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SECTION EDITORS

FIXED PROSTHODONTICS DAVID E. BEAUDREAU


SAMUEL E. GUYER
OPERATIVE DENTISTRY WILLIAM LEFKOWITZ

Anterior guidance-The key to successful occlusal


treatment
Stephen P. Broderson, D.D.S.
Berkeley, Calif.

A n ideai occlusion is one that does not wear, or the masticatory system will ultimately destroy
promotes a healthy periodontium and temporoman- itself. Each individual exhibits unique condylar
dibularjoint, and maintains a quiet neuromuscular border movements, and these occur within Posseh's
(proprioceptive) mechanism. The purpose of this envelope of motion? The condylar border move-
article is to show that the relationship between the ments are controlled by the anterior teeth and the
max!llary and mandibular anterior teeth is them0st neuromuscular system. Masticatory function varies
important factor in the restoration and maintain- infinitely within the envelope of motion, but always
ence of this ideal occlusion. uses some of the border movement pathways.
Two basic philosophies exist pertaining to the Function is dynamic. During function the
treatment of the anterior teeth. The first one is the condyles move from left to right (or vice versa) along
gnathologic approach, which states that the lingual various lengths of the border pathways as the teeth
surfaces of the maxillary anterior teeth arc entirely pass through centric occlusion and on t o the other
controlled by condylar border movements.'. ~ The side. The amount of lateral border pathways that are
second is the Pankey-Mann-Schuyler philosophy, used during function depends on the type of food
which states that the lingual surfaces of the maxil- being chewed. Granger* demonstrated that more
lary anterior teeth are independent o f condylar border pathways were used in chewing meat than in
border movements and are dictated by the need for a chewing cheese (Fig. 1). The border movements are
long centric. 3 After I0 years of clinical observations of braced movements in which the condyles function
functional relationships that exist between the ante- against their disc assemblies and eminentia, permit-
rior and posterior teeth, it seems to this author that ting more power to be used. More power is needed tO
the anterior occlusion is affected by both the chew meat; therefore more of the border pathways
condylar border movements and the positional rela- are used. If there are interferences of the teeth which
tionships of maxillary and mandibular anterior prevent the condyles from reaching the border path-
teeth. ways, muscle dysfunction will occur2" T Anterior
teeth also can cause such interferences.
DETERMINANTS OF ANTERIOR G U I D A N C E
The four determinants of anterior guidance are (1) FUNCTIONS OF ANTERIOR TEETH
esthetics, (9) phonetics, (3) condylar border move- 9The four functions of the anterior teeth are (1) to
ments, and (4) positional relationships of the maxil- incise food, (2) to aid speech, (3) to aid in esthetics,
lary and mandibular anterior teeth. and (4) to protect the posterior teeth. ~
Esthetics and phonetics. Esthetics and phonetics Protection of the posterior teeth involves a change
are best determined by the methods suggested by of movement of the condyles, from much translation
Pound. 4 with little rotation to movement with less transla-
C o n d y l a r border movements. If there were no tion. This redirects a horizontal force of closure,
teeth in the mouth the muscles, ligaments, and transforming it into one that is more vertical. This
functional form of the temporomandibular joints redirection involves thh neuromuscular system.
would determine the movement pattern of the Without the anterior tceth the mandible could
mandible. The articulating (occluding) surfaces of
the teeth musl be in harmony with these movements *Personal communication, Dr. Ernest Granger, J u l y 1968.

396 APRIL 1978 VOLUME 39 NUMBER 4 0022-3913/78/0139-0396S00.50/0 9 1978 The C. V. Mosby Co.
ANTERIOR GUIDANCE IN OCCLUSAL TREATMENT

A !1
Fig. 1. Less border movement pathways are used during the chewing of cheese, A, as
compared to meat, B.

Fig. 2. 9 a shallow articular eminence with a deep vertical 9 the anterior teeth will
have an interference in the occlusion. The amount of tooth Structure that must be removed or
recontoured is estimated on the right.

