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Invited Review Occlusion: The gateway to success

Bhuvaneswaran Mohan, Dhanasekaran Sihivahanan
Department of Conservative Dentistry and Endodontics, SRM Kattankulathur Dental College and Hospital,
SRM University, Potheri, Kancheepuram Dist, Tamilnadu, India.

Address for correspondence: Dr. Bhuvaneswaran Mohan, Email:drmohanb@yahoo.com

ABSTRACT
Success of our clinical procedures is not a singleday entity, but instead survival on a longterm basis. The clinical longevity of
our work is dependent on so many factors and when we have a closer look, all these ultimately depend on the occlusal stability.
The word occlusion itself creates aversion for almost all and very conviently we try to avoid the occlusal principles thinking
that we have to bother about the principles only for tempeoromandibular joint disorder patients. In an irony, it is true that the
principles of occlusion have to be applied in our daytoday practice to be successful. This article aims to simplify the principles
of occlusion so that the readers develop interest in this most rewarding subject. Also, the clinical implication of the occlusal
concepts and the treatment modalities are explained to give the readers an insight into how important this subject is for our
daytoday practice.

CLINICAL RELEVANCE TO INTERDISCIPLINARY DENTISTRY

(1) Important to understand the principles of occlusal harmony, to have a better approach to clinical examination, treatment
panning. And problem solving for any restorative cases.
(2) The failure to embrace sound occlusal principles leads to a plethora of fringetype treatment modalities and unnecessary
overtreatment.
(3) If the signs of occlusal disease can be easily observed at the earliest stages, the progression of the damage can be
intercepted.
(4) Not respecting the dentofacial system may result in restoration, prosthesis, or periodontal treatment failures, along
with relapse of orthodontic and orthognathic surgeries.

Key words: Comprehensive dentistry, occlusal discrepancies, occlusion, temperomandibular joint

