Sem 15 Occ Eq Final

JSS ACADEMY OF HIGHER EDUCATION & RESEARCH
JSS Dental College & Hospital
OCCLUSAL EQULIBRATION
Presenter
Dr. NAGA USHA.N
POST GRADUATE STUDENT
Department of Prosthodontics and crown &
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CONTENTS
• Introduction.
• Indications
• Disadvantage
• Muscles of mastication
• Border and functional movements of mandible
• Types of occlusion
• Armamentarium
• Centric relation interferences and elimination
• Lateral interferences and elimination
• Protrusive interferences and elimination
• Developing anterior guidance
• Finishing of equilibration
• Verification
• Summary
• Review of literature
• References
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DEFINITION
• Occlusal equilibration/selective grinding is the modification of
the occlusal form of the teeth with the intent of equalizing
occlusal stress, producing simultaneous occlusal contacts or
harmonizing cuspal relations.

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INTRODUCTION
• Occlusion is the static, functional and dynamic relationship
between the incising and masticating surfaces of the maxillary or
mandibular teeth.
• An optimum occlusal condition is one when there is even
simultaneous contact of all possible teeth and forces are directed
along the long axes of teeth with condyles in their most superior
anterior (centric relation) position, resting against the posterior
slopes of the articular eminence with the disks properly placed
between them.

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• Occlusal disturbance are closely related in the development of
or to an increase in the severity of TMDs, therefore occlusal
adjustment is one of the initial treatment for TMD.
• Occlusal equilibration is a therapeutical abrasive technique that
can remove or correct occlusal interferences using the selective
grinding of the cuspal slopes or ridges of the teeth that
interfere with normal functional occlusal paths.
• It was first advocated by Schuyler in 1931.

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GOAL OF OPTIMAL DENTISTRY
Long-term stability of all components of the masticatory
system:
1. Teeth
2. Periodontium
3. Muscles of mastication, and
4. Temporo-mandibular joints (TMJ’s).

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• Deflective occlusal contact distracts the mandible from a normal
path of closure
• An occlusal interference can lead to pain in the head and neck
muscles, due to alteration of muscular tonus, discomfort or pain
during chewing.
The two main etiology of occlusal disturbance are
• Emotional or psychological stress
• Existing occlusal interferences or maloccluding teeth, both of
which lead to parafunctional habits.

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Occlusal disharmony creates muscle
hyperactivity
Which in turn focuses its

compressive and tensive forces on
the intracapsular structures of the
tmjs and the teeth.
The trigger for muscle hyperactivity

activate muscle via the
mechanoreceptor sensory system.
The damage can be intensified by
bruxing on the deflective inclines of
the teeth.
As muscle overloads the joints and

the teeth, the weakest link receives
the most structural damage (signs),
but the muscles are often the
primary focus of pain (symptoms).
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Indications
• Management of certain temporomandibular disorders (TMDs)

and complement treatment associated with major occlusal changes.
• When sufficient evidence exist that permanent alteration of
an occlusal condition will reduce or eliminate the symptoms associated with
a specific TMD (Myofascial pain syndrome). When reversible occlusal
appliance has eliminated the TMD symptoms, the occlusal condition
provided by the appliance is permanently introduced in the dentition to
resolve the disorder.
• If extensive crown and fixed prosthodontic procedures are necessary,
selective grinding may be indicated before treatment begins so that a stable
functional mandibular position is established to which the restorations can
be fabricated.
• Selective grinding is appropriate only when alterations of the tooth surfaces
are minimal so that all corrections can be made within the enamel structure.

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Disadvantage
Exposure of dentin poses problems

1. increased sensitivity
2. caries susceptibility
3. wear
• Therefore should not be left untreated. It is extremely
important that the treatment outcome of equilibration
be accurately predicted before treatment.

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MASTICATORY MUSCLES
Temporalis muscle
• The temporalis is one of three muscles that close the jaw and
clench the teeth. The way the muscle is leveraged gives it a great
amount of power, and splinting in the temporalis can cause
serious headaches. It respond favorably to occlusal correction.
• This muscle is also in direct opposition to the lateral pterygoid.

