clinical occlusal investigation Flashcards
Define occlusion
The static relationship between the incising and masticating surfaces of the maxillary or mandibular teeth or tooth analogues
Define articulation
The static and dynamic contact relationship between the occlusal surfaces of the teeth during function
Give examples of some occlusal examinations we can carry out
- Basic occlusal examination
2. Detailed occlusal examination
When is a basic occlusal examination carried out?
Performed at every examination for every patient
What does a basic occlusal examination consist of ?
- Screen for TMJ pathology and muscle pain extra orally
- Screen for signs of parafunction or occlusal trauma intra orally
- Assess ICP and lateral movement intra orally
When is a detailed occlusal examination carried out?
Carried out based on screening findings from a basic occlusal exam
Can be carried out when considering large reconstructive work or repeated history of restoration failure
What does a detailed occlusal examination include?
- Fill TMJ and muscles of mastication assessment (extra orally)
- Lateral and protrusive tooth contacts interferneces
- Wear faucets and signs of parafunciton intra orally
- Retruded contact (RCP) assessment
- Special tests
Give examples of some special tests we can carry out in a detailed occlusal examination
- Occlusal paper/wax/foil
- Articulated study models
- Tooth sleuth
Talk through the extra oral steps of a basic occlusal examination
- History taking including any complaints
- Observations eg masseter hypertrophy
- TMJ clicks, crepitus and deviations
Talk through the intra oral steps of a basic occlusal examination
- Look at soft tissues
- Look at teeth
- Record patients occlusion in ICP
- Look at lateral excursion
Name some soft tissue indications that a person with occlusal problems may present with
- Buccal mucosa ridging
2. Tongue scalloping
What is buccal mucosa ridging also called?
Occlusal line or linea alba
What is buccal mucosa ridging associated with?
Clenching and bruxism
OR
Increased over jet and crowding
What can tongue scalloping be caused by?
Multiple causes including bruxism and clenching
Name some non dental related conditions that can cause tongue scalloping
- Sleep apnoea
- Dehydration
- Hypothyroidism
- Congenital disordered eg downs syndrome
What is tongue scalloping sometimes called?
Lingua indentata
What is linea alba
Buccal muscosa ridging
What does ICP stand for?
Intercuspal postion
What is the intercuspal position
The complete intercuspation of the opposing teeth independent of the condylar position
From an occlusal point of view describe a healthy ICP
- Multiple occluding units balanced around the arch
2. The ICP is stable and can be repeatably found
What questions might you ask yourself when looking at a patients ICP
- Does ti look healthy
- Is it stable and repeatable
- Will the ICP get I. the way of any planned restorations
What is lateral excursion
Guidance
Name the 2 types of guidance a patient may present with
- Canine guidance
2. Group function
How can we check lateral excursion
By making the patient bite together then grind their teeth slightly in a side to side motion
Describe canine guidance
Working side: only the canines contact in lateral motion
Non working side: No contacts
Describe group function n
Multiple contact relations between the maxillary and mandibular teeth in lateral movement on the working side
Which type of guidance is healthier?
Both are healthy
But group function is technically harder to conform to when planning restorations
If a patient has a group function occlusion what must you also be alert to
Any non working side interferences
Talk through the extra oral steps of a detailed occlusal examination
- TMJ examination
2. Muscles of mastication
What would you look for in a detailed TMJ examination
- Deviations on opening
- Clicks
- Degree of opening
- Crepitus (crunching)
How do we examine the muscles of mastication
Palpate them
What are we looking for when palpate the muscles of mastication
Masseter insertion when patient is clenching
Temporalis origin and insertion
What do we look for when investigating protrusion
Looking for whether any of the posterior teeth are kinda clattering or being involved in the intrusive movement
When is it important to look at protrusion
When we are doing anterior restoration work such as crowns, bridges etc
What are wear faucets good at telling us
How the patient bites usually
What is a retruded position
The position where the condyle is fully seated in the glenoid fossa
Name some operator led techniques that can help you position your patient in a retuned position
- Bimanual manipulation
2. Chin point guidance
Name some patient led techniques that can help you position your patient in a retuned position
Anterior deprogrammer
How does the anterior de programmer work
It is placed on the maxillary anterior teeth and it forces the brain to forget there the teeth are
What is RCP-ICP slide
The slide between the rested condyle position and ICP
What is the normal RCP-ICP slide distance
Usually 1mm anterior and downward
What can cause large RCP-ICP slides?
Premature contacts eg over erupted molar
How would you carry out fremitus test
Use your fingertips or flesh of finger and ask the patient to bite down feeling fro vibrations on the tooth you are touching
How much can a patient feel between their teeth
10 Microns
How thick is thick articulating paper
250 micro metres
How thick is thin articulating paper
40 micro metres
Name a tool Better than articulating paper for measuring perception and occlusion
Shimstock occlusal foil
How thick is shim stock foil
8 micro metres
What is lingua indentata
Tongue scalloping
What is linea alba
Buccal muscosa ridging
What is tooth sleuth used to investigate
Investigates cracks on individual tooth cusps (cracked tooth syndrome)
How do you carry out tooth sleuth
- Cup on one side and tell patient to bite on the other
- Cup located over suspect cusp
- Patient closes on the tooth sleuth
- On release any pain is noted
What happen sin cracked tooth syndrome
- Occlusal loading of cusp associated with crack open the crack
- Crack fills with fluid eg saliva
- Release of occlusal load causes crack to rapidly close
- Some fluid is expelled onto surface of tooth
- Some fluid is forced into dentinal tubules leading to stimulation of pulp and pain on release of biting