INTRODUCTION examination, treatment, and problem solving takes

on a new perspective. It is a perspective that pays

A t every level of general practice, a dentist

routinely faces problems of sore teeth,
excessive wear, loose teeth, tempeoromandibular
joint (TMJ) disorders and orofacial pain. Adentist
who does not have a working knowledge of occlusal
principles must resort to guesswork and timewasting
trial and error attempts to solve problems. Even
achieving predictable function and beauty of smile
design is dependent on incorporation of sound
occlusal principles. When principles of occlusal
harmony are understood, the entire approach to
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DOI:
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68
huge dividends of predictability and increased
productivity, regardless of the type of practice.
Attempting to restore an occlusion, correcting a bite
problem, or even reshaping a high restoration without
knowing the precisely correct maxillarymandibular
relationship, can be a timewasting, frustrating, and
unnecessary experience.[1,2]
Even though an understanding of occlusal principles
has value to every level of dental practice, there is
a pervasive misconception that concepts of dental
occlusion are not relevant to everyday dentistry.
The failure to embrace sound occlusal principles
has also led to a plethora of fringetype treatment
modalities, unnecessary overtreatment, and denials
of responsibility for problems that are a direct result
of occlusal mismanagement.[1,2]
A primary tenet of comprehensive dentistry is that
all of the components of the masticatory system are
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Mohan and Sihivahanan: Occlusion
intimately related and dependent on one another for
ideal occlusion. Atrue understanding of occlusion and
comprehensive dentistry is important for the predictability
and longevity of all the beautiful restorations that dentist
create, and the overall comfort and functioning of their
patients. At this point, it is needless to mention that
achieving a stable occlusion requires a multidisciplinary
approach and the specialist involved should have a sound
knowledge of the same. Todays dentistry is shifting
toward conservative and comprehensive dental care.[3,4]
The objective of this article is to explore the role of occlusion
in daytoday practice, and to highlight the multispecialty
approach required in comprehensive dentistry.
TERMINOLOGIES
To understand the concepts of occlusion, it is necessary that
certain terminologies are well understood. Athorough
knowledge of the anatomy of the TMJ and the surrounding
structures is, also equally important. Afew of the
important terminologies and their clinical importance
are listed here.
Centric relation
Definition: It is the relationship of the mandible to the
maxilla when the properly aligned condyledisk assemblies
are in the most superior position against the eminentiae,
irrespective of vertical dimension or tooth position.
The centric relation refers to the fully seated condylar
position regardless of how the teeth fit. Centric
relation is not just a convenience position that is
used because it is repeatable. It is the universally
accepted jaw position because it is physiologically and
biomechanically correct and is the only jaw position
that permits an interferencefree occlusion. Because the
position of the condyledisk assemblies determines the
maxillarymandibular relationship during jaw closure, any
variation in condylar position will change the closing arc of
the mandible teeth against the maxillary teeth. Recording
of an accurate centric relation is critical for the most
costeffective, timeeffective, troublefree restorative or
prosthetic dentistry.[5,6] The mandible is in centric relation
if five criteria are fulfilled:
1. The disk is properly aligned on both condyles.
2. The condyledisk assemblies are at the highest
point possible against the posterior slopes of the
eminentiae.
3. The medial pole of each condyledisk assembly is
braced by bone.
4. The inferior lateral pterygoid muscles have released
contraction and are passive.
5. The TMJs can accept firm compressive loading with
no signs of tenderness or tension.
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The goal of centric relation is a completely released inferior
lateral pterygoid muscle on both sides. This is the essential
requirement for a peaceful, coordinated musculature. It
can only be achieved in the absence of deflective occlusal
interferences to centric relation. In short, centric relation
is bonetobone relationship.[7,8]
Please remember that between bone and muscle war,
muscle never losesHarry Sicher.
Maximum intercuspation position
The toothtotooth relationship in maximum contact is
called as maximum intercuspation position (MIP). Earlier,
this position was called as centric occlusion. The MIP might
not coincide with the centric relation and that is why the
terminology centric occlusion is obsolete.
To highlight again, centric relation is bonetobone relation
and maximum intercuspation is toothtotooth relation.
All the problems related to occlusion begin when there
is a mismatch between centric relation and maximum
intercuspation (MIP). If this mismatch is minor, then the
TMJ adapts itself to MIP and this posture is called as
adapted centric posture.[9]
Adapted centric posture is the manageably stable
relationship of the mandible to the maxilla that is
achieved when deformed TMJs have adapted to a
degree that they can comfortably accept firm loading