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Masseter
• Tenderness to palpation almost always indicates some degree of occlusal
interference that requires displacement of the same side condyle to
achieve maximum intercuspation.
• The muscle may feel quite enlarged/hypertrophied in strong clenchers
and bruxers.
• Tenderness and restricted opening in the morning are almost certain
indications of nighttime bruxing.
• Deep masseter muscle. - This muscle pulls the condyles up, so any
deflective incline that requires down/forward displacement of the
condyle puts the muscle in direct isometric
opposition to the lateral pterygoid muscle
that must act against it to hold the condyle
down the eminentia.

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Medial Pterygoid muscles
• The masseter and medial pterygoid act like a contractile

"hammock" in which the lower jaw rests. These two muscles are
more or less "twins", the masseter acting on the outside of the
lower jaw and the medial pterygoid on the inside.
• The internal pterygoid is a dependable diagnostic landmark in
that it is almost always tender to palpation if the same side
condyle must displace to achieve maximum intercuspation of the
teeth.

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LATERAL PTERYGOID
• The lateral pterygoid muscle is an incredibly important muscle.

• It is responsible for drawing the jaw forward when both the right and left
muscles are equally active.
• It is also responsible for moving the lower jaw from side to side when the
right or left lateral pterygoid is active separately.
• Any deflective occlusal incline that requires displacement of the condyle to
achieve maximum intercuspation is a direct causative factor in lateral
pterygoid hyperactivity and tenderness.

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• This is the positioner muscle that pulls the condyle forward every
time the mandible leaves centric relation, so even the slightest
movement forward always involves the lateral pterygoid muscle.
Contraction of the right lateral pterygoid muscle moves the jaw
to the left, and contraction of the left draws the jaw to the right.
• All movement of the mandible, either forward, right, or left from
centric relation, always involves the lateral pterygoid muscle
because such movements are made by pulling one or both
condyles forward and downward. (Murray GM, Uchida S, Whittle T: The
role of the human lateral pterygoid muscle in the control of horizontal jaw
movements. J Orofacial Pain 15:279-291, 2001.)

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• The inferior belly of the lateral pterygoid muscle is almost always
completely inactive during clenching in the retrusive position.
• The key to success seems to invariably be complete release of the
inferior lateral pterygoid muscle during closure to maximum
intercuspation. This can only be accomplished by eliminating all
deflective interferences to centric relation.

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when all the elevator muscles are pulling the condyle upwards,
what determines the stopping point for the condyle-disk assemblies
??
1. Braced by muscle or
2. Braced by bone
• Anatomic dissections and EMG studies are consistent in their
findings that the only muscle that can stop the condyles from
moving up the eminence is passive during jaw closure., unless
activated by occlusal interferences to hold the jaw forward.

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THE BORDER AND FUNCTIONAL MOVEMENTS
The border and functional movements of mandible occur in each of
the following reference plane.
• Sagittal plane border
• Horizontal plane border
• Frontal plane border.


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ENVELOPE OF MOTION
• Posselt's envelope is first described by Dr Ulf Posselt in
1952.
• It is a diagrammatic representation of a sagittal view of
maximum mandibular movement.
• Posselt postulated that in the first 20mm of opening and
closing, the mandible only rotates and does not
simultaneously move downward and forward.

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SAGITTAL PLANE BORDER AND FUNCTIONAL MOVEMENTS
Mandibular motion viewed in the sagittal plane can have four

distinct movement components.
1. Posterior opening border
2. Anterior opening border
3. Superior contact border
4. Functional
If the chewing stroke is examined in the sagittal plane the

movement will be seen to begin at the intercuspal position and
drop downward and slightly forward to the position of desired
opening. It then returns in a straighter pathway slightly posterior
to the opening movement.
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HORIZONTAL PLANE BORDER AND FUNCTIONAL MOVEMENTS:
When mandibular movements are viewed in the horizontal plane, a
rhomboid-shaped pattern can be seen that has four distinct
movement components plus a functional component:
• Left lateral border
• Continued left lateral border with protrusion
• Right lateral border
• Continued right lateral border with protrusion
CR - centric relation
ICP – intercuspal position
EEP – end to end position of interiors
EC – area used in early stages of

