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RESTORATIVE DENTISTRY
CLYDE H. SCHUYLER,
New York, N. Y.
IN
D.D.S.
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
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
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
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
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