when completely seated at the most superior position
against the eminentiae. Beyond this stage, the muscles
try to knock off all the tooth interferences to go back to
their position. When succeeded, tooth wear begins; if
not, TMJ problem starts. This concept is known as Hit
and Slide concept. This clearly explains the reason why
tooth wear pattern is just not an abrasion of enamel,
but the formation of wear facets in different sizes and
shapes [Figure 1]. When upper and the lower teeth
contact each other, only a total area of 4mm2 comes in
contact, if marked with an articulating paper, we would
get dots in the posterior and lines in the anterior. Most
importantly, anterior stop is necessary for the stability of
posteriors in centric relation (inverted tripod concept).
When restoring teeth, all these have to be kept in mind
to achieve success [Figure 2].
Anterior guidance
Next to centric relation, the anterior guidance is the
most important determination that must be made when
one is restoring an occlusion. The success or failure of
many occlusal treatments hinges on the correctness of
the anterior guidance. The anterior guidance has similar
importance in orthodontic treatment. The functional
movement of mandible constitutes the most fundamental
basis for ideal occlusal design. Every tooth in the mandible
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Mohan and Sihivahanan: Occlusion
Figure1: Occlusal wear facet
(the only moving jaw) has an envelope of motion
(envelope of function) that outlines the outer limits of each
lower tooth to be moved. During full range of anterior
guidance, there should be no posterior interferences. As
the lower anterior slide out, all the posterior teeth should
be in complete dis-occlusion. Failure to properly establish
the correct guidance is a major cause of posttreatment
instability. One thing every dentist should know before
attempting to restore anterior teeth is that besides being
the key to esthetics, the anterior teeth are also the key
factor in protecting the posterior teeth. The relationship of
the anterior teeth in function is the principle determinant
of posterior occlusal form. The formula to analyze the
anterior guidance: dots signify centric relation contact
only, on posterior teeth. Lines signify the role of the
anterior teeth to disclude the posterior teeth in all
excursions.
There is no way to standardize anterior guidance. There
are no cephalometric norms that work for all patients, and
there are no arbitrary guidelines for interincisal angulation
that fit all patients. One of the most important concepts
to understand about anterior guidance is that it is highly
variable from patient to patient. Minute changes can make
a major difference in patient comfort, and slight mistakes
in incisal edge position can profoundly affect the stability
of the anterior teeth over time.
In a perfected occlusion, the combination of condylar
guidance and anterior guidance determines the path
that the mandible follows in function. In an ideal
occlusal relationship, all contact by the posterior teeth is
determined by the combined border paths at both the front
and back ends of the mandible. Thus, the anterior guidance
plays a dominant role in establishing the functional path
that the mandible can travel.
Any disturbances seen in the palatal surface of anteriors
simply means that the anterior guidance is not proper.
Hence, the primary aim of any treatment restorative or
70
Figure2: Maximum intercuspation contacts
prosthetic work should be to get the ideal position of the
anteriors and establishing perfect anterior guidance.[6,7]
Vertical dimension of occlusion
Definition: It is the vertical position of the mandible in
relation to the maxilla when the upper and lower teeth
are intercuspated at the most closed position.[10,11]
The mandiblemaxilla relationship, established by the
repetitive contracted length of the elevator muscles,
determines the vertical dimension of occlusion (VDO).
Even though the VDO occurs when the teeth are fully
articulated, the teeth are not the determinants of vertical
dimension. Rather their position is determined by the
vertical dimension of the space available between the fixed
maxilla and the musclepositioned mandible. There is an
everpresent eruptive force that causes teeth to erupt until
they meet an equal, opposite force. If the opposing force
is greater than the eruptive force, the teeth are intruded
until the eruptive force equals the resistive force against
them. If the resistive force is less than the eruptive force,
the teeth will continue to erupt.[12,13]
The dimension of the jawtojaw relationship is consistent
enough that even severe bruxing, clenching, and abrading
parafunction do not alter the jawtojaw dimension
between bony landmarks in each jaw. Because of
elongation of the alveolar process, even severe abrasion of
teeth does not cause a loss of vertical dimension. Patients
can wear their teeth down to the gum line and still not lose
vertical dimension because the eruptive process matches
the wear to maintain the original vertical dimension.
In very rare situations, tooth wear supersedes the bone
formation and the VDO requires a change. If the VDO
must be changed, it should be determined at the point of
anterior teeth contact, and it should be changed as little as
necessary to reduce the requirements for adaptation to the
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Mohan and Sihivahanan: Occlusion
minimum. Changes in the true VDO are not permanent.