mastication
LC - area used in late stages of mastication

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FRONTAL (VERTICAL) BORDER AND FUNCTIONAL MOVEMENTS
Mandibular movements when viewed in frontal plane produce a
shield shaped functional component and four distinct movement
components.
• Left lateral superior border
• Left lateral opening border
• Right lateral superior border
• Right lateral opening border
1. Left lateral superior
2. Left lateral opening
3. Right lateral superior
4. Right lateral opening
ICP – Intercuspal position
PP – Postural position
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BENNETT SHIFT
It occurs due the contraction of lateral pterygoid muscle because its
origin is located medially to its insertion. When mandible shifts to the
side, its movement occurs in two segments- an immediate side shift in
which the major direction of movement is mediolateral and a progressive
side shift, which begins thereafter and continues with the major
direction of movement being anterior.

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TYPES OF OCCLUSION.
Centric Relation (CR) is a jaw relationship: it describes a

conceptual relationship between the maxilla and mandible.
When both condyle-disk assemblies are completely seated in
centric relation, their medial poles should be at the highest
point of concavity of that part of each fossa. From where the
medial poles are stopped by bone, the fossae walls curve
downward on three sides so that from a correct centric relation,
the condyles cannot travel forward, backward, or medially
without moving downward.

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CENTRIC OCCLUSION
Centric occlusion(CO) the occlusion of opposing teeth when the

mandible is in centric relation; this may or may not coincide with
the maximal intercuspal position; comp, MAXIMAL INTERCUSPAL
POSITION


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BALANCED OCCLUSION
• During the entire lateral movement posterior teeth on both
the working side and the nonworking side are in contact.
• Early workers in the field of occlusion assumed that this type
of occlusal construction was necessary to achieve the best
results for both complete dentures and the natural dentition
(Monson. 1932: Schuyler, 1935).
• Present day thinking has completely dismissed this concept for
restoring the natural dentition. But it is useful in complete
denture construction

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GROUP FUNCTION OCCLUSION

During the entire lateral movement the buccal cusps of the
posterior teeth on the working side are in contact. There is no
tooth contact on the nonworking side.

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CANINE PROTECTED OCCLUSION
During the lateral excursion contact occurs only between the

upper and lower canine, and first premolar on the working side.
There is no contact between the teeth on the non-working side.
The theory of canine protected occlusion is attributed to Nagao
(1919), Shaw (1924) and D'Amico(1958). It is based on the
impression that the canine tooth is the most appropriate tooth to
guide the mandibular excursion .

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IDEAL OCCLUSION
1. Centric occlusion and centric relation being in harmony
(CO=CR)
There should be even and simultaneous contacts of all posterior
teeth when the mouth is closed and the condyles are lying in
their most superior and anterior position, resting against the
posterior slope of the articular eminence (CR)
Note that the anterior teeth should also be occluding, but the
contact should be lighter than the posterior contacts
2. Freedom in CO
This means the mandible is still able to move slightly in the
sagittal and horizontal plane in centric occlusion

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3. Immediate and lasting posterior disocclusion upon mandibular
movement
During lateral excursive movements, the working side contacts act to
disocclude the non-working side immediately
During protrusive movements, the anterior tooth contact and
guidance acts to disocclude the posterior teeth immediately
4. Canine guidance is considered the best anterior guidance system

This is due to their ability to accept horizontal forces as they have the
longest and largest roots as well as a desirable crown/root ratio
They are also surrounded by dense compact bone unlike the posterior
teeth which makes them more suited to tolerate horizontal forces.
However, if the patient’s canines are not positioned correctly for
canine guidance, group function (involving the canines and premolars)
is the most favourable alternative
It is necessary to understand the concepts that influence the function
and health of the masticatory system in order to prevent, minimise or
eliminate any breakdown or trauma to the TMJs or teeth.
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ARMAMENTARIUM FOR EQUILIBRATION
• For occlusal grinding different diamond burs for occlusal

adjustments: round-end tapered diamond, chamfer
diamond, medium wheel diamond, round diamond burs,
dura-white different size, white polishing stone of enamel.
(poppa)
Shim stocks
• It is very thin strip of material that can be
used to check for contact between
surfaces. Usually made of mylar or metal
foil, it is sometimes coated on one side
with a marking substance.

