OCCLUSOGRAM

PRECEPTOR PRESENTED BY
DR. DIVYA SHETTY EMAD AHMAD ANIS
PG 2ND YEAR
Dept. of Orthodontics
 CONTENTS
INTRODUCTION
TYPES OF OCCLUSOGRAMS
APPLICATIONS
REVIEW OF LITERATURE
RECENT ADVANCES
CONCLUSION
REFERENCES
 INTRODUCTION
Currently, the lateral cephalometric head films
is used in many respects to the exclusion of
records that define the third dimension.

Burstone (1961) introduced a new procedure

called occlusogram (positive print 1:1
photographs) and with the help of lateral
cephalometric head films it is now possible to
make treatment plans in all 3 dimension.
An occlusogram is a 1:1 reproduction of the
occlusal surfaces of plaster models on a sheet of
acetate tracing paper.
TYPES OF OCCLUSOGRAMS
 An occlusogram is a 1:1 reproduction of
the occlusal surfaces of plaster models on
a sheet of acetate tracing paper.
 Photographic technique
Introduced by Burstone; 1961, producing
positive - print 1:1 photography of dental casts
and tracing was done with the help of
photograph.
 Photocopier technique
Introduced by Yen. Photocopy of models are
taken and then they are traced and digitized.
 Manual eye viewer technique (JCO, Feb 1982)

Introduced by White, describes a device called

an occlusal tracer, which makes a tracing of
the teeth directly from the model.
 Computerized occlusogram (JCO, August 1979)
Introduced by Burstone, 1:1 photograph is
taken and scanned on to which the points are
digitized..
USES OF OCCLUSOGRAMS White: JCO, Feb 1982

Arch Length Discrepancy Measurement:

The occlusogram also permits the clinician to
make highly accurate and reliable arch length
discrepancy measurements by superimposing
the idealized lower arch form on the original.
Occlusal Simulations:
Marcotte and Burstone suggested setting the
maxillary teeth around an idealized lower arch
form so that it would be possible to do an
occlusal simulation, or what is known as a "set-
up without the time and inaccuracies inherent in
a plaster model technique.
Occlusal simulations permit the orthodontist to
quickly see if the maxillary teeth even have the
possibility of occluding with the lower correctly.
Evaluation of Various Treatment Plans:
The orthodontist can try any alternative he
can think of without risk or harm to the
patient.
Occlusograms Revisited JCO, July 1992
To compare malocclusions with occlusogram
norms.
To formulate accurate tooth-size
discrepancies:
Many clinicians prefer using diagnostic model
setups of standard Bolton measurements, but
setups are time consuming and difficult to master.
Occlusogram set up gives accurate tooth size
discrepancy.
To construct ideal and individualized arch forms:
Nature arranges teeth in arcs through various
forces. An ideal arch selected at the beginning
can provide a template for arch wire
construction throughout treatment.
 To create occlusal simulations.
To evaluate various treatment plans.
To make accurate measurements of arch
length discrepancy (ALD).
OCCLUSOGRAM NORMS (WHITE JCO-1982)

Although occlusograms have been used by a

few orthodontists for several years, there have
been no published norms or guidelines.
 In 1978, White

Illustrated how occlusograms could be used for

arch form determination and arch length
discrepancy measurements.
Occlusograms of twenty-four untreated normal
adult Class I occlusions were made at the
University of Connecticut using Dr. Burstone's
photographic technique.
The measurements on this sample of
occlusograms leads to some suggested guidelines
for those who want to use occlusograms. .
 Each upper tooth touches two lower teeth below
it, with the exception of the last upper molar,
which has only the last lower molar to bite
against.
The biting edge of the upper anterior teeth lies in
front of the biting edge of the lower anterior
teeth by an average of .7mm (anterior overjet).
The upper posterior teeth extend beyond the
lower posterior teeth by an average of 2.3mm on
each side (posterior overjet).
 The upper bicuspids are wider than the lower
bicuspids by an average of 1.9mm on each
side (bicuspid lateral overjet).
The upper molars are wider than the lower
molars by an average of 1.4mm on each side
(lateral molar overjet).
Typical ideal normal Class I occlusogram
 A key to firm static occlusion is the width and position
of the maxillary lateral incisors.
If these teeth are positioned correctly, they will extend
at least to the middle of the mandibular cuspid.
This will insure that the maxillary cuspid will be in
proper occlusal position, conacting the lower first
bicuspid.
If the maxillary incisors are not wide enough to permit
the lateral incisors to engage the mandibular cuspids
properly, it will be impossible to achieve a firm Class I
occlusion without spacing between the upper anterior
teeth.
 TYPES OF ARCH FORMS JCO-Nov 1978: White

Even though various researchers have arrived at different

conclusions while using similar data, a review of the literature
shows that most have labored under at least three common
presumptions.

