Clinical occlusal investigations Flashcards
(25 cards)
What is Occlusion? ๐ฆท
Occlusion is the static relationship between the incising or masticating surfaces of the maxillary and mandibular teeth (or analogues).
What is Articulation? ๐
Articulation refers to the static and dynamic contact relationship between the occlusal surfaces of teeth during function.
When is a Basic Occlusal Exam performed? ๐
At every examination, to screen for TMJ pathology, parafunction, occlusal trauma, and assess ICP and lateral movements.
When do we perform a Detailed Occlusal Examination? ๐ง
When there are signs/symptoms of TMD, parafunction, or if planning major restorative work or seeing restoration failure.
What do you look for extraorally in a basic occlusal exam? ๐งโโ๏ธ
TMJ symptoms: clicks, crepitus, deviations
Muscle pain, masseter hypertrophy
Patientโs history of pain, limited opening
Observation of a โhighly strungโ appearance
What soft tissue signs indicate parafunction? ๐
Buccal mucosa ridging (linea alba)
Tongue scalloping (lingual indentata) โ also seen in sleep apnoea, dehydration, hypothyroidism, Downโs syndrome
What is ICP? ๐ค
ICP (Intercuspal Position) is the complete intercuspation of opposing teeth, independent of condylar position.
How do we assess ICP?
Does it look healthy? (well-distributed occlusion)
Is it causing damage? (tooth/restoration wear)
Is it stable? (can the patient find it repeatedly?)
Will it interfere with restorations?
What is Canine Guidance? ๐ถ
Only the canine teeth contact during lateral movements on the working side. No contact on the non-working side.
What is Group Function? ๐ฅ
Multiple teeth (usually premolars + molars) contact on the working side during lateral movements.
Which guidance is more common in restored dentitions and harder to manage?
Group Function โ more difficult to replicate in restorative dentistry.
What are Non-working Side Interferences? ๐ซ
Contacts on the non-working side during lateral movement โ can cause problems and should be identified.
What extraoral features are examined in detail?๐ง
TMJ: deviation on opening, clicking, crepitus
Range of opening
Muscle palpation: masseter (clenching), temporalis (coronoid)
- Finger up coronoid process
What are retruded contacts and how are they assessed? โฉ๏ธ
Retruded contact position (RCP) is assessed by guiding the mandible into its most retruded position and checking where teeth contact. Techniques include:
Bimanual manipulation
Chin-point guidance
Anterior deprogrammer
What is the RCP-ICP Slide? ๐ข
Itโs the shift from RCP to ICP, usually 1mm anterior and downward. Larger slides = more likely pathological.
What is a Deprogrammer used for? ๐งโโ๏ธ
A device that forces the patient to โforgetโ tooth contacts so the mandible can naturally find its seated position.
What are signs of bruxism or clenching? ๐ฌ
Wear facets
Tooth fractures
Soft tissue changes (e.g. linea alba, scalloped tongue)
Muscle hypertrophy
Fremitus (vibration of teeth)
What is Fremitus? ๐
Vibration/movement of a tooth during occlusion, indicating occlusal instability.
What are the tools used to record occlusal contacts? ๐งป๐
Articulating paper: Thick (250ฮผm) vs Thin (40ฮผm)
Shimstock foil (8ฮผm) โ ideal thickness
Occlusal wax โ marks worn areas
GHM (coloured foils) โ different colours for ICP vs excursions
Vaseline โ helps with marking
Teeth must be dry for accuracy!
What is Cracked Cusp Syndrome? โก
A cusp has a hairline crack
Biting causes it to open โ fluid enters
Releasing pressure = crack closes rapidly
Fluid enters dentinal tubules โ sharp pain
Diagnosed using a Tooth Sleuth ๐ต๏ธ
How does the Tooth Sleuth work?๐
Cusp placed on one side, bite plane on other
Patient bites down and releases
Pain on release = cracked cusp
What does EDEC stand for? ๐ ๏ธ
Examine the occlusion
Design the treatment
Execute it carefully
Check occlusion before/after restoration
What are wax-ups and study models used for? ๐งช
In large cases
Used to plan occlusion, test new restorations
Patient bites on model to test if contact is comfortable or painful
What is the difference between a basic occlusal examination and a Detailed occlusal examination
