Monograph Exam 4 Part II

Question 1

The occlusal relationships of the teeth must be in harmony with the temporomandibular joints and associated muscles, and permit normal functional movements of the mandible.

As the teeth of the mandibular arch are closed into contact with the teeth of the maxillary arch, the occlusal contacts should be ___ and ____

The anterior teeth should either___ ___ in centric occlusion or contact ____than the posterior teeth. If two opposing teeth contact before the other teeth, that contact is called an occlusal prematurity. The prematurity may result in ___ ___ being placed on the ___ ___ of the teeth which occlude first.

Answer 1

The occlusal relationships of the teeth must be in harmony with the temporomandibular joints and associated muscles, and permit normal functional movements of the mandible. As the teeth of the mandibular arch are closed into contact with the teeth of the maxillary arch, the occlusal contacts should be uniform and passive. The anterior teeth should either not contact in centric occlusion or contact lighter than the posterior teeth. If two opposing teeth contact before the other teeth, that contact is called an occlusal orematuritv. The prematurity may result in excessive forces bei~g placed on the supporting structures of the teeth which occlude first.

Question 2

The relationship of non-centric cusps to the opposing teeth is important.

In centric occlusion there should be a space between the____ inclines of the non-supporting cusps and the ___ inclines of the opposing cusps.

This space should be approximately ______.

This space reduces__ ___and helps prevent _____

In the working position, the non-centric cusps are ____ mesiodistally in the opposing ____ (buccal or lingual) or ___ ____ (buccal or lingual).

These embrasures and developmental grooves act as pathways for the non-supporting cusps during mandibular movement

Answer 2

The relationship of non-centric cusps to the opposing teeth is important. In centric occlusion there should be a space between the inner inclines of the non-supporting cusps and the outer inclines of the opposing cusps. This space should be approximately 0.5 mm. to 1.0 mm. This space reduces lateral forces and helps prevent interferences. In the working position, the non-centric cusps are centered mesiodistally in the opposing embrasures (buccal or lingual) or developmental grooves (buccal or lingual). These embrasures and developmental grooves act as pathways for the non-supporting cusps during mandibular movement

Question 3

The relationship of the maxillary first molar to the mandibular first molar provides the basis for the morphological classification of occlusion and malocclusion.

When the___ ___ of the maxillary first permanent molar opposes the ___ ___ ___ of the mandibular first permanent molar and the other teeth are in an ____occlusal relationship, the occlusion is designated a “__ __ ___ ____”.

This designation has the following requirements:

1. ideal _____
2. ideal ___ ___
3. ideal ___
4. ideal ____
5. no ___
6. no ___ ___

and 7. no ___ ___

Answer 3

The relationship of the maxillary first molar to the mandibular first molar provides the basis for the morphological classification of occlusion and malocclusion. When the mesiobuccal cusp of the maxillary first permanent molar opposes the mesiobuccal developmental groove of the mandibular first permanent molar and the other teeth are in an ideal occlusal relationship, the occlusion is designated a “Class I ideal occlusion”. This designation has the following requirements: 1. ideal interdigitation 2. ideal skeletal relationship 3. ideal overjet 4. ideal overbite 5. no impactions 6. no missing teeth and 7. no supernumerary teeth

Question 4

As this is morphological classification,__ ___ discrepancies such as ____s and ____ are not precluded.

The student may refer to the dentoform models, which will be used in the laboratory component of this module, for an example of this type of occlusion.

When the mesiobuccal cusp of the maxillary first permanent molar opposes the mesiobuccal developmental groove of the mandibular first permanent molar and ___ the above requirements are not met, the occlusion is classified as a “__ __ ____” (see Figure VII-2).

Answer 4

As this is morphological classification, functional occlusal discrepancies such as prematurities and interferences are not precluded. The student may refer to the dentoform models, which will be used in the laboratory component of this module, for an example of this type of occlusion. When the mesiobuccal cusp of the maxillary first permanent molar opposes the mesiobuccal developmental groove of the mandibular first permanent molar and all the above requirements are not met, the occlusion is classified as a “Class I malocclusion” (see Figure VII-2).

Question 5

In a “Class II” malocclusion,” the mesiobuccal cusp of the maxillary first permanent molar is _____ to the mesiobuccal developmental groove of the mandibular first permanent molar.