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Ribbons
• The most efficient way to mark interferences is to use very thin film
impregnated with different colors of ink.
• The thinness of the film prevents it from smudging around the sides of
cusps and permits it to mark only surfaces that contact.
• It is made up of a micronized color pigment, embedded in a wax-oil
emulsion. Since it has a soft texture, pseudomarkings are not produced
during the use and it is effective when used intraorally.
Ribbon holder
• The Miller ribbon holder is excellent.

• Several holders should be loaded with
two colors so that time is not lost at the
chai replacing worn ribbons

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Articulation papers
• Articulation papers are manufactured in different thicknesses, colours and
configurations.
• Thicknesses may range from 25 - 350 microns. Use of thin articulation paper
should result in a more accurate marking (marking of a smaller discrepancy).
Thicker paper has the potential to mark not only contacts but also produce
false marks. This could result in adjustment of occlusal markings that are not
necessary.
• The color coating of many articulating papers consists of waxes, oils and
pigments, a hydrophobic mixture which repels saliva (hydrophilic) consisting
mainly of water.

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Waxes
• Thin sheets of dark-colored wax can be placed over the occlusal
surface of the teeth in one arch. The opposing teeth are then tapped
gently into the wax until it perforates.
• Wax is an excellent material for finding interferences on sharp-line
angles that are often difficult to pick up by other methods.
• It requires an excessively large amount of time, compared with the
use of marking ribbons.

Pastes, sprays, and paint-on materials
• A variety of materials are available that can be

painted or sprayed onto tooth contact, and then
the material is perforated so that the contact
areas are made visible. The use of such materials
can be extremely accurate because the film
thickness is so thin.


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COMPUTER-ASSISTED DYNAMIC
OCCLUSAL ANALYSIS
In 1987, Tekscan developed T-Scan, for occlusal analysis. T-Scan
offers instantaneous occlusal data, including timing and force. The
T-Scan instrument was designed to examine and record
occlusal contacts by computer analysis of information from a
pressure sensitive film. The T-Scan system is purported to
digitally record both the location and timing of tooth contacts.

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RULE OF THIRDS.
• The inner inclines of the posterior centric cusps are divided into
thirds. When the condyles are in the desired treatment position
(centric relation) and the opposing centric cusp tip contacts on the
third closest to the central fossa, selective grinding is the most
appropriate occlusal treatment.
• When the opposing centric cusp tip contacts on the middle third,
crowns or other fixed prosthetic procedures are generally indicated.
When the opposing centric cusp tip contacts on the third closest to
the opposing centric cusp tip, orthodontics is the most appropriate
occlusal treatment. Department of Prosthodontics
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and crown &
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Counseling Patients Before Equilibration
1. Proper diagnosis in itself generally prepares the patient.
2. Point out loose teeth and relate them to premature contacts or

lateral excursion interferences.
3. Relate wear problems to occlusal disharmony with the comfortable

joint position.
4. Study the occlusal relationship on properly mounted diagnostic

casts.
5. Demonstrate on the mounted casts the amount of tooth reshaping

that will be required.
6. Tell the patient to expect further adjustments.

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LOCATING THE OCCLUSAL INTERFERENCES
• The centric relation position for each condyle must be confirmed before
tooth contacts are marked.
• If centric relation can be verified at the open position, hold the mandible
on its uppermost axis and close on that arc by increments of a millimeter
or two at a time. As the jaw closes and tooth contacts get closer, some
resistance may be felt.
• Continue a slow opening-closing movement until the first tooth contact
occurs. That will be the first interference.

