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AN EVALUATION OF INCISAL GUIDANCE AND ITS INFLUENCE

RESTORATIVE DENTISTRY
CLYDE H. SCHUYLER,
New York, N. Y.

IN

D.D.S.

UNCTIONAL COORDINATION of the occluding surfaces of the teeth has been


spoken of as one of the most important sciences in the practice of dentistry.
The incisal guidance, which is normally the inclination of the lingual surfaces of
the six upper anterior teeth, might be considered as the key to a harmonious
functional relationship of the natural dentition, or the key to functional occlusion.
It might clarify our thinking to outline some differences in our concept of the
ideal functional relationship of teeth of the complete denture from that of the natural
dentition. In complete dentures, the six upper and six lower anterior teeth seldom
make contact in the centric maxillomandibular
relation; this contact is not necessary for the most favorable distribution of stress over the maximum denture-bearing area. In the natural dentition, contact of the six upper and lower anterior teeth
is most common and is essential for the most favorable distribution of occlusal
forces over the maximum number of teeth.
In complete dentures, the three point balancing contacts in all eccentric positions, lateral and protrusive, are essential for the maximum functional stability of
the dentures and the most favorable distribution of stresses.
In the natural dentition, balancing contacts, that is, contacts of the posterior
teeth in the protrusive relation, or contact of teeth on the nonfunctioning side in the
lateral eccentric relation, seem to be not only nonessential for the most favorable
distribution of functional forces, but these balancing contacts are a common contributing cause for the loss of alveolar support about the posterior teeth or for
pathology of the temporomandibular joint. It is so extremely difficult to differentiate
the nondestructive balancing contacts of the natural dentition from the destructive ones that their elimination would seem to be a reasonable measure of prevention. They should always be eliminated in the treatment of periodontal disturbances
of the teeth involved, or of a dysfunction of the temporomandibular joint. In reconstructive work on the natural dentition, it seems more important to err in having a lack of balancing contacts rather than to have a possibility of excessive
balancing contacts. In the correction of occlusal disharmony of the natural dentition, contacts on the balancing side and contacts of posterior teeth in the protrusive
relation should never be an objective, and, perhaps as a safety measure, they should
be avoided.

Received for publication April 30, 1958.


Read before the American Academy of Crown and Bridge Prosthodontics, Feb. 1, 1958,
Chicago, 111.
374

INCISAL
MANDIBULAR
The

MOVEMENTS

cycle

pattern,

of mastication

but there

tact at times

AND

normally

reason

on the eccentric

37.T

CONTROLS

may

is sufficient

GUIDANCE

conform

to believe

inclines

to the

that

in normal

the

conventional

opposing

function

as well

tear-drop

teeth

make

con-

as in movements

oi

bruxism.
Experience
tooth

teaches

predisposes

tissues.

A favorable

tions

mandible

inclinations

become

the

clinations

factors

the

the more

influential
fossae.

lateral
or

the

inclinaof th(a

and func

and

slot,

part.
necessitates

extreme

of the
guidance

and

nonresilienc!-.

of the condyles
would

and,

:X

guiding

incisal

definite

as some

in

guiding

the

in the movement
to

the

movement

occlusion

restricted
surfaces

the

two

factors,

to the

tooth

time
articulation

mechanism
the

unstrained

extreme

not

the mov(-

a predominating

with

the

control
at which

dentition,

play

masticatory

in a metal

paths

con is

in thr%

comparablr
us to heliestx.

lead

a holus

at times,

by

teeth

can

(ii

guidance

which

is spoken

seldom

exceeds

during

functional

might

inclinations

the

of the anterior

may

pattern

direction

may

influences
fossae

teeth,

the

movements

immediately
gradually

surfaces

and

change

the

are

working

those

Non-

side.

or inclinations

which

of the posterior

of the
The

of occlusal
incisal
degree

after

in the
movement

contact

guidance,

of the

or

might

the

a different
the

fossac,

posterior
or

restricting

teeth

restricted
tooth

movement.

pathologic.

movement

are the

of the condyle

of posterior

Bennett

on the

teeth1
glenoid

a locked

abnormality
of

or border
quite

condyles
lateral

the functional
assume

be divided

inclinations

side.

or a functional

be pathologic

are removed,
may

time
steep

on

inclinations

movement.

at the

movements.

influence

contact

are those

movement

of as the Bennett

relationship

make

functional

lateral

1 or 2 mm.

of posterior
Functional

or balancing

of the lateral
and

surfaces

inclinations.

which

clines

may

TEETII

of occlusal

on the nonworking

incisal

the

joint
contact,

natural

inclines

are

nonfunctional

inclinations

controls

undesirable

the

two

contacting

inclinations
and

contact

abnormal

loss

joint

temporomandibular

surfaces

of flexibility

OF POSTERIOR

or balancing,

The

of

these

the

complete

tooth

bearing

by

SURFACES

functional,

glenoid

that

to a premature

make

due to its proximity

of a ball

functional

surfaces

hand,

ant

supporting

mastication.