1) There must be an algebraic or geometric formula to determine

idealarch form.
2) presumption is that every ideal arch form must adhere to a
generalized scheme that is, a form that is of the same quality,
differing only in size.
3) A third and very important presumption is that every ideal arch is
considered to be symmetrical. This last presumption is directly
related to the mathematical equations used, which make it
impossible to produce asymmetry. Equations are, by
definition, equal values.
 TYPES OF ARCH FORMS JCO-Nov 1978: White

There are four currently popular formulae for

arch shape determination:
Bonwill-Hawley formula,
Brader arch forms,
The Catenary arch design, and
Rocky Mountain Data Systems computer-
derived formula.
 Bonwill-Hawley Arch Design
Based upon the combined mesiodistal widths
of the incisors and cuspids.
Arc of the anterior teeth relates an equilateral
triangle.
Largely been discredited, but it is still widely
used.
The shape of an ideal arch wire from an
orthodontic supply company will most likely be
of the Bonwill-Hawley design.
Bonwill-Hawley Arch Design
 Brader Arch Design
Known as trifocal ellipses.
Based on arch width at the second molars as
measured at the facial, gingival surface.
Brader arch adapts to the facial surfaces of the
teeth and all of the forms are alike in shape.
They differ in size as dictated by the widths at
the second molars.

PR=C
 Brader Arch Design
The maxillary arch form is always one size
larger than the mandibular and coordination
of working archwires throughout treatment is
greatly simplified.
The main clinical criticism of the Brader arches
is that when those forms are followed, there is
often severe narrowing in the cuspid areas.
 Typical narrowing of
cuspids treated with
Brader arch forms.
 Catenary Arch Design
Determined by intermolar widths, but measured
from central fossa to central fossa.
Curve which results when a fine chain is
suspended at its two ends.
Described as a central core or central
perimeter around which the teeth arrange
themselves.
Catenary's popularity is the work of
MacConaill and Scher 1949.
 Catenary Arch Design: .
 MacConaill and Scher acknowledge some deviations
from this "pure form", but suggest that these are due
to pathological forces that occur during eruption of the
teeth and subsequent alveolar development.
Burdie and LillieH found that a basic bony arch is
established as early as 9.5 weeks in utero and they
suggested that this basic arch was of a catenary design.
However, their own evidence shows many arches
which were arranged outside of the catenary form and
certainly this is before any pathological force has
disturbed the catenary "pure form ".
Rocky Mountain Data Systems computer-derived formula

RMDS is based upon measurements taken from

intermolar width, intercuspid width, and arch
depth as measured from the facial surface of the
incisor to the distal surface of the terminal molar.
This allows the computer to be programmed
with Cartesian x and y coordinates that are
necessary for a two-dimensional, computer-
derived formula.
Facial type is also considered in this arch
computation.
 Computer-derived arch Design
All of these techniques have one common area
of agreement, the anterior part of the dental
arch is part of a curve.
This curve has been described as
1. an ellipse, two focal points such that the sum of the distances to the two focal points is constant for every point on the curve

2. a parabola, The path of a projectile under the influence of gravity follows a curve of this shape.
3. part of a trifocal ellipse,
4. catenary. formed by a wire, rope, or chain hanging freely from two points that are not in the same vertical line.
Computer derived arch design
 A study was undertaken to see how a
collection of ideal, untreated arches
conformed to the predetermined arch forms
of the most popular formulae, and to come to
conclusions, if possible, about how
reasonable, ideal arch forms can be derived
for individual patients.
 Dental casts of twenty-four orthodontically
untreated, superior, adult occlusions were
collected. Tracings of the teeth were made on
acetate paper and overlays were constructed
and superimposed. RMDS recognized the
possibility of arch asymmetry and changed its
computer analysis method to use a different
mathematical curve for each side of the
asymmetric patient. .
 Only 8% of the Bonwill-Hawley designs could be considered
a good fit, while 52% were poorfits.
The Brader designs had two more good fits, but the
percentage was still low at 12.5%.
Catenaries had more good fits than the previous two
combined, but the percentage was still only 27%; and there
was an equal percentage of poor fits.
The RMDS computer-derived arch designs, impressively,
had no poor fitting designs, but had only two arches that
could be called good fitting designs. Since only lower arches
are computed by RMDS, the sample number is one half
that of the other designs. 92% of the RMDS designs were
judged to be moderately good fits.
 Clinical Technique Determining Physiologic Archforms
Oakes method (JCO,Feb1991)