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ELIMINATING INTERFERENCES TO CENTRIC RELATION
Centric relation interferences can be differentiated

into two types:
1. Interference to the arc of closure

2. Interference to the line of closure

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INTERFERENCE TO THE ARC OF CLOSURE
• As the condyles rotate on their centric relation axis, each lower tooth
follows an arc of closure. Any tooth structure that interferes with this
closing arc has the effect of displacing the condyles down and
forward to achieve maximal intercuspation at the most
closed occlusal position (anterior slide).
• The basic grinding rule to correct an anterior slide is always
• MUDL: Grind the Mesial inclines of Upper teeth or the Distal inclines
of Lower teeth .

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INTERFERENCE TO THE LINE OF CLOSURE
Line of closure interferences refer to primary interferences that cause the
mandible to deviate to the left or the right from the first point of contact in
centric relation to the most closed position.
The basic grinding rules are as follows:

1. If the interfering incline causes the mandible to deviate off the line of
closure toward the cheek, grind the buccal incline of the upper or the lingual
incline of the lower, or both inclines.

2. If the interfering incline causes the mandible
to deviate off the line of closure toward the
tongue, the grinding rule is: Grind the lingual
incline of the upper or the buccal incline of the
lower, or both inclines.

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GRINDING RULES
Rule 1: Narrow stamp cusps before reshaping fossae

• If the first reshaping is directed at opening out the fossae to accept
bulky stamp cusps, it unnecessarily grinds away more enamel than
would be needed to accommodate narrower stamp cusps.
• It also facilitates dividing the reduction of tooth structure more evenly
between upper and lower teeth.


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Rule 2: Don’t shorten a stamp cusp Avoid the cusp tip.
• The cusps should be narrowed on the side that marks when the jaw
closes to centric relation contact
• Upper teeth are always adjusted on the inclines that face the same
direction as the slide. Lower teeth are adjusted by grinding
of inclines that face the opposite direction from the path of
the slide.

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Rule 3: Adjust centric interferences first
It is wise to give first priority to the elimination of all interferences to
centric relation closure. There are three reasons
for this:
1. improve cusp-tip position
2. occlusal grinding is more evenly distributed to both arches
3. eccentric interferences can be eliminated with speed and simplicity.

Rule 4: Eliminate all posterior incline contacts. Preserve cusp tips only.
If all eccentric contacts on posterior teeth are to be eliminated,
any posterior incline that marks in any excursion can be reduced.

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LATERAL EXCURSION INTERFERENCES
1. Manipulate the mandible to centric relation, and verify centric
relation with load testing.
2. Close on the centric relation axis arc to the first point of
contact.
3. Slide the forefinger around to join the other three fingers on
the working side.

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4. Use the thumb and bent forefinger to exert pressure toward
the working condyle
5. Slide the jaw to the left (or right). It might be necessary to have the
patient help, with continued upward pressure through the working side
condyle.
6. Dry ribbon is inserted to record the interferences. Slide the jaw to the
outer border position, and then have the patient squeeze hard back to
centric.

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ELIMINATING LATERAL OCCLUSAL INTEREFEENCE AND
DEVELOPING LATERAL GUIDANCE
• Procedure for canine guidance- once centric contacts is accomplished,

the teeth are again dried and the black eccentric and blue centric
marking procedure is repeated. At the completion of this procedure
the posterior teeth reveal only black CR
contacts on the cusp tips and flat surfaces.
The canines reveal the blue laterotrusive
contacts,and the incisors (with possibly
the canines) reveal the blue protrusive
contacts.

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Procedure for group function guidance-
The desirable contacts are the laterotrusive on the buccal cusps of the
premolars and the mesiobuccal cusp of the first molar. When the
selective grinding procedure is completed, the occlusal condition reveals
only the black CR contacts on the posterior teeth. The canines reveal the
blue laterotrusive contacts as the movement becomes great enough to
disocclude these teeth. The incisors reveal the blue protrusive contacts.