The VDO will return to its original dimension measurable
at the masseter muscle.
Failure to understand the physiology and biomechanics of
vertical dimension will lead to inappropriate overtreatment
and result in iatrogenic damage to dentition and missed
diagnosis of temperomandibular joint disorders [TMD].[14,15]
Vertical dimension at rest (VDR)
When a muscle is neither hypotonic nor hypertonic, it is
said to be at rest. Even resting muscle is in mild state of
contraction. This mild contraction of antagonist muscles
is necessary to maintain the posture and alignment of the
skeletal parts. Despite the popularity of using rest position
as a starting point for determining VDO, it is an unreliable
approach because the dimension between the teeth at the
rest position is not consistent for different patients. The
rest position is not consistent even in the same patient.
The rest position is also altered by the presence of any
noxious stimuli from occlusal interferences that can cause
varying degrees of muscle incoordination. The effects of
masticatory muscle incoordination can range from slight
hypercontraction to severe trismus, all of which can have
a profound effect on the postural position of the mandible
at rest[16] [Figures3 and 4].
Please remember that between teeth and muscle war,
muscle never losesPeter E. Dawson.
Neutral zone
Definition: The potential space between the lips and cheeks
on one side and the tongue on the other.
Teeth are the most movable part of the masticatory
system. If outward horizontal forces from the tongue
are greater than inward forces exerted by the buccinator
muscle bands and the lips, the teeth will move
horizontally until the opposing forces are equal. This
is the neutral zone. Understanding of the neutral zone
Figure3: Compensation of bone for loss of VDO
Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2
makes it readily apparent why so many orthodontic
results do not remain stable. It also explains why many
postrestorative problems occur and even why some
periodontal procedures are unsuccessful. Relapses with
orthognathic surgery can almost always be explained by
neutral zone imbalance. Also, complete or partial denture
failures are often related to noncompliance with neutral
zone factors. Regardless of the treatment, any part of the
dention out of harmony with the neutral zone will result
in instability, interference with function, or some degree
of discomfort[17] [Figures5 and 6].
Plane of occlusion
The term plane of occlusion refers to an imaginary surface
that theoretically touches the incisal edges of the incisors
and the tips of the occluding surfaces of the posterior teeth.
Together, the curve of Spee, the curve of Wilson, and the
curve of the incisal edges are properly referred to as the
curve of occlusion[18] [Figure7].
Curve of spee
It is the anterioposterior curvature of the occlusal surfaces,
beginning at the tip of the lower canine and following
the buccal cusp tips of the bicuspids and molars, and
continuing to the anterior border of the ramus. The curve
of Spee aligns each tooth for maximum resistance to
functional loading. The long axis of each lower tooth is
aligned nearly parallel to its arc of closure around the
condylar axis.
Curve of monson
If the curved line continued further back, it would ideally
follow an arc through the condyle. The curvature of the
arc would relate, on average, to part of a circle with a
4inch radius. The posterior part of the occlusal plane will
always be flat enough and low enough to be discluded
by the normal condylar path on its steeper eminentiae. It
is because of this geometric design that the 4inch radius
of the Monson curve works so effectively if the condyle
is used for a survey point.
Figure4: Changes in bone during loss of VDO
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Mohan and Sihivahanan: Occlusion
Figure5: Neutral zone role of tongue and cheeks
Figure6: Neutral zone tongue and lip
Figure7: Plane of occlusion
The anterior posterior curvature of the occlusal plane is
designed to permit protrusive disclusion of the posterior
teeth by the combination of anterior guidance and condylar
guidance. Prevention of increased muscle loading on the
teeth and the joints is the dominant reason for making
72
certain that the occlusal plane is correctly evaluated as a
part of every complete examination.
Curve of wilson
It is the mediolateral curve that contacts the buccal and
lingual cusp tips on each side of the arch. The curve
of Wilson results from inward inclination of the lower
posterior teeth. There are two reasons for this inclination
of posterior teeth. One has to do with resistance to loading
and the second has to do with masticatory function.
The form of the occlusal plane is directly related to specific
functional requirements. In addition to alignment of teeth
in relationship to the arc of closure for best resistance to
loading, it should permit ease of access for positioning of
the food on the occlusal surfaces. The occlusal plane is a
critical consideration in solving many different problems
of occlusion. But if basic requirements for acceptability of
an occlusion plane are understood, resolution of problem
occlusions can be achieved more readily. When restoring
multiple teeth or rehabilitating using prosthesis removable
or fixed, it is very important that all these principles are
taken care of.[19,20]
TYPES OF OCCLUSION
For many years, the standard classification for occlusion has
been Angle`s classification of malocclusion. The problem