Mandibular model with all permanent teeth

present provides the best basis for
construction of a correct or "physiologic" arch
form.
This technique takes less than three minutes
For the best symmetry, trace first from the
midline to the left, then flip the acetate over
and trace from the midline to the left on the
opposite side.
1. Attach cake-decorating beads, representing
the ideal bracket positions, to the mandibular
model with toothpaste.
2. Place a clear piece of glass or plastic over the
model, or place the model in an occlusogram jig
and overlay the jig with acetate. .
3. Viewing the model from directly overhead,
transfer the bead positions to the acetate, glass,
or plastic with a permanent marker. .
4. Remove the acetate, glass, or plastic from the model,
and connect the dots as symmetrically as possible.
Some smoothing is often needed to obtain symmetry in
cases with anterior crowding.
Place the lower arch wire directly over the traced
arch form. Bend the upper arch wire to lie outside
the traced arch form.
 Physiologic archforms are difficult to construct in
cases where there is severe intercanine
constriction.
If the original intercanine width is maintained,
the arch form will be "squeezed" in the cuspid
region.
Although the principle is sound, such an arch
form would be unacceptable. In these cases,
expansion is necessary and extended retainer
wear must be encouraged.
 The simple technique described above
produces individualized physiologic archforms
that reduce the potential for relapse of
orthodontic expansion.
 TYPES OF OCCLUSOGRAMS
Study model set-up, Black-and-white camera
on horizontal photo copy stand, with lights.
 Photographic Technique:
The dental impressions are made, casts
poured.
Wax jaw registration be made in centric
relation.
This wax centric relation registration is then
placed between the dental casts while the
posterior borders of the casts are trimmed
and made flush with each other.
 A registration groove is placed in
the backs of both casts
simultaneously by means of a
custom- made dental cast
scriber.
The casts have thus been
trimmed with their backs
mutually perpendicular to the
occlusal plane and to the palatal
midline and have also been
scribed to permit the positive-
print, occlusograms to be
oriented laterally.
The casts are then finished and
polished in the usual manner. .
 Central groove cut into the backs of models by
a triangular file; to cut central orientation
groove.
 Occlusogram camera assembly consists of a 4
by 5 inch box camera, a dental cast stage, two
375- watt floodlights, and a hinged Plexiglas
plate.
The camera is mounted on
a sliding track, so that the
distance from the edge of
the stage can be adjusted
and fixed to produce a 1:1
magnification.
 For this particular installation a 210 mm lens is
found to be satisfactory.
The dental cast stage has an adjustable guide
onto which fit the registration grooves on the
backs of the dental casts.
 Lower dental cast on the registration track of the
occlusostat.
The registration lines can
be seen on the leading
face of the occlusostat
. The occlusal surfaces
of the cast have also
been made flush with
the leading edge of the
occlusostat. .
 Registration dots which are located in the leading
edge of the stage will also be recorded on the
occlusogram.
With a fine-grain positive film placed into film
cassette and with both flood lights focused on the
dental casts, a typical exposure is made.
Processed according to manufacturer's directions,
maxillary and mandibular occlusograms are
produced at 1:1 magnification. .
 Using the registration dots on the leading edge of
the stage as reference points, both occlusograms
are registered on these dots and permanently
fixed at the bottom edge with a noncracking type
of tape.
Since the positive print film is transparent, the
existing occlusal relationships in centric relation
can be seen when the occlusograms are folded
over. For most treatment procedures, however,
an occlusogram tracing is required.
 For this occlusogram tracing, acetate paper is
placed over the occlusograms and the
maxillary and mandibular teeth are outlined,
showing the gingival tooth contours, incisal
edges, buccal cusp ridges, central grooves, and
cusp tips.
Also traced are the palatal rugae, the
midpalatal raphe, and the registration dots.
 Occlusogram tracing
Upper and lower occlusogram tracings. Both are shown with the
registration dots on the backs and the registration lines (R).
A mid saggital reference line is also drawn on the upper
occlusogram tracing .
 Both the occlusogram tracing are assembled
on the registration dots.
 Photocopier technique
Yen makes a photocopy of the model and then
traces or digitizes the photocopy.
Yen's method is easier than the other two, but
the photocopying can introduce varying degrees
of distortion because the models are three-
dimensional.
This distortion can be limited to about 1 -2
percent enlargement if the models are placed on
the surface of the machine so that the least
amount of shadow is projected to the copy.
Photo copier method
Reliability of Measurements from Photocopies of Study Models:
MICHEL JCO,1992 Oct

Ten sets of study models (20 occlusal surfaces)

were photocopied on a Canon PC-25 photocopier.
Each model and its photocopy were then
measured by the same operator, using an
electronic digital caliper.
The following measurements were recorded:
1. Total arch length (the sum of all maxillary and
mandibular individual tooth widths)
2. Intercuspid width
3. Intermolar width .
 Results: There was little difference between
the actual models and the photocopies in
measurements of arch width.
However, there was a substantial difference in
the measurements of total arch length.
 Photocopies of models appear to be valid for:
Comparing pre- and post-treatment archforms
Checking original tooth rotations or the initial arch
form during treatment.
Producing occlusograms for demonstration
purposes Photocopies may be less precise for:
Measuring arch length
Producing occlusograms for space analysis .
Manual method

