c 1st lec

Æ

 
c

•cclusion: its better defined as concept of complete

dentistry.

It͛s concerned with Ú
Ú
Ú

that are capable
of Ú


 
to the
deterioration of oral health or function.

Æt covers more than 50% of dentistry.

Dental problems are either bacterial 40% or occlusal

60%.

Æt¶s a biological process not a mechanical one.

So our ultimate goal is to achieve a maintainable health of the whole masticatory system.

c ¦imitations of achieving this goal:

1.c 3uring diagnosis we don͛t see occlusal surface or lingual surface where most of the problems lie.
2.c There is no ideal occlusion.
3.c It͛s rather a range so there is no need to seek ideal occlusion as long as the entire stomato-gnathic
system is in harmony.

•cclusion: In dictionary is defined as the act of closure.

3ental •cclusion: its contact relationship between teeth, it comprises multifactorial functional
relations between teeth and other components of masticatory system.
c The masticatory system (stomatognathic
system):
1.c Teeth
2.c TMJ: meniscus, articular eminence, synovial
cavities, mandibular fossa, condyles
3.c Investing structures
4.c ¦igaments: stylomandibular, sphenomandibular
5.c Muscles: elevators (medialptergoid, masseter,
temporalis), depressors ( lateral ptergoid , ant belly
of digastrics mylohyoid)

c §oncepts:
c Úll parts of the masticatory system act in harmony which means,
If one part is affected the entire system is affected:
c Ú carious Tooth or premature contact affects the whole
masticatory system.
c ?ruxism causes excess wear of teeth.
c Mobility due to alveolar bone resorption decreases functional
performance of mastication

Those three steps can be combined in one sequence that a carious tooth
was restored improperly which lead to the presence of a premature
contact the patein in sake of decreasing the discomfort .this develops bruxism in an attempt to grind
the restorations. ?ut the problem is that the bruxer uses teeth contact 60 times the normal this may
lead to loss of the tooth support and mobility due to resorption of alveolar bone leading to a decrease
in the mastication efficiency
 The total time of tooth contact in bruxers and clenchers (parafunctional habits) is 4 hours, while the
total time during the normal functions is 4 min which is 60 times more than normal people.

c So the main problem that lead to the loss of the tooth supporting structure was not purely the
bruxism but was the high restoration which lead to bruxism and correcting the effect without
correcting the cause would lead to incomplete resolution of the problem.
c It is important to understand that dental problems are progressive and deterioration of the whole
system will eventually occur if the problems are left untreated in a reasonable time frame . So no
problem will resolute by itself but it must be treated or it will progress to worse.

c §arful diagnosis by complete examination will lead to

identifying the causes and effects of any disharmony and to
establish definitive goals and assess the prognosis of any
required interference by treatment since the ultimate objective
is optimum oral health of the patient.
c The figure shows an abfracted tooth. just filling the cavity
without correcting the problem will not treat the problem.
 c •ur goals are:
1.c •ptimum oral health: this is achieved during first and second phase of treatment plan
2.c Únatomic form: gives static harmony.
3.c Functional harmony: during function
4.c •cclusal stability.

Æ


 

½


  



c ?asic principles for applying the concept of complete dentistry:

1.c It is a concept for both 3iagnosis and management of occlusal problems
2.c Understanding the reasons for form and its relation to functions of teeth provide a link of cause-
effect relationship
3.c Health of dentition depends on both form and function if disturbed diseases will occur.
4.c Interference for correction of dentition should be limited to conditions where there is no harmony
of form & function and should be directed towards why? Rather than how do we correct.
5.c Treatment of effect without eliminating the cause is rarely successful.

c §ases

c §omplete denture patients: there is a changed occlusal habit so there are malformations and muscles
changes.

c In traumatic occlusion there are wear facets.

c §arious tooth will affect other parts

c If a tooth is mobile this will lead to over use of the other

side which will lead to devolpment of muscles on the
 other side. This can be corrected by physical therapy e.g. chewing gum.

