SECTION EDITORS
FIXED PROSTHODONTICS
OPERATIVE DENTISTRY
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,
promotes a healthy periodontium and temporoman-
dibularjoint, and maintains a quiet neuromuscular
(proprioceptive) mechanism. The purpose of this
article is to show that the relationship between the
max!llary and mandibular anterior teeth is them0st
important factor in the restoration and maintain-
ence of this ideal occlusion.
Two basic philosophies exist pertaining to the
treatment of the anterior teeth. The first one is the
gnathologic approach, which states that the lingual
surfaces of the maxillary anterior teeth arc entirely
controlled by condylar border movements.'. ~ The
second is the Pankey-Mann-Schuyler philosophy,
which states that the lingual surfaces of the maxil-
lary anterior teeth are independent o f condylar
border movements and are dictated by the need for a
long centric. 3 After I0 years of clinical observations of
functional relationships that exist between the ante-
rior and posterior teeth, it seems to this author that
the anterior occlusion is affected by both the
condylar border movements and the positional rela-
tionships of maxillary and mandibular anterior
teeth.
DETERMINANTS OF ANTERIOR G U I D A N C E
The four determinants of anterior guidance are (1)
esthetics, (9) phonetics, (3) condylar border move-
ments, and (4) positional relationships of the maxil-
lary and mandibular anterior teeth.
Esthetics and phonetics. Esthetics and phonetics
are best determined by the methods suggested by
Pound. 4
C o n d y l a r border movements. If there were no
teeth in the mouth the muscles, ligaments, and
functional form of the temporomandibular joints
would determine the movement pattern of the
mandible. The articulating (occluding) surfaces of
the teeth musl be in harmony with these movements
396 APRIL 1978 VOLUME 39 NUMBER 4
DAVID E. BEAUDREAU
SAMUEL E. GUYER
WILLIAM LEFKOWITZ
or the masticatory system will ultimately destroy
itself. Each individual exhibits unique condylar
border movements, and these occur within Posseh's
envelope of motion? The condylar border move-
ments are controlled by the anterior teeth and the
neuromuscular system. Masticatory function varies
infinitely within the envelope of motion, but always
uses some of the border movement pathways.
Function is dynamic. During function the
condyles move from left to right (or vice versa) along
various lengths of the border pathways as the teeth
pass through centric occlusion and on t o the other
side. The amount of lateral border pathways that are
used during function depends on the type of food
being chewed. Granger* demonstrated that more
border pathways were used in chewing meat than in
chewing cheese (Fig. 1). The border movements are
braced movements in which the condyles function
against their disc assemblies and eminentia, permit-
ting more power to be used. More power is needed tO
chew meat; therefore more of the border pathways
are used. If there are interferences of the teeth which
prevent the condyles from reaching the border path-
ways, muscle dysfunction will occur2" T Anterior
teeth also can cause such interferences.
FUNCTIONS OF ANTERIOR TEETH
9The four functions of the anterior teeth are (1) to
incise food, (2) to aid speech, (3) to aid in esthetics,
and (4) to protect the posterior teeth. ~
Protection of the posterior teeth involves a change
of movement of the condyles, from much translation
with little rotation to movement with less transla-
tion. This redirects a horizontal force of closure,
transforming it into one that is more vertical. This
redirection involves thh neuromuscular system.
Without the anterior tceth the mandible could
*Personal communication, Dr. Ernest Granger, J u l y 1968.
0022-3913/78/0139-0396S00.50/0 9 1978 The C. V. Mosby Co.