Occlusion principles for the practising dentist in the digital age

Fig. 1: Mandibular position with condyles seated in the fossae and no intercuspation.

Fig. 2: Mandibular position with condyles down the eminence and maximal intercuspation.

Fig. 3: A drawing of the mandible, anterior teeth and fossae, showing a reversed tripod.

Fig. 4: Mandibular position defined as condylar position and vertical dimension of occlusion.

Fig. 5: Occlusion represented as mandibular position and intercuspation.

Fig. 6: Methods to find a new mandibular position.

Fig. 7: Composite resin device creating a disclusion of posterior teeth.

Fig. 8: Leaf gauge creating a disclusion of posterior teeth.

Fig. 9: The condyle position is based on the vector of force of the elevator muscles—perpendicular to the contour of the eminence.

Fig. 10: A complete-coverage occlusal device to relax the muscles and heal the joints.

Fig. 11: Clinical decision guideline for occlusal evaluation and treatment.

Fig. 12: Clinical decisions regarding occlusion. IC = intercuspation; MP = mandibular position; TMD = temporomandibular joint dysfunction syndrome.

Fig. 13: Intercuspation requiring opening of the vertical dimension for restorative space.

Fig. 14: Significant wear requiring occlusal coverage and altering of occlusion.

Fig. 15: Occlusion with the mandible in centric relation and a significant open bite.

Fig. 16: Occlusion with intercuspation but a non-functional mandibular position.

Fig. 17: Treatment modalities to recreate intercuspation in the new mandibular position.

Fig. 18: TRIOS 3 software (3Shape) matching digital casts of arches to side view inter-arch scan (in light blue).

Fig. 19: Occlusal record limited to the prepared tooth area (when existing intercuspation is not altered).

Fig. 20a: Digital recording of intercuspation.

Fig. 20b: Digital recording of intercuspation.

Fig. 21: Composite resin device at the desired vertical dimension of occlusion stabilises the mandible in centric relation.

Fig. 22: Analogue recording of centric relation using a composite device to stabilise the mandible and polyvinylsiloxane recording paste.

Fig. 23: Analogue recording of centric relation using a composite device to stabilise the mandible and polyvinylsiloxane recording paste.

Fig. 24: Centric relation recording using an intra-oral scanner while the mandible is stabilised by a leaf gauge at the desired vertical dimension of occlusion.

Fig. 25: Digital centric relation recording at the desired vertical dimension of occlusion of all existing mandibular teeth, in preparation for a fixed complete denture.

Fig. 26: Digital recording of centric relation using a conventional finding method with a composite device at the desired vertical dimension of occlusion.

Fig. 27: Digital recording of centric relation using a conventional finding method with a composite device at the desired vertical dimension of occlusion.

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Occlusion principles for the practising dentist in the digital age

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