1. Chapter 9: Functional Occlusion and Malocclusion

2. I. Ideal Occlusion Versus Malocclusion
Ideal Class I Occlusion
Dental Malocclusions of Teeth (Including Class I)
Class II Malocclusion
Class III Malocclusion

3. A. Ideal Class I Occlusion (Normal or Neutroclusion)

4. Normal Overjet (Horizontal Overlap)

5. Normal Overbite (Vertical Overlap)

6. Ideally, Buccal Cusps of Maxillary Teeth are Positioned More Buccal than Buccal Cusps of Mandibular Teeth

7. Ideally, Maxillary Teeth are Positioned Slightly Distal to their Corresponding Mandibular Teeth

8. B. Dental Malocclusions of Teeth: Crowding Where Tooth #24 is in Labioversion; #7 and 10 are in Linguoversion

9. Dental Malocclusion: Tooth #8 is Rotated, in Torsiversion

10. Dental Malocclusion: Tooth #1 is Supraerupted or Extruded, in Supraversion; Also, Facets on Mandibular Cusps Indicate Heavy Occlusion

11. Dental Malocclusion: Posterior Teeth are in Crossbite because the Buccal Surfaces of Mandibular Teeth are Positioned more Buccal than Maxillary Buccal Surfaces

12. Dental Malocclusion: Posterior Teeth are Almost in a Type of Crossbite where Lingual Cusps of Maxillary Posterior Teeth Do Not Fit in the Opposing Fossa but are Buccal to (here are even with) the Mandibular Buccal Cusps

13. Anterior Dental Malocclusion: Anterior Teeth are in Crossbite Since the Mandibular Incisors are Labial to the Maxillary Incisors

14. Anterior Dental Malocclusion: Anterior Teeth are in a Deep Overbite Relationship Since the Maxillary Incisors Completely Overlap (Vertically) the Mandibular Incisors

15. Anterior Dental Malocclusion: Anterior Teeth are in an Edge-to-Edge Relationship Since the Incisal Edges of Both Arches Line Up

16. Anterior Dental Malocclusion: Anterior Teeth are in an Open-bite Relationship Since the Incisal Edges of Both Arches Do Not Touch or Overlap Vertically when All Posterior Teeth are in Contact

17. Anterior Dental Malocclusion: Anterior Teeth are in an Over-jet Relationship Since the Maxillary Incisors are Considerably Anterior to (Horizontal Overlap), and Not Occluding with, the Mandibular Incisors

18. C. Class II Malocclusion (Distal Occlusion)

19. Class II Malocclusion with Anterior Overjet

20. Class II Malocclusion, Division II, Often Exhibits Deep Overbite with Maxillary Central Incisors Tipped Lingually but Laterals Tipped Labially

21. Class II Malocclusion, Division I, May Exhibit Considerable Overjet (Often with All Maxillary Incisors Tipped Labially)

22. D. Class III Malocclusion

23. Class III Malocclusion: The Anterior Relationship is Often Edge to Edge or in Crossbite

24. Class III Malocclusion Profile

25. II. Normal Movements Within the Temporomandibular Joint (TMJ)
Anatomy of the Temporomandibular Joint (TMJ)
Movements within the Lower Joint Space (Hinge, Rotary Movement with Minimal Opening)
Movements within the Upper Joint Space (Sliding, Translating, Bodily Movement when Open Wide)
Total Joint Movement (Ginglymoarthrodial = Rotates and Translates)
Dislocation of the Mandible

26. A. The TMJ: Articular Eminence and Fossa of Temporal Bone, and Mandibular Condyle

27. The TMJ: Inferior view of the Articular Eminence and Fossa of the Temporal Bone, and the Mandibular Condyle

28. The TMJ: Cross Section of the Articular Eminence and Fossa, and Mandibular Condyle with Stress Bearing, Fibrous Areas in Red

29. The TMJ: Articular Eminence and Fossa, Upper (Synovial) Joint Space, Disc, Lower (Synovial) Joint Space, and Mandibular Condyle

30. The TMJ: The Limiting, Surrounding Fibrous Capsule

31. B. Movements within the Lower Joint Space: Is Hinge Type or Rotational Occurring with Minimal Mouth Opening

32. C. Movements within the Upper Joint Space: Is Translational where the Mandible Moves (Translates) Bodily Forward when Opening the Mouth Wide

33. E. Dislocation of the Mandible

34. III. Terms Used to Describe Jaw Relationships between the Mandible to the Maxillae
A. Maximal Intercuspal Position
B. Centric Relation
C. Physiologic Rest Position
D. Jaw Relations During Horizontal Movements of the Mandible

