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My BDS3 > Occlusion > Flashcards

Occlusion Flashcards

1
Q

what is the main cause of TMJ disease pain?

A

the retrodiscal colateral tissue which is highly vascular and innervated moves too far anteriorly and becomes wedged between the bone and the head of the condyle

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2
Q

what does the Retrodiscal colateral Tissue attach to?

A

the mandibualr fossa

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3
Q

what muscles are involved in mandibular movements?

A

Muscles of mastication: temporalis, masseter, lateral & medial pterygoid

Suprahyoid: digastric, geniohyoid, mylohyoid, stylohyoid

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4
Q

what is the function of the temporalis?

A

retracts and elevates

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5
Q

what is the function of the masseter?

A

elevates and protracts

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6
Q

what is the function of the medial pterygoid?

A

elevates, protracts and lateral movement

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7
Q

what is the function of the lateral pterygoid?

A

depresses, protracts and lateral movement

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8
Q

describe the resting vertical dimension. (2)

A

mouth slightly open

teeth not in contact - freeway space between

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9
Q

name the types of mandibular movement. (3)

A

rotation/hinge

translation

lateral translation

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10
Q

how much opening is there in hinge/rotation movements?

A

20mm - fairly passive

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11
Q

describe translation movements. (3)

A

Lateral pterygoid contracts and pulls the condyl and articular disc anteriorly

The condyle moves downwards and forwards along the articular eminence

The condyl can also move laterally

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12
Q

name the 3 planes of border movements.

A

sagittal

horizontal

frontal

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13
Q

describe the ICP stage on posselts envelope. (2)

A

Tooth positon regardless of condylar position

The maximum interdigitation of the teeth which is comfortable

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14
Q

in what position/stage of poselts envelope are most restoration made in unless the occlusion is reorganised?

A

ICP

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15
Q

name and describe the E stage on posselts envelope. (3)

A

edge to edge

Translational movement which Refers to tooth position.

When teeth slide forward from ICP guided by the palatal surface of anterior teeth the incised edges of the upper and lowers will touch and the posterior teeth will either be apart or occluded depending on the type of guidance they have

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16
Q

(E stage)
what type of guidance will a patient have if when teeth slide forward from ICP the incised edges of the upper and lowers will touch and the posterior teeth have space between them?

A

anterior guidance

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17
Q

(E stage)
what type of guidance will a patient have if when teeth slide forward from ICP the incised edges of the upper and lowers will touch and the posterior teeth occlude?

A

group function

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18
Q

name and describe the Pr stage on posselts envelope. (4)

A

protrusion

At this stage the condyl has moved forwards and downwards on the articular eminence

Initially only the incisors and canines will touch

Eventually no teeth will contact

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19
Q

(Pr stage) what is occuring if posteriors touch at this point?

A

protrusive interference

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20
Q

name and describe the T stage on posselts envelope. (3)

A

maximum opening

Full translation of the condyle over the AE = mouth wide open
No tooth contacts

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21
Q

name and describe the R stage on posselts envelope.

A

retruded axis position

This is the most superior anterior position of the condylar head in the fossa

No tooth in contact

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22
Q

name and describe the RCP stage on posselts envelope.

A

Retruded contact position

The first tooth contact when the mandible is leaving the retruded axis position

Retruded axis position - the most superior anterior position of the condylar head in the fossa

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23
Q

describe the relationship between the ICP and the RCP.

A

ICP is approx 1mm anterior to the RCP (90% of patients)

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24
Q

what are lateral translation movements also known as?

A

Bennet movement

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25
Q

describe the bennet movements.

A

refers to a working side and a non-working side (working side is whichever side the mandible moves to)

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26
Q

what are bennet movements controlled by?

A

contraction of 1 of the lateral pterygoid muscles

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27
Q

describe the movements of the condyl on the non-working side during bennet movements.

A

the condyle moves forwards and inwards

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28
Q

describe a working side contact. is this desirable?

A

tooth contact on the working side in the lateral excursion poison

no its occlusal interference

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29
Q

describe a non-working side contact. is this desirable?

A

If you had a tooth contact on the non-working side in the lateral excursion poison

no its occlusal interference

30
Q

define the bennet angle.

A

The path of the non-working condyle in the horizontal plane during lateral excursion

31
Q

name the 2 types of occlusion.

A

Dynamic

Static

32
Q

how thick is articulating paper?

A

40 microns

33
Q

why do we use 2 different colours of articulating paper?

A

1 to mark static occ

1 to mark dynamic occ

34
Q

describe how we mark static ICP occlusion.

A

Dry teeth and tap teeth together on the paper

35
Q

describe how we mark dynamic occlusion.

A

Move mandible from side to side and forward whilst biting on the paper

36
Q

when should we mark tooth contacts?

A

before altering anything;
i.e. tooth prep or restoration removal

after placing anything i.e. crown or restoration

37
Q

name the types of tooth contacts we want to achieve. (2)

A

Tripodised = very difficult to achieve

Cusp tip to fossa = more commonly used

38
Q

name the part of the tooth that is in contact when in ICP? (1)

A

Functional cusps - occlude with the opposing fossa
maxilla = palatal
Mandible = buccal

39
Q

where are the functional cusps in ICP in the mandible and maxilla?