Occlusal map maker

 The most primitive technique for making accurate
1:1 occlusal reproductions is to trace the occlusal
surfaces of the teeth onto a clear 1/8" plastic
sheet that is secured against the dental cast.
Since the eye of the viewer is the camera, the
viewer's head must not be moved while tracing
both sides of the model.
With a minimum of practice, highly accurate
tracings can be made with inexpensive materials .
Manual eye viewer occlusogram .
 Computerized occlusogram
(Burstone -Jco-1979)

Digitizing the points of the 1:1 occlusal

photograph of the model give the both
measurements and a diagram of the tooth
positions .
The computer does a setup.
Points are digitized at the mesial and distal
contacts and the tips of the buccal cusps of the
lower, and the functional cusps on the upper will
be the tips of the lingual cusps.
The computer draws the teeth.
Digitizing points on a 1:1 occlusal photograph.
 The computer calculates the variations from
the mean in tooth size.
The reason for seeing this on the screen at this
time is to find out if there are major tooth size
differences and make a decision on extraction,
or to point out a mistake in digitizing.
 Now the computer will first of all draw the
original malocclusion on which you see certain
control points which the orthodontist decides.
The anterior part of the arch is a segment of a
parabola, so it fits a parabola between the
points that clinician select.
There are enough control points, so that each
arch form is individualized for the patient.
Also, the computer graphically shows where
each tooth will be in the individualized arch.
 Now, the computer asks if he want to see a
hard copy.
Normally hard copies are made as a
permanent record at the end.
The printout is three times life size, so he can
see what the relationships are in detail.
 Now, we have the new arch form constructed.
Both the original and final arches are shown on the
screen.
 Computerized setup . Lower teeth (red) and upper teeth (green).
 Computer-Aided Space Analysis
YEN- JCO, Apr 1991

Make a photocopy of the upper and lower

study models.
Digitize the key landmarks from the
photocopy. (If necessary, allow for any
enlargement introduced by the photocopier.)
Run the program and print out the data.
Printout of space analysis and computer-generated arch
form. Horizontal lines in arch form indicate arch widths.
 Computerized arch form is made by simply
connecting the most mesial and distal points of
each tooth from second molar to second molar.
Each arch is divided into anterior (B + C) and
posterior (A + D) segments for space analysis.
 .The "required space" for each segment is the
sum of the tooth sizes in that segment; the
"available space" is the total width of the
segment.
 THE 3-D OCCLUSOGRAM SOFTWARE
AJO, Sep 1999: Foirelli

The 3-D Occlusogram (3-DO) procedure

includes 4stages, which are performed by
different components of the software:
Image scanning and setting
Occlusal view processing
Lateral cephalometric processing
Occlusogram construction .
 The treatment goal can be produced either
manually, by means of 3-dimensional scanning
equipment, or by means of the software
demonstrated above coupled with a common
flatbed scanner.
The latter has the advantage that, after a rather
short training period, it is more rapid and more
precise than the manual method without
requiring any special and expensive equipment
that the orthodontist does not generally already
possess.
 Conclusion
Occlusograms offer us an accurate way to
measure, compare, and evaluate
malocclusions, to plan and forecast treatment,
and to visualize occlusal objectives.
Hoping that orthodontists will take one more
look at this valuable technique.
The rewards to both patient and doctor clearly
make occlusograms a worthwhile adjunct to
our diagnostic armamentarium.
 References
(Am J Orthod Dentofac Orthop 1997;112:676-
80).
JCOVolume 1978 Nov(779 - 787):
Individualized Ideal Arches
Volume 1979 Aug(539 - 551): JCO Interviews:
Dr. Charles J. Burstone on the Uses of the
Computer
Volume 1979 Jul(442 - 453): JCO Interviews:
Dr. Charles J. Burstone
 JCO Volume 1992 Jul(396 - 401): Occlusograms in
Orthodontic Treatment Planning - RICHARD D.
FABER
JCO Volume 1992 Oct(648 - 650): Reliability of
Measurements from Photocopies of Study
Models MICHEL.
JCO Volume 1991 Feb(79 - 80): Technique Clinic
Determining Physiologic Archforms - CHARLES
OAKE
JCO Volume 1992 Jul(389 -): 390 THE EDITOR'S
CORNER
 JCO Volume 1991 Apr(236 - 238): Computer
Aided Space Analysis - CHEN-HSING YEN,
JCO Volume 1982 Feb(92 - 103): The Clinical
Use of Occlusograms
THE 3-D OCCLUSOGRAM SOFTWARE
AJO, Sep 1999: Foirelli