A “Class II malocclusion” is designated as “____ __” or “___ ___” based on the relationship of the___ ___

Answer 5

In a “Class II” malocclusion,” the mesiobuccal cusp of the maxillary first permanent • molar is anterior to the mesiobuccal developmental groove of the mandibular first • permanent molar. A “Class II malocclusion” is designated as “Division 1” or “Division 2,” based on the relationship of the anterior teeth.

Question 6

In “Division 1” there is ____ ____of the anterior teeth (see Figure VII-3). Figure VII-

Answer 6

In “Division 1II there is excessive overjet of the anterior teeth (see Figure VII-3). Figure VII-

Question 7

In the typical “Division 2,” there is an excessive__ ___ of the maxillary____ incisors and an excessive ___ inclination of the maxillary ____incisors. In Figure 4 below, a severe “Division 2” is illustrated tn which the maxillary lateral incisors are also___ inclined (see Figure VII-4).

Answer 7

In the typical “Division 2,” there is an excessive lingual inclination of the maxillary central incisors and an excessive labial inclination of the maxillary lateral incisors. In Figure 4 below, a severe “Division 2” is illustrated tn which the maxillary lateral incisors are also lingually inclined (see Figure VII-4).

Question 8

In a “Class III malocclusion” the mesiobuccal cusp of the maxillarv first permanent molar is _____ to the mesiobuccal developmental groove of the mandibular first permanent molar (see Figure VII-5). The anterior teeth mayor may not be in ___ ____

Answer 8

In a “Class III malocclusion” the mesiobuccal cusp of the maxillarv first permanent molar is posterior to the mesiobuccal developmental groove of the mandibular first permanent molar (see Figure VII-5).The anterior teeth mayor may not be in cross-bite.

Question 9

From a functional standpoint, it should be noted that ·_________ and “______” malocclusions lack or are deficient in ___ ___. This also occurs with an ___ ___ ___,” where there is a localized ____ of occlusion in the anterior region.

Answer 9

From a functional standpoint, it should be noted that ·Class II, Division 1· and “Class III” malocclusions lack or are deficient in anterior guidance. This also occurs with an “anterior open bite, II where there is a localized absence of occlusion in the anterior region.

Question 10

An articulator is a mechanical device on which casts of patients’ teeth can be mounted for use in diagnostic, restorative and prosthetic procedures. The two main portions of the articulator are the ___ and ___ ___

. On the upper member the____ ______represent the _____ portion of the temporomandibular joints (see Figures VII-6 and VII-7).

Answer 10

An articulator is a mechanical device on which casts of patients’ teeth can be mounted for use in diagnostic, restorative and prosthetic procedures. The two main portions of the articulator are the upper and lower members. On the upper member the condylar guidances represent the cranial portion of the temporomandibular joints (see Figures VII-6 and VII-7).

Question 11

With the upper member superimposed over the skull, the mechanical representation can be visualized (see Figure VII-B)

Answer 11

With the upper member superimposed over the skull, the mechanical representation can be visualized (see Figure VII-B)

Question 12

The lower member, to which the patient’s lower cast is attached, represents the mandible. The lower member includes the___ ____(or condylar __).

A superimposition of the complete articulator over the complete skull is shown below (see Figure VII-9).

Answer 12

The lower member, to which the patient’s lower cast is attached, represents the mandible. The lower member includes the condylar balls (or condylar elements). A superimposition of the complete articulator over the complete skull is shown below (see Figure VII-9).

Question 13

Mandibular Movements and Articulators When casts are properly mounted on an articulator, mandibular movements are simulated with sufficient accuracy to allow indirect fabrication (not done directly in the patient’s mouth) of restorations.

This is possible because of the following components:

1. ı Condylar guidance -made up of the ___ ___ (condyles) and ____ (adjustable ____) which simulate the temporomandibular joints.
2. ı Anterior guidance -made up of the i___ ___ ___le and___ ___. Together these simulate the guidance to mandibular movements provided by the anterior teeth.

Measurements and records can be obtained from the patient to set the adjustable components of the articulator in order to closely represent a mechanical and functional equivalent of the patient.

