FACTORS 01; OCCI>USION API’I~ICAI3I.

l~ TO K ESTORATIVE
1)17X-I’ISTRY

S UNDERS’I‘;\Nl )IS(; of the factors controlling the pattern or contours of

A occluding tooth surfaces is desirable in planning for the maintenance of oral
health and function. This is equally important \vhether we are maintaining the
natural dentition or are supplying a prosthesis for the partially or fully edentulous
1110uth.
\\%ile the muscles of nlasticatioll supply the motive power to the mandible, its
direction of movement while the teeth rlf the natural dentition are in contact is
controlled by the contacting tooth surfaces and guiding factors within the tempo-
romandibular joints, and not by the muscles. The movable bases of full dentures
reduce the factor of tooth control. The three main factors of control are: the inci-
sal guidance, the anterior articulating incline of the glenoid fossae, and the lateral
incline of the glenoid fossae or Jhnrtt movemrnt.

‘l’llc incisal gui(ianw jrlstitirs wir tirst cc.)nsi(lrr;ltion as having the most pro-
found influence “pan the i~uictioiial c~clri~ic~ii of posterior twth, or upon the pattern
or contour given to lwsterior occlutling tooth surfaces in the planning of an oral re-
habilitation. The inckil g~~itiniice in the normal occlusion is the lingual contours of
the upper ankrior twth. I{! its prosimity to thr posterior teeth, it has a predom-
inating influence ulmi posterior tooth function. It predominates also hecausc it is
definite and iinvieltling iii nature. in contrast to n dcgrw of fkxibilitv in the move-
mcnts of the rondvics ill the ~glcilc~itlfosix..
Tn the natural cientition. ;m t~sc~s.si~~t~I~-i;terl) in&al guidance may preclude
norninl ccwiltric iutlctioli on the post~~rior twtll. It may have a definite influence
upon the iiio~cnicnt of the condyles ii1 the ~lenoid fossnr. In iact it may have a
definite influcncc upm~ the contours of the ,ylwoiti fossar lvhich mav change per-
wptibiv over a lwricxt of time, as tiic inciwl guidanw is modified.
.\ most fa\-orable tlistribrltinn of >trrss of the natural dcntition is OIIC in which
Imtii antrrior :uiti lwstcrinr teeth mnlw :tid iilaintaiil ;~II ccIu:tlized frmctinnal contact
in both centric anti eccentric niasill(,-ni:~ntiil~~~i:~rrelations. This requires a contact
oi the nrrtc*r.iov/rcTfll in the cr.lrtr-ic-rc,lnfio~r.and a fa\or;tlk incisal guidance to permit
or maintain the inow invnralk distribution of stress in the wcentric pnsitinns.
;;‘;re;; FACTORS OF OCCLUSION APPLICABLE TO RESTORATIVE DENTISTRY 773

This favorable incisal guidance should be the primary objective of the orthodontist,
the periodontist, and those practicing restorative dentistry.
An excessively steep incisal guidance either precludes normal functional con-
tact of posterior teeth, or requires excessively steep posterior tooth inclines which
rnay place an undesirable lateral stress upon their alveolar support, oftentimes in
excess of physiologic tolerance.
A large percentage of the students of occlusion agree that a steep incisal
guidance is contraindicated in the natural dentition, and endeavor to avoid the use
of steep incisal guidance in all forms of oral rehabilitation. Another school of
thought, with a more limited following expresses little fear of the steep incisal guid-
ance and the steep posterior tooth inclines associated with it. We have been told
by them that any material change of the incisal guidance and the posterior tooth in-
clines, which would necessarily be involved, introduces abnormal function or move-
ments of the condyles in the glenoid fossae, and is therefore contraindicated. While
a steep incisal guidance may necessitate a restricted movement, or cause a pathologic
movement of the condyles in the fossae (which may be materially improved by a
reduced steepness of the incisal guidance), I can see no logic in the claim that the
function of the joint may be impaired by a reduction of the steepness of the incisal
guidance.
The esthetics factor may limit the reduction or the desired change in steepness
of the incisal guidance. In the rehabilitation of a patient’s occlusion, the reduction
of the incisal guidance from an undesirable 60 degrees or more, to 30 or even 20 de-
grees is not often impossible to accomplish. This may be made possible by a slight
opening of the maxillo-mandibular relationship where indicated, or by a reduction
in length of the lower anterior teeth, and in some instances where esthetics permit,
a reduction of the length of the upper incisors.
Centric maxillo-mandibular relationship, the degree of vertical opening, and
the desired or favorable changes of the anterior teeth to comply with the esthetic
demands should be our first step in oral rehabilitation. Automatically, this enables
us to establish the desired incisal guidance for the patient (Fig. 1). The incisal
guidance then controls the necessary steepness of all posterior tooth inclines. Many
men have advocated the rebuilding of all posterior teeth as the first step in oral re-
habilitation. May I ask what factors have influenced their selection of the posterior
cusp steepness? If posterior cusp inclines then influenced incisal guidance, what
influence might an undesirable incisal guidance have upon anterior tooth function
and esthetics ?
The contour of incisal guidance will be also the primary factor controlling
the contour of occluding posterior tooth surfaces. We have been told that
occluding contours of posterior teeth must be convex, that such surfaces are
most efficient, and that they materially reduce occlusal trauma. This I do not
believe. The convex cusp forms present as definite. a locked occlus~l relationship
as do nonconvex forms, and in most instances, a reduction of the convexity
reduces the steepness nearest the static centric position, and thus reduces the
severity of the lock. A degree of convexity of posterior cusp forms will require a
convex incisal guidance. The lingual surfaces of the upper anterior teeth are nor-
774 SCHUY LER J. Pros. Den.
November, 1953