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STEPS IN HARMONIZATION OF THE ANTERIOR
GUIDANCE
1. Establish stable holding contacts on all anterior teeth

2. Extend the centric contact forward on all anterior teeth to provide long
centric of upto 0.5 mm.
3. Equalize contact in the protrusive path. If a single tooth is carrying 100
percent of the forces when the mandible slides forward, reduce the incline
as needed to bring more incisors into contact in protrusive
4. Adjust the lateral anterior guidance as needed to permit smooth,
comfortable excursions that do not stress or torque guiding teeth.

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PROTRUSIVE INTERFERENCES
• Only the front teeth should touch in protrusive excursions.
• All posterior contact should be eliminated in protrusion as soon as the
posterior teeth move forward of their centric holding contacts.
The rule for eliminating protrusive interferences is
• DUML: Grind the Distal inclines of the Upper or, in some instances, the
Mesial incline of the Lower teeth.
• Posterior disclusion in protrusion is accomplished by both the anterior
guidance and the downward movement of the protruding condyles. With
steep anterior guidances, correction for protrusive interferences is
usually minimal.

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THE SECRET OF FINISHING AN EQUILIBRATION
Dry the posterior teeth completely
Use a fresh red marking ribbon.
Using bilateral manipulation, find and verify centric with firm upward loading of
both condyles.
Ask the patient to grind in all directions as firmly as possible.
Remove the red marking ribbon and immediately insert a fresh black ribbon.
Manipulate to centric andDepartment

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of Prosthodontics lightly
crown &together in centric only.
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THE GOAL OF A PERFECTED OCCLUSION

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GRIND ALL RED MARKS ON POSTERIOR TEETH. DO NOT TOUCH
ANY BLACK MARKS

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VERIFICATION OF COMPLETION
Clench Test
Ask the patient to clench the teeth together and squeeze firmly (empty
mouth). If the patient can feel any discomfort in any tooth, the equilibration
is not complete. There will be an interference there as long as the patient
can feel a sore tooth with empty mouth clenching or grinding. This is a very
reliable test.

Anterior Deprogramming Splint
If the anterior splint completely separates all the posterior teeth, all
discomfort will dissipate if the cause of the discomfort is totally related to
occlusion. Relief of all discomfort when the posterior teeth can’t touch
indicates that there were still occlusal interferences remaining and that the
discomfort will dissipate when the remaining occlusal interferences are
completely eliminated.
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SUMMARY
1. Find and verify centric relation or adapted centric posture (ACP). Rule
out intracapsular disorders.
2. Mount casts with a facebow and a centric relation or adapted centric
bite record.
3. Analyze casts to make sure that equilibration is the best choice of
treatment.
4. Eliminate all deflective inclines that interfere with complete closure in
centric relation or ACP.
5. Verify simultaneous contact on both posterior teeth and anterior
teeth if arch alignment permits.
6. Verify that maximum intercuspation occurs in perfect harmony with
centric relation or ACP.
7. Eliminate all excursive contact on posterior teeth. The only posterior
tooth contact is in centric relation or ACP.

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8. Refine anterior guidance for all excursions (may need to do more
reduction of excursive inclines on posteriors as anterior guidance is
altered).
9. Recheck posterior teeth while firmly clenching and grinding. There
should be no contacts on inclines.
10. Verify dots in back . . . lines in front.
11. Test the results. If an empty mouth clench can cause any sign of
discomfort or pressure in any posterior tooth, the equilibration is not
completed.

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REVIEW OF LITERATURE
Kerstein RB, Neff PA. A comparison of traditional occlusal equilibration and
immediate complete anterior guidance development. Cranio®. 1993 Apr 1;11(2):126-40.
• They aimed at reducing the time required for posterior teeth to

disclude from each other. Disclusion time reduction is a method of
occlusal adjustment, known as "immediate complete anterior
guidance development” (ICAGD), has been shown to significantly
lessen contractile Muscle activity in the masseter and temporalis
Muscles.
• The results showed clinically in dramatic reductions in Chronic
MPDS symptoms in approximately one to three Month's time from
initiation of treatment Immediate complete anterior guidance
development (ICAGD) refers to the occlusal adjustment process
that Focuses primarily on establishing immediate posterior
Disclusion ( < 0.5 sec) in the right and left excursions, and
Secondarily in the protrusive excursion.
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2) Occlusal adjustment in patients with craniomandibular disorders including
headaches A 3- and 6-month follow-up
Danila Vallon, Ewacarin Ekberg, Maria Nilner & Sigvard Kopp
Evaluated the therapeutic effect of occlusal adjustment on symptoms