35. A. Maximum Intercuspal Position (MIP) of Handheld Casts
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36. B. Centric Relation: The Anterior-superior Surface of Mandibular Condyle Articulates Against the Posterior Part of Articular Eminence
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37. Centric Relation Does Not Always Coincide with Maximum Intercuspal Position (MIP)
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38. Centric Jaw Relation Does Not Always Coincide with MIP
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39. Deflective (Premature) Occlusal Contact of Tooth #1 Shifts Mandible Forward When Moving from Centric Jaw Relation into MIP

40. Casts Mounted on an Articulator to Reproduce the Relative Position and Movement of the Mandible Relative to the TMJ Anatomy

41. C. Physiologic Rest Position
Vertical dimension of rest (physiologic rest position)
Interocclusal rest space or freeway space

42. Effect of Posture on Physiologic Rest Position (Differs Leaning Back Versus Sitting Up)

43. D. Jaw Relationships During Horizontal Movements of the Mandible
Protrusive Jaw Relation and Occlusion
Lateral Mandibular Relation and Occlusion

44. 1. Protrusive Jaw Relation and Occlusion: Anterior Horizontal and Vertical Overlap Provide Incisal Guidance of Mandible (Anterior Protected Occlusion) Separating Posterior Teeth
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45. Protrusive Jaw Relation and Occlusion: Maximum Protrusion of the Mandible Usually Results in Anterior Crossbite
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46. 2. Lateral Mandibular Relationship and Occlusion: Canine Overlap Results in Mandible Moving Inferiorly Toward the Working Side (Laterotrusion), thus Separating Posterior Teeth (Disocclusion)

47. IV. Functional Movements: Chewing and Swallowing
Incising
Masticating (Chewing)
Swallowing (Deglutition)

48. V. Parafunctional Movements and Heavy Tooth Contacts: Signs and Symptoms
Examples of parafunctional (nonfunctional) contacts
Clenching
Bruxing
Biting on pipe stem, pencil, fingernails
Cheek biting

49. Possible Symptoms Related to Parafunctional Contacts
Ringing in ears (tinnitus)
Sinus pain
Dizziness
Head, neck, and/or back aches
TMJ pain (also from arthritis, injury)
Tired muscles of mastication
Sore tooth (sensitive to percussion)

50. Possible Signs Related to Parafunctional Contacts [cont.]
Tooth mobility (fremitus)
Tooth wear (flat, shiny facets)
Widened periodontal ligament
Angular bone loss
Thickened lamina dura
Root resorption

51. VI. Treatment Methods Related to Malocclusion
Teach avoidance: avoid clenching
Patient education
Biofeedback
Jaw muscle exercises
Nutritional counseling
Tranquilizers and muscle relaxants
Psychological counseling
Occlusal bite guard or adjustment

52. Occlusal Devise (Also Called Bite Plane, Night Guard)
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53. Full Mouth Rehabilitation (an Older Example of Changing All Occlusal Surfaces with Restorations)
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54. Full Mouth Rehabilitation (a more Contemporary Example of Changing all Occlusal Surfaces with Restorations)
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55. Surgery to Realign Jaws (in this Case, Shortening the Mandible to Change Class III Relationship to Class I)

56. VII. Advanced Topics in Occlusion
Envelope of Motion
Anterior Deprogramming and Accurate Recording of the Centric Relation Jaw Position
Long Centric Articulation

57. Frontal Envelopes of Motion Showing Maximum Movement of the Mandible: Note Movement from MIP where the Mandible Moves Down and Laterally Indicating Canine Overlap
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58. Total Maximum Movement of Mandible Seen on Sagittal Envelope of Motion: Retruded Opening from MIP at First is Hinge; Opening More Widely is then Translational
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59. Anterior Deprogramming
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60. Anterior Deprogramming: Sliding Guiding Inclined Gauges
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61. After Anterior Deprogramming: Registration in Centric Jaw Relation
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62. Learning Exercise: Maximum Protrusion = H + P
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63. Learning Exercise [cont
Learning Exercise [cont.]: Total Lateral Movement (Side to Side) = Maximum Left Lateral Movement + Maximum Right Lateral Movement
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64. Learning Exercise [cont.]: Maximum Opening = V + All of O
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65. Learning Exercise: Sketch All Teeth in Ideal Class I Occlusion
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66. Learning Exercise: Sketch All Teeth in Ideal Class I Occlusion [cont.]
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