with Angle`s classification is that it does not consider TMJ
position or condition when relating the mandibular arch
to the maxillary arch. Analysis of any occlusion requires
careful inspection of MIP in relation to both the position
and condition of the TMJs. Probably, this is the reason
why sometimes, Angle`s Class I patients develop severe
TMJ problems and Angle`s Class III patients live happily
without any problems.
Dawson's classification
In the analysis of any occlusion in relation to the TMJs, the
condition and position of the TMJs must be determined
before the occlusion can be analyzed.[2124]
Type I: Maximal intercuspation is in harmony with centric
relation.
Type IA: Maximal intercuspation occurs in harmony with
adapted centric posture.
Type II: Condyles must displace from a verifiable centric
relation for maximum intercuspation to occur.
Type IIA: Condyles must displace from an adapted centric
posture for maximum intercuspation to occur.
Type III: Centric relation cannot be verified.
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Mohan and Sihivahanan: Occlusion
Type IV: The occlusal relationship is in active stage of
progressive disorder because of pathologically unstable
TMJs.
Group function occlusion
Refers to distribution of lateral forces to a group of teeth.
Group function of the working side is indicated whenever
the arch relationship does not allow the anterior guidance to
do its job of discluding the nonfunctioning side. Problems
with group function result from improper harmony of the
contacting lines. Attempts at group function with convex
inclines are invitations to hypermobility. For group function
to be effective in reducing stress, the cusp inclines must
be in perfect harmony with the lateral border movements
of the jaw. Incline interferences on posterior teeth get
progressively more stressful as they get closer to the
condyle fulcrum; a slight interference on a second molar
would probably be more stressful than a more noticeable
interference on a canine.
Canineprotected occlusion
Refers to disclusion by the canines of all other teeth in
lateral excursions. It usually serves as the cornerstone of
what is called mutually protected occlusion.
When it is impractical to distribute the lateral guidance
stresses over several teeth, disclusion of the posterior
teeth can be accomplished by use of the canines in one
form or another of canineprotected occlusion. In natural
canineprotected occlusions, the pattern of function is
rather vertical, and so the mandible does not use lateral
movements that would subject the canines to stress in
that direction either. The canines actually assume the role
more as a guidance that actuates vertical function rather
than as a resistor to lateral stress.
Balanced occlusion
The balanced occlusion originally referred to actual
balancing contact to stabilize the dentures on the side of
the downward moving, orbiting condyle. When the same
concept of balanced occlusion is applied to the natural
dention, it results in hypermobility, excessive wear, and
periodontal breakdown. Bilaterally balanced occlusion
does not work because there is no way to harmonize the
balancing inclines of the teeth to all of the variations of
muscle force against the unbraced orbiting condyle.
OCCLUSAL DISEASE
It is a puzzling observation that the most prevalent
evidence or damage to teeth is so routinely ignored.
The signs of occlusal disease are so easily observed even
at the earliest stages when progression of the damage
can usually be intercepted. If the signs and symptoms of
Journal of Interdisciplinary Dentistry / May-Aug 2012 / Vol-2 / Issue-2
occlusal disease are readily recognized, then they respond
to treatment at a high level of predictability.[25,26]
Lytle was the first to introduce the term occlusal disease.
He defined it as the process resulting in the noticeable
loss or destruction of the occluding surfaces of the
teeth. He postulated that the disease is primarily, but
not necessarily precipitated by bruxism or parafunction.
Occlusal disease is deformation or disturbance of function
of any structures within the masticatory system that are
in disequilibrium with a harmonious interrelationship
between the TMJs, the masticatory musculature, and
the occluding surface of the teeth. To appreciate the full
scope of occlusal disease, it is necessary to understand
how interdependent all parts of the masticatory system
are. Any disharmony between the teeth, the muscles,
and the TMJs is sufficient to cause stress, deformation,
or dysfunction on any or all of the other parts in the
system.[27,28]
Basic mechanisms for tooth surface
deformation
According to Grippo etal., it is now apparent that
deformation of tooth structure results from three basic
physical and chemical mechanisms that can act alone or
in combination.
1. Stress results in compression, flexure, and tension. It
can produce microfracture and abfraction as a dental
manifestation.
2. Friction includes abrasion from exogenous material
and attrition, which is endogenous. The end point of
both is wear of tooth surfaces.
3. Corrosion is the result of chemical or electrochemical
degradation.
These three basic mechanisms often overlap and interact
to accelerate structural damage to the teeth. Thus, much
of the structural deformation of teeth must be considered
as multifactorial.
Examples of occlusal disease[29]
1. Attritional wear: This type of wear on the lower
anterior teeth is one of the most common untreated
problems. The posterior teeth with deflective incline