OCCLUSAL
The

and

tooth

movements

be influenced

during

the

guidance
Of

factor
Their

to the movement
may

incisal

degree of resiliency

is a

glenoid

In

guiding

fossae.

teeth

teeth

coordination

posterior

are

opposing

factors.

in the glenoid

make

its

of the temporomandibular

opposing

or contacting

occlusal
of

which

the

of the

important

Cotnplete

into

necessitates

and the temporomandibular

until

of opposing

coordination

food

stresses

on any

of

of mastication.

of mastication

guiding

but

inclination

changes

contributes

to pathology

of the muscles

muscles

of the

There

lateral

pathologic

of occlusion

contribute

disturbances
The

dyles

steep

and

of eccentric

disharmony

and it may

ments

an excessively

to trauma

distribution

A functional
tional

tooth

similar guiding tooth surfaces be smooth and equilibrated.

of

teeth,

us that

that

When

of the condyles
pattern.
controls

On

in-

These

the
have

these
in the
other
been

376

SCHUYLER

J. Pros. Den.
May-June, 1959

eliminated. I do not know of a dysfunction of the temporomandibular joint that


has been aggravated in complete oral rehabilitation when the posterior occlusal
contours have been functionally coordinated with the incisal guidance and a horizontal Bennett movement. By building posterior occlusal contours to some irregular
functional movements of the condyles, we may be perpetuating pathology of the
joints.
The anterior movement of the condyles upon the articulating eminences of
the glenoid fossae has little or no influence upon the functional relation of the posterior tooth surfaces on the working side. In a complete oral rehabilitation, it
has little or no influence upon the steepness of lateral working inclines of the teeth.
BALANCING

CONTACTS

Incisal guidance and the forward movement of the condyles upon the articulating eminences of the glenoid fossae are the factors controlling the functional
relation, or tooth inclinations of posterior teeth on both the balancing side and in
the protrusive relationship.
The desirability of posterior balancing contacts of the natural dentition is
questionable. In a complete oral rehabilitation of the natural dentition, I reduce
the steepness of recorded condylar inclinations by about 5 degrees. The result being
that there may be a very slight separation of these eccentric balancing contacts. In
adjusting the instrument to record condylar movements, there is usually a range
of mobility in the adjustment mechanism. I use the least steepness. Premature
balancing contacts, which would result if the condyle paths of the instrument are
excessively steep, must be avoided.
INCISAL

GUIDANCE

In the evaluation of factors controlling posterior occlusal contours of the complete oral rehabilitation of the natural dentition, we must come to the conclusion
that incisal guidance is the predominating factor. Therefore, the establishing of
the anterior tooth relation, esthetics, and incisal guidance should be the first step
in planning the oral rehabilitation.
Posterior tooth surfaces are then formed to
function in harmony with this guiding factor.
INCISAL

CONTACTS

When the anterior teeth of the natural dentition make contact with the opposing teeth in the centric maxillomandibular
relation, they should be continued in
contact or rebuilt to contact for two very definite reasons. First, the value of support of posterior segments of the arch is normally reduced by the loss of some posterior teeth, or the loss of alveolar support of the remaining teeth, or by both the
loss of teeth and the loss of alveolar support. By eliminating the support of the
anterior teeth resisting the stresses in centric and, to a degree, eccentric contact
positions, there is the possibility or probability that the supporting structures of the
posterior teeth will not tolerate the added functional stresses. This would result
in pathologic changes to the supporting tissues ; but, if the stresses had been distributed over the greater number of teeth, the functional stress might have been
within the limits of physiologic tolerance.