and signs of craniomandibular disorders (CMD), including headaches,
after 3 and 6 months .There was significant improvement in overall
subjective symptoms at the 3- and 6-month follow-up visits. They
concluded that occlusal adjustment is a treatment modality with a
statistically significant short-term effect on symptoms of CMD of
muscular origin and superior to counseling.

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REFERENCES
• Dawson PE. Functional Occlusion-E-Book: From TMJ to Smile
Design. Elsevier Health Sciences; 2006 Jul
• Okeson JP. Management of temporomandibular disorders and

occlusion-E-book. Elsevier Health Sciences; 2014 Jul 21.
• Vallon D, Ekberg E, Nilner M, Kopp S. Occlusal adjustment in

patients with craniomandibular disorders including headaches A
3-and 6-month follow-up. Acta Odontologica Scandinavica. 1995
Jan 1;53(1):55-9.
• Kerstein RB, Neff PA. A comparison of traditional occlusal

equilibration and immediate complete anterior guidance
development. Cranio®. 1993 Apr 1;11(2):126-40.

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• Garg AK. Analyzing dental occlusion for implants: Tekscan’s TScan
III. Dent Implantol Update. 2007 Sep 1;18(9):65-70.
• Kerstein RB, Neff PA. A comparison of traditional occlusal

equilibration and immediate complete anterior guidance
development. Cranio®. 1993 Apr 1;11(2):126-40.
• Garg AK. Analyzing dental occlusion for implants: Tekscan’s TScan

III. Dent Implantol Update. 2007 Sep 1;18(9):65-70.
• Kirveskari , P. , et al. ( 1989 ). Effect of elimination of occlusal

interferences on signs and symptoms of craniomandibular
disorder in young adults . Journal of Oral Rehabilitation , Vol. 16 ,
pp. 21 – 26

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JSS ACADEMY OF HIGHER EDUCATION & RESEARCH

JSS Dental College & Hospital

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Which in turn focuses its

The trigger for muscle hyperactivity

As muscle overloads the joints and

• Management of certain temporomandibular disorders (TMDs)

Department of Prosthodontics and crown &

Exposure of dentin poses problems

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

• The masseter and medial pterygoid act like a contractile

Department of Prosthodontics and crown &

• The lateral pterygoid muscle is an incredibly important muscle.

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Mandibular motion viewed in the sagittal plane can have four

If the chewing stroke is examined in the sagittal plane the

ICP – intercuspal position

EEP – end to end position of interiors

EC – area used in early stages of

LC - area used in late stages of mastication

Department of Prosthodontics and crown &

1. Left lateral superior

2. Left lateral opening

3. Right lateral superior

4. Right lateral opening

ICP – Intercuspal position

Department of Prosthodontics and crown &

Centric Relation (CR) is a jaw relationship: it describes a

Department of Prosthodontics and crown &

Centric occlusion(CO) the occlusion of opposing teeth when the

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

During the lateral excursion contact occurs only between the

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

4. Canine guidance is considered the best anterior guidance system

• For occlusal grinding different diamond burs for occlusal

Department of Prosthodontics and crown &

• The Miller ribbon holder is excellent.

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

• A variety of materials are available that can be

Department of Prosthodontics and crown &

Department of Prosthodontics and crown &

1. Proper diagnosis in itself generally prepares the patient.

2. Point out loose teeth and relate them to premature contacts or

3. Relate wear problems to occlusal disharmony with the comfortable

4. Study the occlusal relationship on properly mounted diagnostic

5. Demonstrate on the mounted casts the amount of tooth reshaping

6. Tell the patient to expect further adjustments.

Department of Prosthodontics and crown &