we have
one of the following cases:
 Group function.
It’s mean all the bucchal cusps of the lower teeth are in
contact with all the bucchal cusps of the upper teeth.
 Canine guidance.
But sometimes because of the prominent of Canines,
these canines only are the guidance.
The canine guidance is risky because if you move your
mandible to the lateral side, the whole load will be on the
Canines.

20
  Protrusive
 Incisal guidance.
All the time the incisal surface of the upper incisors is the
guidance for the forward movement of the mandible.
 Retrusive
 The most retrusive position is the centric
occlusion in complete dentures.
We talked about it in the Oral Physiology.

THE END

Done By: Ramiz Alrashwani

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