Volume 9
NunrbPr 3

INCISAL

GUIDANCE

377

Second, if the anterior teeth normally made contact with opposing teeth in
the centric relation but are left out of contact in the rehabilitation, they most often
will continue to erupt until contact is restored in the centric position. As the teeth
erupt, premature contact and trauma in eccentric positions develops progressively
with their eruption. This continued eruption also contributes to a lack of functional coordination with the established posterior occlusal contours.
The reduction of horizontal stresses by a reduction of the steepness of posterior
occlusal inclinations may be desirable. This necessitates a reduction of the lateral
guiding inclines of the anterior teeth, these being the controlling factors to the
inclines of the posterior teeth.
Esthetics may require a steeper protrusive incisal guidance which can be coordinated with the less steep lateral guiding factor within normal functional ranges.
Under these conditions, there will be no posterior balancing contacts in the extreme
protrusive position which seem unimportant.
SHAPE

OF

INCISAL

GUIDANCE

We might also evaluate the shape or contour of the incisal guide component of
some of the articulating instruments since the incisal guide component of the instrument should be compatible with the predetermined lingual contour of the upper
anterior teeth. For example, if the anterior teeth are to make contact in both centric
and functional eccentric positions, their lingual contours should conform to the
incisal guide component of the instrument used. The incisal guide component of
the instrument, as it is most often used, is an important adjunct in formulating pasterior occlusal contours.
In the main, the incisal guide components of the articulating instruments have
three distinct shapes or contours. They are concave, plane, or convex. The incisal
guidance predetermines the concave, plane, or convex posterior occlusal contour.
As examples, the original Hanau and the Dentatus have concave incisal guide components. The Sears guide component, commonly used with the Hanau instrument,
and that of Gysi instruments have plane surfaces while the McCollum, Terrell,
and some other instruments have convex guiding components. The Transograph
has a very steep lateral control and a horizontal contour in the straight protrusive
movement. Most often, to satisfy function and favorable esthetics, the straight
protrusive guiding factor should be steeper than the lateral guiding component.
CENTRIC

RELATION

Some consideration must be given to the centric relation record because this
involves both anterior tooth guidance as well as posterior tooth intercuspation.
Posselt2 has shown a slight variable in closed terminal positions in graphs of
the opening and closing movements of the mandible. The habitual closing position
was shown to be slightly forward to the most retruded or axis closing position.
Posselt estimates the habitual closing position as being from 1.0 to 1.4 mm. anterior
to the most retruded or axis position. Since 1929, I3 have advocated advancing the
mandibular member of the articulator from 0.5 to 0.75 mm. when arranging teeth
for complete artificial dentures. Patients seem to accommodate themselves to the

378

SCHUYLER

J. Pros. Den.
May-June, 1959

dentures more readily and to require fewer adjustments. I attributed their greater
comfort to an accommodation for the settling of the dentures and the consequent
change of intercuspation. My present understanding of the difference between the
mandibular position of the axis closure and functional closure leads me to believe
that patients acceptance and comfort would be greater, and the possibility of trauma
would be reduced, if all fixed and removable restorations were constructed with a
limited anteroposterior freedom of movement. My procedure has been to mount
casts in the articulating instrument with a retruded, but unstrained centric maxillomandibular relation record. After this relation record has been checked and
proved and the instrument has been set to the recorded movements, the mandibular
member of the instrument is advanced by placing a strip of tin foil of the desired
thickness in front of the axis balls in the slot in the condylar guidances of the instrument. The thickness commonly used is 0.5 or 0.75 mm. The restorations on
the teeth are finished and milled at this advanced position. Then the articulator is
retruded to its normal position and the occlusal surfaces of the restorations are
milled again to that position. This procedure provides a slight range of anteroposterior freedom for the mandible and a slight freedom in intercuspation. Complete
dentures and complete oral rehabilitation are more readily tolerated when this freedom is built into the occlusion.
Roentgenograms of the temporomandibular joint should be made : (1) before a
complete oral rehabilitation of the natural dentition is started, (2) at the time when
the centric maxillomandibular
relation record is made, and (3) upon completion
of the work. Some badly disorganized occlusal problems present an abnormal positioning of the condyle in the glenoid fossa which might be corrected. Such roentgenograms are a very necessary protection for the dentist if discomfort and complications should arise following a complete oral rehabilitation.
REFERENCES

1. Schuyler, C. H.: Factors of Occlusion Applicable to Restorative Dentistry, J. PROS. DEN.


3:772-782, 1953.
2. Posselt, U.: Range of Movement of the Mandible, J.A.D.A. 56:10-13, 1958.
3. Schuyler, C. H. : Principles Employed in Full Denture Prosthesis Which May Be Applied in
Other Fields of Dentistry, J.A.D.A. 16:2045-2054, 1929.
400 MADISON AVE.
NEW YORK 17. N. Y.

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