Answer 13

Mandibular Movements and Articulators When casts are properly mounted on an articulator, mandibular movements are simulated with sufficient accuracy to allow indirect fabrication (not done directly in the patient’s mouth) of restorations. This is possible because of the following components: 1.ı Condylar guidance -made up of the condylar elements (condyles) and fossae (adjustable guidances) which simulate the temporomandibular joints. 2.ı Anterior guidance -made up of the incisal guide table and incisal pin. Together these simulate the guidance to mandibular movements provided by the anterior teeth. Measurements and records can be obtained from the patient to set the adjustable components of the articulator in order to closely represent a mechanical and functional equivalent of the patient.

Question 14

Positions and movements of the mandible must be taken into consideration when constructing indirect restorations.

1.ı Centric occlusion -the tooth to tooth position of ___ ____. This is the position of habitual closure of the jaws. This is represented on the articulator by the tntercuspatlon of the upper and lower teeth after the casts are mounted in maximum intercuspation with the ___ ___ ____.

Answer 14

Positions and movements of the mandible must be taken into consideration when constructing indirect restorations. 1.ı Centric occlusion -the tooth to tooth position of maximum intercuspation. This is the position of habitual closure of the jaws. This is represented on the articulator by the tntercuspatlon of the upper and lower teeth after the casts are mounted in maximum intercuspation with the centric locks closed.

Question 15

2.ı Protrusive movement -this is a straight forward movement of the mandible during which the upper and lower teeth pass across one another and the two condyles ___ ___ the articulator eminences.

This is represented on the articulator by the ___ ___s, moving forward in the ___ ___.

At the same time the___ ___ follows the angles set on the ___ ___.

Remember the ____member of the articulator moves, but in the skull the mandible moves.

Answer 15

2.ı Protrusive movement -this is a straight forward movement of the mandible during which the upper and lower teeth pass across one another and the two condyles translate down the articulator eminences. This is represented on the articulator by the condylar elements, moving forward in the condylar guidances. At the same time the incisal pin follows the angles set on the incisal table. Remember the upper member of the articulator moves, but in the skull the mandible moves.

Question 16

If the anterior teeth contact in centric occlusion, forward movement of the mandible should result in immediate _____ of the posterior teeth. This disclusion is due to the “_____ guidance”-the incisal edges of the mandibular anterior teeth sliding across the lingual surface of the opposing maxillary anterior teeth.

If the anterior teeth do not contact in centric occlusion, there should be ___ ____ of the posterior teeth during protrusive movement of the mandible until the____ ___ ___.

Answer 16

If the anterior teeth contact in centric occlusion, forward movement of the mandible should result in immediate disclusion of the posterior teeth. This disclusion is due to the “anterior guidanceu-the incisal edges of the mandibular anterior teeth sliding across the lingual surface of the opposing maxillary anterior teeth. If the anterior teeth do not contact in centric occlusion, there should be uniform contact of the posterior teeth during protrusive movement of the mandible until the anterior teeth contact.

Question 17

As the mandible moves forward, the mandibular anterior teeth assume an ___ __ ___position with maxillary anterior teeth. This relation is called incisal edge position.

Answer 17

As the mandible moves forward, the mandibular anterior teeth assume an edge-to edge position with maxillary anterior teeth. This relation is called incisal edge position.

Question 18

Right and left lateral movements -during a lateral movement, the condyle on the working side is called the ____condyle. While the rotating condyle is said to ___ or tum in the fossa, it may actually move ____,____ or ____and ___ or ____.

The condyle on the non-working side is called the ____ condyle. As the orbiting condyle _____ or moves down the eminence, it moves____, ___ and ____

This is simulated on the articulator by the ____ of one condylar element and the ____ of the other.

During such a movement, certain anterior teeth glide across one another. At the same time the incisal pin follows the angle set on the incisal guide table during the recording of the anterior guidance.

Answer 18

Right and left lateral movements -during a lateral movement, the condyle on the working side is called the rotating condyle. While the rotating condyle is said to rotate or tum in the fossa, it may actually move laterally, forward or backward and upward or downward. The condyle on the non-working side is called the orbiting condyle. As the orbiting condyle translates or moves down the eminence, it moves downward, forward and medially. This is simulated on the articulator by the movement of one condylar element and the roation of the other. During such a movement, certain anterior teeth glide across one another. At the same time the incisal pin follows the angle set on the incisal guide table during the recording of the anterior guidance.

Question 19

As the mandible moves to the right, the buccal cusps of the mandibular right posterior teeth move into ____ ____with the ____cusps of the maxillary right posterior teeth.

The movement is called ____ lateral excursion, and the resultant position called the ____ ____.