c Úbfraction of teeth all over mouth

c Úbfraction of lower anterior teeth from lingual surface

c §ause-Effect relation: when we see a clinical sign we must know the cause and we must treat cause
not the symptoms to achieve optimal oral-health.
Àc Únterior open bite caused by tounge thrust
treat openbite (effect) without stopping habbit
(cause) is rarely successful.
Àc ÿroup guided occlusion: more distribution of
forces
Àc §anine guided occlusion more load on a single

Úpplication of basic goals of complete dentistry in diagnosis and treatment of occlusal problems (4 goals):

•ptimum oral health:

Àc Úim: to obtain highest functional performance of dentition
Àc How: deterioration of oral health requires thorough diagnosis and treatment planning to achieve,
2 major objectives:
1.c Finding cause of deterioration
2.c 3etermining the best (suitable) method to eliminate each cause of deterioration.
Àc -. ?: 3egree of success of treatment depends on the degree of elimination of cause of deterioration
Àc -.?: Keep in mind that total elimination is not always possible.
 c §onsiderations:

Àc §auses of deterioration usually come in multiple

Àc The same causative insult can produce variety of responses in different individuals due to differences
in:
1.c 3ifference in host resistance
2.c 3ifference in intensity of insult
3.c 3ifferent duration of insult
Àc Similar symptoms may result from completely different causes. Symptomatic relief without
identifying the cause is considered an insufficient poor type therapy.
Àc §onfusion about the cause effect relationship is mostly due to failure to distinguish between thec


cc

c
c c 
c

.

§ontributing factors:
Àc This factor 3oes not by itself cause disease but it :
1.c ¦owers resistance of the host to a causative factor or
 2.c Increases intensity of function or stress.
Àc So our Treatment plan should be directed primarily to:
1.c Remove the direct causative factor
2.c Increasing host resistance and
3.c 3ecreasing intensity of stress should be the adjunctive therapy.

Examples of high restoration with inclines interferences in lower molar(this insult may cause different
responses depending on):

1.c intensity
2.c 3uration of insult
3.c Host resistance
4.c 3egree stress during sleep
5.c presence of periodontal problems
6.c Presence of Úrticular or muscular problems.

cëhere are at least 15 different ways that patients might respond

to this specific insult:
1.c ëhe tooth may become


to hot or cold or it may ache.
2.c ëhe tooth may become 
to touch.
3.c ëhe tooth may become 

4.c ëhe tooth may become d 
5.c ëhe mandible may deviate around the interference causing 



 
d 
d
6.c ëhe deviated jaw function may cause other teeth to be 

7.c ëhe deviated jaw function may cause the masticatory muscles to become
 Ú
or become
Ú

8.c ë 


may result from the muscle spasticity.
9.c Muscle 

Ú
ÚÚ

may develop.
10.c ëhe combination of sore teeth, sore muscles and headaches may cause


Ú

 


11.c ëension and stress may lead to  


c ëhe combination of deviated mandible and spastic musculature may cause
a  


 Ú 

c ëhe combination of the disk derangement and elevator muscle spasm may
initiate   Ú
Ú  
Ú 


 Ú Ú


14.c Ú
of the above.
15.c -
of the above.

c Úll the signs and symptoms listed above are a direct result of the same causative factor the occlusal
interference from the high crown
c -one of the contributing factors that altered the response actually caused the problems.
c Æf the causative insult had been corrected before irreversible damage, all symptoms would have
disappeared without any changes having to be made in host resistance
c ºost resistance is not the only variable. Variations in intensity of function can alter response to the
same potentially damaging causative factor
c ëhe same type of occlusal interference mentioned above may go completely un-noticed by the very
 Ú
patient who has no tendency to clench or brux
c ëhe 
 Ú
or the person who sleeps with the mouth open will have fewer if any symptoms
because no stress results in the absence of tooth contact
c ëhe same patient under stress may begin to clench or brux, activating the trigger that programs the
muscles into an ÚÚ
pattern, further complicating the symptoms in the teeth, the muscles, and
possibly the joints.