OCCLUSION IN

FPD AND
IMPLANTS

SUBIYA
 Introduction
Significance of occlusion
Terminologies
History of study of occlusion
Concepts of occlusion
CONTENT Criteria for optimum functional occlusion

S Determinants of occlusion
Occlusal adjustments
Implant Protective Occlusion
Recommended occlusion for different types of prosthesis
Conclusion
References
Introduction

“clusion” means “occlusion” means

“oc” means “up”
“closing” “closing up”

“ Occlusion means to block , to shut in , to bring together

″
Occlusion : (GPT 9)
“The static relationship between the
incising or masticating surfaces of the
maxillary or mandibular teeth or tooth
analogues”
Centric Relation :

• Position of the mandible when the joints are in a Orthopedically stable

position

• Muscles of mastication function more harmoniously and with less intensity

when the condyles are in CR

• Reproducible & reliable relation of mandible and maxilla for controlling

occlusal contact pattern

• Repeatable position – facilitates precision

• Functional movements of mandible start at CR

• Used when centric occlusal position is dysfunctional or cannot be preserved

• Helps create stable occlusion

Centric Occlusion : (GPT 9)
“The occlusion of opposing teeth when the mandible is in centric relation. This may or may
not coincide with the maximal intercuspal position”

Maximum Intercuspation : (GPT 9)

“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”
• Articulation : (GPT 9)
“The static and dynamic contact relationship between the occlusal surfaces of teeth during
function”

• Dynamic occlusion :
“The dynamic occlusion refers to the occlusal contacts that are made whilst the mandible is
moving relative to the maxilla”
• Malocclusion :
“Any deviation from a physiologically acceptable contact between the opposing dental arches”
Or
“Any deviation from a normal occlusion”

• Pathogenic Occlusion :
“An occlusal relationship capable of producing pathologic changes in the stomatognathic
system”
History

• Gnathology
1926

• Dynamic individual occlusion

1970’s
Philosophies of occlusion

Gnathology Functionalism
• Mc Collum & colleagues 1926 • Schuyler 1929

• Study of TMJ movements, their selective • Arrangements of teeth will provide the
measurements, reproduction and their use highest efficiency during all the excursions
as determinants in the diagnosis and of the mandible which are necessary to the
treatment of occlusion function of mastication
Concepts Of Occlusion
Concepts of Occlusion

Bilaterally balanced Unilaterally balanced Mutually protected

occlusion occlusion occlusion

Anterior protected
Not used in FPD
articulation

Canine protected
articulation
Bilaterall
y
Balanced
Occlusion
Based on the work of Von Spee &
Monson
Advantages Disadvantages
Useful in complete dentures It is not a healthy occlusion

There is cross arch and cross tooth contacts Does not normally occur

Increases stability Increases rate of occlusal wear

Accelerated periodontal breakdown

Neuromuscular disturbances

difficult to fabricate and to maintain

Unilaterally balanced occlusion/
Group Function
• Its origin is in the work of Schuyler

• “Demonstrated the destructive

nature of tooth contacts on the
non-working side and concluded
cross-arch balance not required in
natural teeth and it is best to
eliminate all tooth contacts on the
non working side”
Advantages Disadvantages

Distributes occlusal loads better Excessive load on posterior teeth of

working side
Absence of contacts on non-working side prevents
those teeth from being subjected to the destructive
forces

Saves centric holding cusps from excessive wear

Maintains occlusion
Mutually Protected Occlusion

• Advocated by Stuart &

Stallard
• Based on earlier work of
D’Amico
• Anterior teeth protect the
posterior teeth in all
mandibular excursions and
posterior teeth protect
anterior teeth at intercuspal
position
• According to ( GPT -9)

“An occlusal scheme in which the posterior teeth prevent excessive contact of the anterior teeth in
maximum intercuspation, and the anterior teeth disengage the posterior teeth in all mandibular
excursive movements. Alternatively, an occlusal scheme in which the anterior teeth disengage the
posterior teeth in all mandibular excursive movements, and the posterior teeth prevent excessive
contact of the anterior teeth in maximum intercuspation”
Anterior Protected Articulation
• ORGANIC OCCLUSION
• According to GPT 9 : “A form of mutually
protected articulation in which the vertical and
horizontal overlap of the anterior teeth
disengages the posterior teeth in all
mandibular excursive movements”
Canine Protected Occlusion
• CANINE GUIDED OCCLUSION
• According to GPT 9 :
“A form of mutually protected articulation in
which the vertical and horizontal overlap of the
canine teeth disengage the posterior teeth in the
excursive movements of the mandible”
Anatomical Evidence In Support Of Canine
Guided Occlusion :