On the opposite side of the arch, the buccal cusps of the mandibular left posterior teeth move under the ____ cusps of the maxillary left posterior teeth. This position may be referred to as either the ___ __ ___ or the _____ positionu.

As the mandible moves to the left (Uleft lateral excursion”), the left side assumes the ___ position, and the right side becomes the ____ side.

Answer 19

As the mandible moves to the right, the buccal cusps of the mandibular right posterior teeth move into buccolingual alignment with the buccal cusps of the maxillary right posterior teeth. The movement is called uright lateral excursion u, and the resultant position called the “working positionu• On the opposite side of the arch, the buccal cusps of the mandibular left posterior teeth move under the lingual cusps of the maxillary left posterior teeth. This position may be referred to as either the unon-working positionu or the ubalancing positionu. As the mandible moves to the left (Uleft lateral excursion”), the left side assumes the working position, and the right side becomes the balancing side.

Question 20

Many movements are also possible between a straight protrusive movement and a pure lateral movement. These movements are called___ ___ ____

When waxing restorations or examining mounted casts for diagnostic purposes, all possible movements of ‘the teeth across one another should be taken into consideration.

Answer 20

Many movements are also possible between a straight protrusive movement and a pure lateral movement. These movements are called lateral protrusive movements. When waxing restorations or examining mounted casts for diagnostic purposes, all possible movements of ‘the teeth across one another should be taken into consideration.

Question 21

Border Movements

The drawing below illustrates border movements of the mandible in the____ plane. The drawing depicts what is called a gothic arch tracing.

The apex of the ‘V’ corresponds to ___ ___

. The sides of the “V’ represent___ movements of the mandible for ___ and ___ lateral excursions. The apex of the ..V” and its sides are ____.

The line extending forward from centric relation represents a ___ ___. A protrusive movement is not a border movement and it is___ ___

Answer 21

Border Movements The drawing below illustrates border movements of the mandible in the horizontal plane. The drawing depicts what is called a gothic arch tracing. The apex of the UV’ corresponds to centric relation. The sides of the “V’ represent border movements of the mandible for right and left lateral excursions. The apex of the ..V” and its sides are repeatable. The line extending forward from centric relation represents a protrusive movement. A protrusive movement is not a border movement and it is not repeatable.

Question 22

The drawing below represents border movements of the mandible in the____ plane. For this drawing assume that centric occlusion and centric relation are coincident.

It should also be assumed that the patient has ____ rise on both the right and left ‘sides of the mouth.

Point “A” represents___ ___.

Lines “AD” and “AC” represent ___ ___of the mandible in right and left ___ excursions.

Lines “BC” and “BD” represent the border movements when going from the endpoint of a lateral excursion to ___ ____

Answer 22

The drawing below represents border movements of the mandible in the frontal plane. For this drawing assume that centric occlusion and centric relation are coincident. It should also be assumed that the patient has cuspid rise on both the right and left ‘sides of the mouth. Point MAB represents centric occlusion. Lines MAD” and MAC” represent border movements of the mandible in right and left lateral excursions. Lines uBC” and “BD” represent the border movements when going from the endpoint of a lateral excursion to maximum opening.

Question 23

The drawing below represents border movements in the ___ ____ plane. This drawing is commonly referred to as____ diagram.

Answer 23

The drawing below represents border movements in the mid-sagittal plane. This drawing is commonly referred to as Posselt’s diagram. The drawing is labelled as tollows:

Question 24

Anterior Guidance and the Incisal Guide Table

The incisal guide table, when properly adjusted, is the mechanical equivalent on the articulator to the___ ___ of the patient.

The incisal guide table has the following uses:

1. it ____ the____ teeth on mounted stone models from ___during ___ movements
2. it may ____ and ____ _____ ant guidance during the fabrication of anterior restorations
3. it may ___e and ____ ____ anterior guidance during the fabrication of temporary crowns and final restorations

Answer 24

Anterior Guidance and the Incisal Guide Table The incisal guide table, when properly adjusted, is the mechanical equivalent on the articulator to the anterior guidance of the patient. The incisal guide table has the following uses: 1. it protects the anterior teeth on mounted stone models from wear during excursive movements 2. it may reproduce and maintain existing anterior guidance during the fabrication of anterior restorations 3. it may reproduce and maintain provisional anterior guidance during the fabrication of temporary crowns and final restorations