close in positions "that would direct forces horizon- This is because of a concavity on tile lingual surfaces
tally on the posterior teeth. T h e lingual surfaces of of the maxillary anterior teeth. This shape is critical
the maxillary anterior teeth act as proprioceptive to the health of these teeth; if there is not enough
guides to bring the teeth together in centric occlusion concavity the anterior teeth become interferences in
so that closing forces will be vertically directed onto the occlusion.
the posterior teeth. A closure in a protrusive or Bennett movement occurs in the sagittal, vertical,
lateroprotrusive direction would cause the mandib- and horizontal axes and is made up of rotational and
ular anterior teeth to contact the maxillary anterior translational movementsP T h e timing of the transla-
teeth somewhat forward of or lateral to centric tion with the rotation must be incorporated into the
position. This type of Contact triggers the neuromus- lingual surface of the maxillary anterior teeth, 9
cular system to close the mandible into centric cially the canines. These teeth have large root surface
position so that the posterior teeth can receive the areas and are placed anterior to powerful closing
final closuri~ load. muscles. T h e y are ideally suited for directing a
There are only a few instances where the interin- vertical closure of the mandible.
cisal angle approaches 180 degrees; that is, where the 9 When an occlusion is being restored the character
forces are directed parallel to the long axes Of the of the border movements must be known, but the
teeth. These instances do not fall into normal or ideal ultimate effect of the m o v e m e n t pattern depends On
categories~ but occur when teeth are in an end-to-end the positional relationships of tile anterior teeth.
relation and with Class III and Class II, division 1. Phonetics and esthetics usually determine the incisal
malocclusions. In a study o f 40 normal occlusions, edge position/ but usually the incisors are present.
Do~vns8 recorded an averag e interincisa! angle of 135 Horizonial and vertical overlap and the axial incli-
degrees. Because of this angle the anterior teeth are nation Of the teeth determine (along with a varying
proprioceptively sensitive and serve to redirect the amount of Bennett movement) the amount of
path of closure. lingual concavity needed for the maxillary anterior
The anterior teeth also must allow the Bennett teeth. In Waxing the restoration on the articulator, it
movement to occur so that in final closure forces will is difficult to determine exactly how much concave
be directed along the long axis of the posterior teeth.' c u r v a t u r e is needed. I~ Three areas of help are the

THE iOURNAL OF PROSTItETIC DENTISTRY 39'7


BRODERSON

Fig. 3. A, the angle of separation of the anterior teeth is not in harmony with condylar
movement, t3, anterior teeth and condylar movement are in harmon)'.

B A

Fig. 4. Canines in the frontal9 plane. Increasing the Bennet movement, line (b) condyle,
requires an increase in the lingual curvature (arc (b), incisors).

amount Of Bennett movement, the a m o u n t of hori- The lingual surfaces of the maxillary anterior teeth
zontal and vertical overlap, and the steepness of the must allow for this, or an anterior interference will
eminences. result. This produces notching o n the lingual
A deep Vertical overlap with little horizontal surfaces of the maxillary anterior teeth and wear on
overlap (lingually inclined maxillary anterior teeth) the incisal surfaces of the mandibular teeth. There
requires more lingual concave curvature than when may be lingual pockets, recession of bone, gingivitis,
the maxillary anterior teeth are more normally mobility, and temperature sensitivity about tile
inclined (Fig. 2). If there is no appreciable a m o u n t of maxillary anterior incisors. Patients with such condi-
9 Bennett movement and the angle of the eminence is tions require a long centric when restoration is ac-
steep, the Occlusion will be in harmony. As more complished using the Pankey-Mann-Schuyler tech-
Bennett movement is introduced and the angle of nique.
the eminence decreases (the mandible needs more In Fig. 4, B, the anterior guidance is in h a r m o n y
room in the lateral and protrusive ranges), more with the steep eminences, and therefore only a small
lingual concave curvature is needed. amount of curvature is needed. As soon as the
Deep vertical overlap with little horizontal over- mandible opens, the condyles move down the steep
lap, combined with a steep eminence, requires less eminences and the occlusion of the teeth is in
concave curvature of the maxillary lingual surface harmony with the border movement pattern.
than when the eminences are flatter (Fig. 3). In In the frontal plane the relationship of the canines
normal functional movements the condyle comes is also affected by the amount of vertical and
forward and then down upon opening (Fig. 4, A). horizontal overlap and the amount of Bennett move-