• Canines are best suited to accept horizontal forces :

1. Longest & largest roots
2. Best crown-root ratio
3. Surrounded by dense compact bone
4. The location far from TMJ
5. Many receptors are present in the periodontal
ligament , so it controls lateral pressure by
directing vertical masticatory movements
Advantages Disadvantages
Absence of frictional wear Good periodontal health of anterior teeth is a
must
Minimizes horizontal loading of posterior teeth
Angle’s class II or III can not be guided by
anterior teeth
In intercuspation, no obliquely directed forces on
anterior teeth
Cannot be used in Crossbite situations
Ease of fabrication

Greater tolerance by patients Missing / prosthetic canine

• Nut cracker theory by
Dawson
Criteria For Optimum Functional Occlusion
• Orthopedically stable joint position :
Even and simultaneous contact of all
posterior teeth. The anterior teeth
also contact but more lightly than
the posterior teeth
Criteria For Optimum Functional Occlusion
Optimum functional tooth contacts
Criteria For Optimum Functional Occlusion
All tooth contacts provide axial loading of occlusal forces
 Cusp Marginal Ridge Occlusion Cusp Fossa Occlusion

• Payne / Lundeen • Peter K.Thomas

• 1 tooth to 2 teeth relation • 1 tooth to 1 tooth relation

• Two point contact • Tripod contact (Tripodism)

Centric intercuspal contacts in
coronal plane :
•A – Lower Centric cusp with Upper Shear cusp
•B – Lower Centric cusp with Upper Centric cusp
•C – Lower Shear cusp with Upper Centric cusp
Centric inter-cuspal contacts in sagittal plane :

1. Closure Stoppers
2. Equalizers
Criteria For Optimum Functional Occlusion

When the mandible moves into latero-trusive

positions, restore ideal canine relations – canine
guided occlusion
Criteria For Optimum Functional Occlusion

When the mandible moves into a protrusive

position, adequate tooth-guided contacts on the
anterior teeth should be present to disocclude
all posterior teeth immediately
Criteria For Optimum Functional Occlusion
In the upright head position and alert feeding position, posterior tooth contacts
should be heavier than anterior tooth contacts
 2. Anterior controlling 1. Posterior controlling
factors factors
Determinants Of Occlusion
Vertical determinants Of Occlusal Morphology
• Factors that influence the heights of cusps and the depths of fossae
• Determined by three factors:
1. The ACF of mandibular movement (i.e., anterior guidance)
2. The PCF of mandibular movement (i.e., condylar guidance)
3. The nearness of the cusp to these controlling factors
 Effect Of Condylar Guidance (Angle Of The Eminence)
On
Cusp Height :

Shallow protrusive condylar inclination requires short cusps (A)

Steeper path permits the cusps to be longer (B)
Effect Of Anterior Guidance On Cusp Height :
Effect Of The Plane Of Occlusion On Cusp Height :
Effect Of The Curve Of Spee On Cusp Height :
Effect Of Mandibular Lateral
Translation Movement On Cusp
Height :

• Amount
• Direction
• Timing
Effect of the Amount of Lateral Translation
Movement on Cusp Height :
Effect of the Direction of the Lateral Translation
Movement on
Cusp Height :
Effect of the Timing of the Lateral Translation
Movement on
Cusp Height :
Horizontal Determinants Of Occlusal
Morphology
• Influence the direction of ridges and grooves
on the occlusal surfaces and the placement of
cusps
• Each centric cusp tip generates
--Mediotrusive pathway
-- Laterotrusive pathway
Effect Of Distance From The Rotating Condyle On
Ridge
And Groove Direction :
Effect Of Distance From The Midsagittal Plane On
Ridge
And Groove Direction :
Effect Of Mandibular Lateral Translation
Movement On
Ridge And Groove Direction :
 • Occlusal adjustment refers to selective recontouring and
grinding of teeth in order to remove prematurities
• Indications:
1. Evidence of trauma from occlusion, by changes in
Occlusal the periodontium

Adjustmen 2. Symptoms of TMJ dysfunction and habit neurosis

(Bruxism)

ts 3. Excessive tooth mobility

4. Excessive tooth wear
5. Need for extensive restorative work and Pre-
restorative treatment
• Aim in allowing maximal intercuspation of teeth in centric relation
• Marginal ridge angles
• Cusp heights
• Angles of triangle and oblique ridges
• Maintain the rounded contours and do not create flat surfaces
Sequence of Occlusal Adjustment :

Correction of
Correction of Correction of Correction of
Centric Relation
Protrusive Non-Working Working
Occlusal
Interferences Interferences Interferences
Interferences
Sequence of Occlusal Adjustment :

