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ICP > Occlusion > Flashcards

Occlusion Flashcards

1
Q

Consequences of bad occlusion

A 
Fractured cusps, teeth, restorations
Failed crowns and bridges
Localised periodontal disease
Drifting/overerupted teeth
Loss of vitality of teeth
TMD
Muscle pain
Parafunction
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2
Q

ICP

A

Mandible position when there is maximum cuspation of teeth

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3
Q

RCP

A

Mandible position when condyles are fully seated in glenoid fossa/in most superior position - first tooth contact in this position

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4
Q

CR

A

Jaw position when condyles are fully seated in glenoid fossa/in most superior position - best neuromuscular position because muscles don’t need to work as hard. Condyle braced by bone so muscles are doing less work.

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5
Q

Techniques to find CR/RCP

and when to use

A 
Gothic arch tracing
Manual positioning/Dawson technique
Flat plane splint
Anterior jig
- Useful for when reorganising occlusion or if ICP is unstable or OVD needs to be increased e.g. CD, TMD
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6
Q

THA/terminal hinge axis

A

Hinge movement of condyles in CR

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7
Q

Lateral excursion details [4]

A

The working side is the side you’re moving to. Group function or canine guidance.
NWS - there shouldn’t be any contacts hee. If there are, they are called interfering contacts and lateral force on cusps can cause a fracture.

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8
Q

Bennett movement/angle

A

Horizontal plane
During lateral excursion
NWS Condyle moves down forward and rotates = Bennett’s movement
WS condyle rotates ~7.5 degrees = Bennett’s angle

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9
Q

Protrusive excursions

A 
Anterior guidance or group function if class 3 or edge-to edge.
Condyle moves down and forward
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10
Q

Condylar movement

A

Rotation movement in glenoid fossa first and then moves down articular eminence.
Rotation and translation

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11
Q

Occlusal schemes [4]

A 
Ideal occlusion
Balanced occlusion (For CD)
Group function
Gnathecial occlusion (all teeth working in all movements. Difficult)
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12
Q

Principles of ideal occlusion [4]

A
  1. ICP = RCP
  2. Mutual protection bw anterior and posterior teeth, heavier contacts on posterior teeth during ICP movements, lighter during eccentric.
  3. Posterior teeth disocclude on eccentric movents
  4. Forces down long axis of the molar teeth
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13
Q

Bruxists in ideal occlusion

A

Parafunction in RCP and destroy this contact
Grind in ICP and increase neuromuscular activity
- Good to know where RCP contact is and provide tougher restoration or make ICP = RCP

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14
Q

Why is canine guidance good

A

Good crown: root ratio
Highly innervated so can feel when too much force etc
Distance from TMJ muscles/hinge means less force through it

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15
Q

What is group function

A

Lots of teeth contacting on WS, NWS teeth disocclude

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16
Q

Class 2 div 1 protrusive movements

A

May have posterior contacts/less anterior guidance, esp if proclined.

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17
Q

Class 3 protrusive movements

A

Will have posterior contacts or group function e.g. if edge-to-edge

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18
Q

Different types of articulators [5]

A

Simple hinge articulator - just has the teeth in ICP, no eccentric movements.
Anatomical articulators - have the hinge in the same place as TMJ so models can be mounted in CR. Show eccentric movements
- Average value articulator = 30-degree condylar angle and flat/straight condylar pathway
- Semi-adjustable = adjustable condylar angle but a flat condylar pathway
- Fully adjustable = custom made condylar pathways
Denar Automark articulator = 20-degree condylar angle, which means that any posterior work will definitely have disocclusion on the model, and be more in real life bc IRL condylar angle is steeper.

19
Q

What is a facebow used for/details

A

Used to record the relationship between condyles and teeth.
2 separate parts - earbow to record TMJ position, and one on the occlusal plane and then join them together and send to the lab.
Also useful for getting the correct height of the model.
Can get different ones for maxilla and mandible.

20
Q

Complete denture - equipment and occlusal considerations

A

ICP = RCP
Facebow and models mounted in CR
To create balanced occlusion (ICP = RCP) and restore OVD

21
Q

Restorative work on posterior disoccluding teeth - equipment and occlusal considerations

A

Facebow and mount models in ICP
Can use a 20-degree articulator to ensure no posterior interfering contacts
Or use a simple articulator and rely on the anterior guidance.

22
Q

Restorative work on guiding anterior teeth- equipment and occlusal considerations

A

Facebow and mount in ICP
Record all eccentric movements and contacts on the anterior teeth on the articulator
Make sure not to change these movements
- If intending to change the movements, need to mount the models in CR

23
Q

RPD - equipment and occlusal considerations

A

If OVD and ICP are stable - mount the models in ICP.

If unstable, facebow and mount models in CR and recreate ideal occlusion (ICP = RCP, eccentric movements, etc.)