Fig. l.-In complete oral rehabilitation, the planning and establishing of a desirable incised
guidance should be the first step in the procedure. After the in&al guidance has been estab-
lished, the formation of posterior tooth contours to function in harmony with the incisal guid-
ance is a simple procedure. Esthetics will control the length and position of the upper an-
terior teeth. In&al guidance may be changed from C to D by increasing the vertical relation,
by reducing the length of the lower anterior teeth, and in some instances by reducing the length
of upper teeth when esthetics permit.
The incisal guidance is the most important control or posterior occlusal contours. For
the maximum distribution of stress and functional efllcicncy, anterior teeth should be in func-
tional contact in both centric and eccentric positions. If porcelain jacket crowna are not neces-
sary to restore esthetics of the upper anterior teeth, the lingual surfaces of the upper anterior
teeth may be rebuilt by the use of pinledge castings to rest,ore the desired contact in centric
occlusion and to establish the desired incisal guidance.
Line A represents the Bennett movement; I? the anterior incline of the glenoid fossa. They
influence the posterior occlusal contours.
If convex posterior occlusal contours are desired, the incisal guidance must be convex. A
straight plane in&al guidance will produce straight plane occlusal contours of the posterfor
teeth. A convex incisal guidance will produce convex occlusal contours of posterior teeth.
After the incisal guidance has been established, posterior teeth are prepared. The illustration
shows crown preparations. Cutting edge F is established on the lower buccal cusps at the height
and position desired for the central fossae of the upper teeth. A small round wire or any
type of anteroposterior cutting edge may be waxed into position. Soft wax is placed on the
occlusal surface of the upper tooth. A right lateral movement with the anterior teeth following
the in&al guidance D will shear incline G on the upper teeth. A left lateral movement follow-
ing the in&al guidance E’ will shear incline 1 on the upper teeth. The buccal and the lingual
contours of the upper teeth are completed as desired. Wax is then placed upon the occlu~al
surfaces of the lower teeth, the occlusion Is closed, and right and left lateral movements will
complete the lateral occlusal contour of the lower teeth. Supplementary fissures may be added
as desired to increase the cutting and functional efficiency.
J represents the in&al guidance of an articulating instrument, the inclines of which may
be set to correspond to the established incisal guidance. A slight freedom of lateral movement
in the centric position can be established by the use of a horizontal section in the incisa1 guidance
plate at point K.
Volume
Number6 3 FACTORS OF OCCLUSION APPLICABLE TO RESTORATIVE DENTISTRY 775

mally concave, not convex. The first degree of wear of the natural dentition elimi-
nates convexities of occluding posterior tooth surfaces, and straight or concave
surfaces are soon developed.

Fig. 2.-Steep anterior tooth guidances as found in patients with a deep vertical overlap
may have an undesirable influence upon the nature and direction of the Bennett movement.
A shows a premature contact of the cuspid teeth in the lateral functional eccentric position.
With this cuspid contact as a fulcrum, the muscles of mastication would have a tendency to draw
the condyle upward in the glenoid fossa until contact is made in the molar region,
B, In the same lateral eccentric functional position, a premature contact of anterior teeth
will act as a fulcrum on the incline plane of these teeth. The muscles of mastication may cause
the mandible to be forced to the distal until posterior tooth contact is obtained, thus an occlusal
anamolie may cause a distal and upward Bennett movement that is undesirable or pathologic
in nature which would change perceptibly with a favorable reduction of the anterior tooth
guidances.