A 
mandible = buccal 
maxilla = palatal
40
Q

what problems can we detect in static ICP occlusion? (5)

A

Incisor relationships

overbite

overjet

crossbite

openbite - anterior or posterior

41
Q

what are we examining in dynamic occlusion?

A

guidance; canine or group

protrusion

42
Q

describe canine guidance.

A

mutally protected occlusion with only the canines in contact with a freeway space between the other teeth.

no protrusive interference

43
Q

describe the contacts in protrusion.

A

Only the incisors and canines tough, no posterior contacts

44
Q

what problems can we detect in dynamic occlusion? (1)

A

occlusal interferences - may produce mandibular deviation

45
Q

name the types of occlusal interferences.

A

Working side: the interference is usually posterior in the direction of travel of the mandible

Non-working side: the interference is on the posterior on the opposite side from the movement

Protrusive: any posterior contact during protrusion

46
Q

Why should we avoid posterior contacts/interferences? (2)

A

Teeth are NOT designed to absorb lateral forces
(normal = down the long axis)

muscles are always active, no rest = painful, enlarged muscles, TMJ problems

47
Q

what pathology can arise from poor occlusion/occlusal movements? (3)

A

bruxism

tooth wear

occlusal trauma

48
Q

name the two types of bruxism.

A

eccentric

centric

49
Q

describe eccentric bruxism - what can this cause?

A

Parafunctional movements of the mandible from side to side which cause occlusal trauma

Involuntary, rhythmic, spasmodic or function gnashing

50
Q

describe centric bruxism. - what is this associated with?

A

Parafunctional clenching (pressing and clamping) of the teeth and jaws.

Associated with nervous tension and physical effort

51
Q

what are the clinical signs of bruxism? (8)

A

Toothwear - lose the anatomy of the teeth
Tooth mobility and widened PDL from occlusal trauma (not perio)
Fractured restorations
Pain and stiffness of the TMJ and muscles
Tooth migration
Headache
Earache

52
Q

name the types of tooth wear.

A

Abrasion
Attrition
Erosion
Abfraction

53
Q

describe occlusal trauma.

A

Injury resulting in tissue changes within the attachment apparatus i.e. the perio ligament, alveolar bone, cementum, as a result of occlusal force

54
Q

name and describe the types of occlusal trauma that occur in a healthy periodontium. (2)

A

Primary:
When there is trauma and movement of an intact periodontium with no periodontitis (no inflammation and loss of attachment)

Secondary:
When there is trauma and movement of a reduced but healthy peridontium (no inflammation and loss of attachment)

55
Q

define fremitus.

A

Fremitus is when there is palpable/visible movement of a tooth subjected to occlusal forces

56
Q

how can we assess movement of teeth only?

A

Place your index finger on the tooth i.e. the central and ask the patient to tap their teeth together

57
Q

when assessing occlusion what should we examine? (6)

A 
Incisor relationship
Guidance 
Overjet/bite
ICP contacts 
Occlusal interference- Working/non-working/protrusive contacts 
Pathology
58
Q

what must we do before recording the occlusion?

A

mount the casts on an average value articulator.

59
Q

what is the bennet angle and the condylar guidance set to on an average value articulator?

A

BA = 15

C guidance = 30

60
Q

what do we need to take before mounting a maxillary cast?

A

Facebow transfer

61
Q

what do we need to take before mounting the mandibular cast?

A

take an Interocclusal registration

62
Q

describe how to take a facebow registration.

A

Assemble the face vow on the patient by sliding the bite fork arm through the clamp marked #2

Fit the earpieces into the ears

Tighten the centre wheel

Raise or lower the bow so that the pointer aligns with the anterior reference point

Once aligned, tighten the #1 and #2 clamps

Once face bow is in place;
Ensure that the bow is parallel to the inter pupillary line/floor

Loosen the finger screw on the measuring bow, slide open the bow and remove the face bow from the patient

Detach the measuring bow from the transfer jig by loosening the finger score

Disinfect the apparatus

63
Q

when do we use an ICP interocclusal registration?

A

conformative approaches

64
Q

when do we use an RCP interocclusal registration?

A

use when taking a reorganised approach

65
Q

what ways can we take an interocclusal registration in ICP? (4)

A

Recording ICP with no material

Recording ICP with wax wafer

Recording ICP with registration paste

Recording ICP using a record block

66
Q

When would we take an interocclusal registration in ICP using no material?

A

ICP is obvious and many teeth are in contact

67
Q

When would we take an interocclusal registration in ICP using a registration paste?

A

used when the ICP is not obvious

68
Q

When would we take an interocclusal registration in ICP using a record block?

A

used when there’s a free end saddle and cannot hand articulate

69
Q

what happens if we use too much wax/registration paste when taking an interocclusal registration in ICP?

A

Increases OVD and restorations will be too high.

70
Q

define the conformative approach.

A

the provision of restorations in harmony with the existing jaw relationships

71
Q

when can we not use the conformative approach? (4)

A

(When do we not place restorations in ICP)

When an increase In vertical height is required to make space for restorations

When a tooth/teeth are significantly out of position i.e. over erupted, tilted, rotated

A significant change in appearance is wanted

There is a history of occlsually related failure or fracture of existing restorations: multiple fractures seen.

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