398 APRIL 1978 VOLUME 39 NUMBER 4


ANTERIORGUIDANCEIN OCCLUSALTREATMENT

mcnt (Fig. 4). Given the same tooth arrangement, an Work


increase in the amount of Bennett movement

J
/
requires an increase in the lingual curvature of the
canines. As the mandible moves into a lateral func-
tional movement, the condyles also translate lateral-
ly." T h e canine articulation must allow for this ,/
movement to occur; otherwise an occlusal interfer-
ence will result. One may see a cusp of a m a n d i b u l a r
canine worn off, especially if the lingual surface of
the maxillary teeth is restored in porcelain. This is
devastating to the rest of the dentition because of
resultant posterior interferences.
] ro.
Fig. 5. The timing of the Bennett movement cannot be
Small amounts of vertical and horizontal overlap recorded with eccentric registrations (checkbites). They
(almost an end-to-end relationship) of the anterior only record the relative lateral displacement of the
teeth are influenced very little by the condylar condyle (arrows indicate direction of condyle move-
determinants. However, this situation requires the ment).
utmost attention in the development of occlusion for
the posterior teeth. The posterior teeth are usually confirmed, and the anterior guidance can be felt by
worn off early, or deflective occlusal contacts the patient. The patie_nt can tell almost immediately
produce pain-dysfunction syndrome, recession, mo- if there is enough concave curvature. If, upon clos-
bility, or a combination of these. It is very difficult to ing, the mandibular anterior teeth striking the
build an interference-free restoration for these lingual surfaces of the maxillary anterior teeth feel
patients. If a posterior reconstruction is contem- "high" even though the centric occlusion seems to be
plated, closure:of the vertical dimension of occlusion accurate, the interference must be reduced outward
can sometimes help to gain more anterior guid- from centric occlusion to make the restoration
ance. comfortable. It is important' to have the patient
sitting in an upright position for this testing, because
DEVELOPING AN ANTERIOR GUIDANCE gravity can affect the procedure. T h e anterior teeth
If the anterior teeth are to be restored, the angle of may feel comfortable while the head is back, but as
the eminences and the amount and timing o f t h e soon as it comes forward an interference will be felt.
Bennett movement are the critical factors to be This explains the need for a long centric?
examined. T h e angle of the eminence can be approx- Temporary restorations should be worn until both
imated by using protrusive registrations. T h e the dentist and the patient are satisfied with the
Bennett movement can be recorded only by a result. A diagnostic cast is made of the maxillary
pantograph or a type of generated path. Registra- arch, which is transferred to the articulator using a
tions for lateral movement only give the approxi- face-bow. After the mandibular diagnostic cast is
mate amount of lateral displacement of the mounted and the articulator adjusted, a custom
mandible at a given point along the border move- incisal guide table is made. Using this incisal guide
ment path. They do not show the amount and table, the dentist is able to make the final restoration
timing of the translation, which are critical to knowing that the lingual surfaces of the anterior
planning and performing the restoration of the teeth will be in h a r m o n y with the movement
lingual surfaces of the anterior teeth (Fig..5). patterns of the patient.
After the necessary information is obtained from
the patient, and the articulator has been pro- CONCLUSIONS
grammed, the restoration can be begun. This proce- 1. T h e occlusion of the anterior teeth is the key to
dure is difficult because there are no rigid rules On developing and perpetuating an "ideal" occlusion.
how much lingual curvature is needed in the devel- 2. The anterior teeth protect the posterior teeth
opment of anterior guidance. If there is some doubt by disoccluding them in eccentric positions, and the
about the accuracy of tile selected guidance (and posterior teeth protect the anterior teeth by receiving
there usually is), then a resin diagnostic temporary most of the forces of closure in centric position.
restoration should be made. Esthetics can be 3. The anterior guidance is a result of both

THE JOURNALOF PROSTHETICDENTISTRY 399


BRODERSON

anterior tooth position and condylar border move- 6. Sicher, H., and DuBrull, E. L.: Oral Anatomy. St. Louis,
m e n t s ; b o t h factors m u s t b e c o n s i d e r e d in t h e 1975, The G. V. Moshy Company, pp 172-173.
7. Shore, N. A.: Temporomandibular Joint Dysfunction and
creation of an anterior guidance. Occlusal Equilibration. Philadelphia, 1969, J. B. Lippincott
REFERENCES Company, pp 160-181.
8. Thurow, R. G.: Atlas of Onhondontic Principles. St. Louis,
1. Stuart, C. E.: Oral Rehabilitation and Occlusion, With 1976, The C. V. Mosby Company, p 84.
Some Basic Principles on Gnathology, vol 5. Ventura, 9. Kornfeld, M.: Mouth Rehabilitation, Clinical and Labora-
California, 1976, The G. E. Stuart Gnathological Instru- tory Procedures, vol 2. St. Louis, 1967, The C. V. Mosby
ments, chap 5. Company, pp 406-407.
2. Huffman, R. W., Regenos, J. W., and Taylor, R. R.: 10. Lucia, V. O.: Modem Gnathological Concepts. St. Louis,
Principles of Occlusion: A Laboratory and Clinical 1961, The G. V. Mosby Company, p 468.
Teaching Manual. Columbus, 1969, H and R Press, pp I-GI- 11. Adams, S. It., and Zander, H. A.: Functional tooth contacts
I-G26. in lateral and centric oc~:lusion. J Am Dent Assoc 69:465,
3. Dawson, P. E.: Evaluation, Diagnosis, and Treatment of 1964.
Occlusal Problems. St. Louis, 1967, The C. V. Mosby
Company, pp 78-79, 149. Reprint requests to:
4. Pound, E.: The mandibular movements of speech and their DR. STEPHENP. BRODERSON
seven related values. J South Galif State Dent Assoc 3-t:435, 1653 SOLA,~OAVE.
1966. BERKELEY,CALIF. 9"t707
5. Posseh, U.: Physiology of Occlusion and Rehabilitation.
iPhiladelphia, 1966, F. A. Davis Company, pp 52-57.

INFORMATION FOR AUTHORS


Most of the provisions of'tile Copyright Act of 1976 became effective on J a n u a r y l, 1978.
Therefore, all manuscripts must be accompanied by the following statement, signed by each
author: " T h e undersigned author(s) transfers all copyright ownership of the manuscript
entitled (title of article) to T h e C. V. Mosby C o m p a n y in the event the work is published. T h e
author(s) warrants that the article is original, is not under consideration by another journal,
and has not been previously published." Authors will be consulted, when possible, regarding
republication of their material.

400 APRIL 1978 VOLUME39 NUMBER4