Correction of Protrusive Interferences

Grinding rule –
‘DUML’ : grind distal inclines of
upper or mesial incline of lower
teeth
Sequence of Occlusal Adjustment :

Correction of Non-Working Interferences

Grinding rule --
‘BULL’ : grind the buccal inclines of upper
or lingual inclines of lower
Sequence of Occlusal Adjustment :

Correction of Working Interferences

Sequence of Occlusal Adjustment :

Correction of Centric Relation Occlusal Interferences

Grinding rule –
‘MUDL’ : Grind the mesial inclines of upper
teeth or distal inclines of lower teeth
Implant protective occlusion
• Misch,1993
• Occlusal load transferred within physiologic limit
• Specifically for restoration of endosteal implants
• Provides an environment for improved clinical longevity of implants and
prosthesis
Concept
No premature occlusal contacts or interferences

Timing of occlusal contacts

Influence of surface area

Mutually protected articulation

Implant body angle to occlusal load

Cusp angle of crowns

Cantilever or offset distance (horizontal offset)

Crown height (vertical offset)

Occlusal contact positions

Implant crown contour

Occlusal materials
 Hobo S, classified osseointegrated prosthesis as
follows
Recommende • Fully bone anchored bridge
d occlusion • Free standing bridge
for different • Kennedy Class I
types of • Kennedy Class II
• Kennedy Class III
osseointegrat • Kennedy Class IV
ed prosthesis • Bridge connected to natural teeth
• Single tooth replacement
OCCLUSION FOR FULLY BONE ANCHORED
PROSTHESIS

• Recommended occlusion - Mutually protected

occlusion
• Centric stops on posterior teeth should be present
• Disclusion should be employed to eliminate
horizontal stresses.
• Anterior guidance should be made slightly flatter
than natural teeth to avoid overstress of the fixture.
• Recommended amounts of disclusion for fully bone anchored bridges are
• Protrusive - 1.0 mm
• Non working side - 0.8 mm
• Working side - 0.3 mm
Free standing bridge
(Kennedy Class I)

• Amount of disclusion required for this case is

the same as in the natural dentition because
anterior guidance is provided by the natural
dentition:
• Protrusive - 1.1 mm
• Non working side - 1.0 mm
• Working side - 0.5 mm
Free standing bridge
(Kennedy Class II & III)

• In centric
• Posterior osseointegrated bridge and
anterior teeth - 30 µm open contacts
• Strong bite pressure – Contact begins
• The amount of disclusion suggested is the
same as for natural dentition.
Free standing bridge
(Kennedy Class IV)

• Recommended occlusion – Group Function

• Recommended amounts of disclusion
• Protrusive - 1.0mm
• Non working side - 0.4mm
• Working side - 0mm
BRIDGE CONNECTED TO NATURAL
TEETH

Non rigid Rigid Telescopic

connector connector crown
Key is connected
Natural tooth is
to the Ankylosis of the
permanently
osseointegrated abutment tooth depressed
bridge

Creating Cement connecting

Keyway is placed
resorption of root the outer crown to
on the distal end
or resorption of the inner crown is
of the retainer broken down
alveolar bone
SINGLE TOOTH REPLACEMENT
Anterior Posterior
tooth tooth

Contact in centric equal to In centric a clearance of

natural dentition 30 µm is given

Eccentric movement- During eccentric

contact with opposing movements restoration
teeth in order to create must disclude and avoid
anterior group function. lateral stress.

This eccentric contact is

essential to prevent
extrusion of opposing
teeth.
 Most restorative procedures affect the shape of
occlusal surfaces.

Proper dental care ensures that functional contact

relationships are restored in harmony with both
Conclusion dynamic & static conditions.

Therefore, maxillary & mandibular teeth should

contact to allow optimum function, minimal trauma
to supporting structures, & an even load distribution
throughout dentition
References
• Dawson; functional occlusion From TMJ To Smile Design
• Okeson; management of temporomandibular disorers and occlusion, 6th edition
• Rosensteil, Land, Fujimoto; Contemporary Fixed Prosthodontics, 4th edition
• Shillingburg , Hobo, Whitsett, Jacobi, Brackett; Fundamentals Of Fixed Prosthodontics, 3rd
edition
• Tylmans , theory and practice of fixed prosthdontics
• Paul H. Pokorny,et al; Occlusion for fixed prosthodontics: A historical perspective of the
gnathological influence, J Prosthet Dent; 2008;99:299-313
• S. Davies, and R. M. J. Gray; What is occlusion? British Dental Journal 2001; 191: 235–245
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