interferences to centric relation are so often the cause
of a forward slide of the mandible during closure
to maximum intercuspation. This forces the lower
anterior teeth forward into a collision with the upper
anterior teeth.
2. Erosion of enamel: A combination of acid from fruit,
abrasion from mulling fruit between endtoend
anterior contacts, and attrition from bruxing produces
invagination of incisal enamel.
3. Splayed teeth: Splaying of teeth is a common sign of
occlusal disease that should be diagnosed and treated
early by eliminating the deflective interferences that
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Mohan and Sihivahanan: Occlusion
force the mandible forward. Improperly contoured
restorations that are too thick on the lingual of
the upper anterior teeth or overcontoured lower
restorations are common cause of splaying.
4. Destroyed dentition: This is the result of not
intercepting occlusal disease early. Signs of severe
wear, fractured maxillary and mandibular teeth, and
elongated alveolar process are typical.
5. Advanced occlusal disease: This disease results
from a combination of attritional wear and moved
teeth. This is occlusal disease left undiagnosed and
untreated until the late stage of progressive damage
has occurred.
6. Anterior guidance attrition: This occurs when anterior
teeth that interfere either with centric relation closure
or with functional jaw movement patterns develop
early signs of attritional wear of the lingual enamel
on upper anterior teeth.
7. Sore teeth: Compression of periodontal ligaments
can be combined with pulpal hyperemia to cause
considerable soreness or pain on biting. If empty mouth
clenching causes any discomfort in a tooth, it is an
indication that the sore tooth is in occlusal interference.
8. Hypermobility: An early sign of occlusal disease
is tooth hypermobility. It can result in widened
periodontal space and greater susceptibility to
periodontal disease.
9. Painful musculature: A common symptom of
occlusal disease results from disharmony between
the occlusion and the TMJs. Deflective occlusal
interferences that require the jaw joints to displace
to achieve maximum intercuspation are a potent
cause for painful masticatory musculature. Occlusal
overload can cause excessive wear, hypermobility,
fractured cusps, and hypersensitivity.
CLINICAL CONSIDERATIONS
By now, it is very clear that the science behind a
beautiful smile is not as simple as what we think. The
dentist of today must become a physician of the total
masticatory system.[30] this is not surprising because
knowledge about occlusionrelated issues is essential to
good clinical practice in all disciplines. The loss of tooth
structure is the first sign that any clinician should keep
a watch to control the occlusal disease. We all know
that signs precede symptoms, hence if the patient is
symptomatic; it simply means that a lot of destruction
has already happened.[31]
Loss of enamel resulting in attrition, both in anteriors
and posteriors, is not a minor issue to be neglected. As
discussed earlier, the occlusal diseases are a result of
improper positioning of teeth. When unattended, this will
result in periodontal destruction and ultimate loss of tooth
structure. The reasons for failure of restorations, prosthesis,
74
or periodontal treatment, and relapse of orthodontic and
orthognathic surgeries are nothing, but not respecting the
dentofacial system.[32]
A proper diagnosis considering all the etiological factors
will avoid most of the failures in daytoday practice.
Let it be restorative treatment, prosthetic rehabilitation,
or a periodontic surgery, all concepts of occlusion have
to integrate to achieve success and all these branches
of dentistry are interrelated and the specialists have to
work in harmony. The main aim of any treatment should
be to make sure that the teeth are positioned in centric
relation and all our final restorations have to be in this
position too.[33,34]
Treatment planning
Step 1: To confirm if there is a discreprency between
centric relation and MIP.
Step 2: Deprogramming of the patient if the discreprency
is seen with anterior bite plane, Lucia jig, and Pankey jig.
Step 3: Once the muscles are deprogramming, recording
the centric relation with face bow transfer is done.
Step 4: Finding out the occlusal discr epancy in
semiadjustable articulators.
Step 5: Correction of the discrepancy in the mouth.
The periodontal treatment can be initiated at this phase.
After completing the periodontal treatment, once again
the steps35 have to be carried out to make sure that
there are no occlusal discreprencies. This is because
during periodontal treatment, the teeth may change their
positions. It is well known that occlusal discreprencies
could be the primary etiology for periodontitis, but
the reason for failure of properly done periodontal
rehabilitation is nothing, but not taking care of the
abovementioned factors.[35]
The restorative and the prosthetic work will start after
stage5. It is needless to say that periodontal treatment
precedes all rehabilitation work.
Step 6: Temporization of patient with prototype
restorations.
Prototype restorations are nothing, but the exact replica
of the final restorations.
Step 7: Followup of the patient with temporaries.
Correcting occlusal discreprencies of temporaries in both
centric and eccentric position.
Step 8: If the patient is comfortable and temporaries are
stable, then proceed to permanent restorations.
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Mohan and Sihivahanan: Occlusion