24
Q

Hard acrylic splints - equipment and occlusal considerations

A

Facebow and mount models in CR

20-degree articulator to ensure posterior disocclusion

25
Q

How to carry out an occlusal assessment (before examination)

A

Occlusal history

  • Pain during movements, facial or muscle pain
  • TMD
  • Parafunction

Dental history

  • Failed crowns/bridges
  • Signs of occlusal disharmony
  • Fractured cusps and restorations
  • TMD
  • Patient’s expectations

Medical history

  • Contraindications to long complex treatment
  • Medications that cause clenching/bruxism
  • Joint/bone conditions or previous h&n trauma/surgery

Social history

  • Stress
  • Contraindications to long complex tx
26
Q

Occlusal assessment examination

A
  • TMJ
  • Muscles of Mastication
  • ICP, RCP and the slide bw the 2
  • Excursive movements and guidance and contacts inc interfering
  • Skeletal, molar and incisor relationship
  • Overjet, overbite, crossbite
  • OVD
27
Q

Occlusal treatment planning considerations for simple direct restorations

A

Check contacts before and after to make sure you’ve not changed anything.
If planning on changing things
- Excursive contacts not on restoration or cusps
- ICP contacts not on restoration interface
- Remove NWS interfering contacts
- Re-introduce canine guidance (will protect lingual cusps of lower posterior teeth)

28
Q

Occlusal treatment planning considerations for indirect restorations - confirmative and simple

A

Non-guidance teeth - no facebow needed.
Study models to check contacts and guidance beforehand.
Need enough occlusal preparation depth so new restoration doesn’t affect contacts.
Check contacts after fitting.

29
Q

Considerations for indirect restorations on the last tooth in the arch

A

Patient will bite down and adjust bite so all the space you just prepared is lost.

1) check ICP contact and don’t remove this (prepare whole tooth and leave this island)
2) Send imp to lab and they will remove this island and make the crown
3) Remove this island in the clinic and fit the crown - don’t let patient bite down until final restoration is in place

30
Q

Occlusal treatment planning considerations for indirect confirmative complex

A

If 3+ unit bridge, guiding tooth or complex occlusion. - Facebow transfer and mount models on articulator.

  • Can use a diagnostic wax up.
  • Metal backing or high strength porcelain for guiding surfaces
  • ICP contacts should be on abutment tooth, and no guidance contacts on pontic tooth esp if cantilever.
  • Can get a customized incisal guide from the lab to replicate the guidance on the models.
31
Q

Occlusal treatment planning considerations for complex reorganised cases

A

If changing OVD, multiple units, full mouth rehab

  • Need diagnostic wax ups (can do a mock up using ProTemp)
  • Models articulated in CR using facebow transfer
  • Ideal occlusion principles.
32
Q

Types of hard occlusal splints

A 
Mitchigen Upper
Tanner lower
Interocclusal appliance
Stabilisation splint
Flat plane occlusal splint
33
Q

Why use splints

A 
TMD
Bruxism
Protect extensive restorative work
Finding CR
Diagnose occlusal problems
- Splints can reprogramme neuromuscular system by separating teeth and allowing condyle to seat in most optimal position so protect teeth from parafunction/excessive forces
34
Q

What occlusal plan do you try to achieve with hard splints

A

Ideal occlusion
in CR (facebow and articulate models on 20 degree adjustable articulator)
Full coverage to stop teeth overerupting

35
Q

Dahl concept (old)

A

Cement a partial CoCr with an anterior bite plan that allows posterior teeth to disocclude.
- Posterior teeth overerupt
- Anterior teeth intrude
Creates FWS in new ICP and you can provide anterior restorations now

36
Q

Dahl concept (new)

A

Restore anterior teeth first and the posterior teeth will over erupt (+ intrusion of anterior teeth) to create a new ICP.
New posterior contacts can from 6 weeks after anterior cons.
If the posterior teeth don’t over-erupt, may need to provide indirect restorations.

37
Q

What occlusal planning needs to be done before Dahl concept

A

Models articulated using facebow
Wax up of proposed anterior cons
Occlusal RCP records
Regular reviews to get a record of the occlusal changes.

38
Q

Security vs stability of dentures

A 
Security = retention, ability to resist forces and displacement in an axial direction
Stability = ability to resist forces in other non-axial directions
39
Q

Retention of complete denture compromised by what

A

Lack of moisture/suction seal
Post dam = air gets in
Not fitting ridge
Unfavourable anatomy e.g. fibrous ride, atrophic ridge

40
Q

What is the neutral zone

A

The balance between cheek/muscle forces pushing teeth in and tongue forces pushing teeth out
Teeth should be placed here

41
Q

How to record the neutral zone

A

Get a wax registration block
Remove anterior wax and replace it with alginate
Take an impression and record all the movements and sounds made by the mouth
Send to the lab and ask them to place teeth here.

42
Q

Rules for complete dentures wrt neutral zone

A

Teeth shouldn’t be placed too lingually = the tongue will displace them, trauma to the tongue, bad lip support, and tongue cramp.
7’s aren’t needed and if u do add them, need to make sure they don’t take away from the tongue’s space
Teeth shouldn’t be placed too buccally/labially bc will cause cheek trauma and lift on function

43
Q

Problems when making a complete upper denture opposed by lower natural teeth

A

Fibrous upper ridge so needs combination impression tray and muco-static material/technique.
Careful recording of face height and OVD.

ICP (7 decks)

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