Figure8: Improperly done fixed dental prosthesis Figure9: Another case of improperly done fixed dental prosthesis

Figure10: Severe attrition of anterior and posterior teeth Figure11: Prototype restorations done on the lower posterior teeth

Figure12: Occlusal view of the prototype restoration Figure13: Severe attrition of lower posteriors

Figure14: Table top restorations Figure15: Cemented table top restorations

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Mohan and Sihivahanan: Occlusion
Step 9: Make replica of the temporaries (prototype)
and communicate to the lab to make per manent
restoration exactly resembling the temporaries. These
final restorations, strictly speaking, should not have any
changes in the mouth.
All these stages have to be followed for multiple
restorative work, prosthetic reconstruction, and full mouth
rehabilitation when an occlusal problem is diagnosed.
If not, all restorative and prosthetic procedures have to
incorporate steps69 to make sure that we do not induce
an occlusal problem.
Figures8 and 9 shows improperly done fixed prosthesis,
which had resulted in severe TMD and periodontal
destruction. Figure10 shows severe occlusal disturbance
with all anterior and posterior destruction. Figures11
and12 show the picture of a patient undergoing
rehabilitation with prototype restoration. Figure13
shows severe attrition of lower posterior teeth due to
severe mismatch of centric relation and MIP. It is general
tendency to perform root canal therapy and restore them
with ceramic crowns. Since root canal treatment and
crowns will not solve patients primary problem, root
canal therapy in such cases is not at all warranted and is
considered as improper diagnosis and treatment planning.
Figure14 shows the replica of prototype with press and
stain ceramic restorations. Figure15 shows individual
table top restorations cemented in all the lower posteriors.
Patient is now completely rehabilitated in accordance with
centric relation. The reasons for success and failure are very
vivid now. The failure, not necessary to be a catastrophic
one, might range from a fracture of single composite
restoration, chipping of the ceramic crowns, debonding
of the fixed prosthesis to the complete instability of partial
and full dentures and also unscrewing of implants.[36]
CONCLUSION
The subject of occlusion has to be given much more
importance in our daytoday practice. Instead of finding
out the reasons for the failure of our procedures, it is better
to understand and respect the dentofacial system to avoid
such failures. Within the limitation of this article, we have
discussed the basics of occlusion and its role in daytoday
practice. Also, the importance of interdisciplinary approach
to this problem and treatment protocol has been briefly
explained. When all these concepts are followed, success
is sure to come.
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How to cite this article: Mohan B, Sihivahanan D. Occlusion: The gateway
to success. J Interdiscip Dentistry 2012;2:68-77.
Source of Support: Nil, Conflict of Interest: None declared.

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