THE BENNETT MOVEMENT

Next let us consider the Bennett movement and its influence upon posterior
tooth contour. First, I wish to state that an undesirably steep incisal guidance,
i.e., a locked relationship of the anterior teeth restricting lateral functional con-
tact of posterior teeth, may influence or induce a distal and vertical Bennett move-
ment (Fig. 2). This direction of movement may be undesirable or pathologic, and
776

it ma!. be modified materially I)y normal tissues changes follo\+?ng the elimination of
the undesirable anterior guidance and the establishing of ;L favorable posterior
tooth contact in function. .A contlylr \vhich has been forced to move to the distal
and upward, as the posterior teeth are brought into functional contact, may
function in a more lateral horizontal movement as the in&al guidance is modified.
In my experience, I have never known an arbitrary horizontal Bennett movement
as is common to lllost of our semiadjustable articulating instruments to have
caused a functional disturbance in the teml~ort,tnandil,ular joint.
‘The range of the htCrd iiiwY!iilelit (Jf the tnandibk while the teeth are in

functional contact is seldom in excess of four millimeters in the incisal region,

two to three millimeters in the molar region, and l~robably never in excess of two
millimeters and Inost often less than one millimeter in the region of the condyle.
The Bennett movement might. of course’. bc in cxccss of this when the teeth are
not in hilCti(Jnal contact, hut we ne~tl 1~ concerned only with the movement
while the teeth arc in functional contact. \\‘e are dealing with structures that
possess a degree of resiliency or fcsihility. j ankelson’ has shown by cinbradiog-
raphy that the patter11 of movement is indefinite. The pattern of movement
when recorded with a central bearing point might vary much from that when
food is interposed between the teeth. Kurth’. in speaking of the Bennett move-
ment in relation to the masticatory stroke, in his analysis of three dimensional
tracings, said, “The movements oi the condyl~s wcrc so slight th;tt a comparison
in this region would only confuse the tracing.”
1 do not wish to discredit or discourage the applicati,>n of the most accurate
procedures in the practice of clentistqp. I do think that theory must be halanced
by Jjractical application. We nitlst recognize the 1)ossibility of error in recording
direction, when the nlovemcnt is so limitctl and when it involves nonrigid
structures. Ii accurate records are obtained, are these limited movements in the
eCCetltriC r&tio~lS readily tr:mSfcrd t!s ;\I1 :lrtiC&tillg i~lStr~mlellt without PoSSi-

bility oi error? J’veryonc familiar with the use of adjustable or semiadjustable

articulating instruments recognizes the fact that movements of one or two milli-
meters are recorded \vith a great deal of uncertainty. Any inaccuracy in the
recording of centric nlaxillo-mandibltlar relation precludes accuracy in recording
or transferring all eccentric positions. 1Ve have been let1 to believe that if an
axis face-J)ow has lmn used in positioning the casts in the instrument, centric
relation records can he obtained several millimeters open from the desired occlusal
position. If, in making the centric relation Wcording, thr rondylc has been for-
ward from its normal rest position, the J<ennctt movement would in all probability
he recorded as a back~vartl, or a backward and upward movement. because the con-
dyle would drop hack to its normal fmictional position in the lateral excursion.
Should we erroneously record a posterior liennett movement, the lateral inter-
cuspation would he less readily tolerated than would the lateral intercuspation re-
sulting from the failure to record sucl~ a nlovcment where it might exist.
The incisal guidance and Bennett movement are the controlling factors to
posterior tooth functional contours or inclines on the working side. ‘The incisal
guidance for reasons previously mentioned, is the predominating factor. The an-
p&rr; FACTORS OF OCCLUSION APPLICABLE TO RESTORATIVE DENTISTRY 777

terior incline of the glenoid fossa has but little if any influence upon contacting
tooth contours or inclines on the working side in the act of mastication.

BALANCING SIDE CONTROLS

The contour of balancing inclines on the nonfunctioning side are controlled

primarily by the incisal guidance and the anterior incline of the glenoid fossa.
The incisal guidance again predominates because of its proximity to these teeth.
The anterior movement of the condyle, due to the range of its movement, can and
should be recorded as a means of obtaining balancing contacts when desired, and
as a means of avoiding excessive balancing contacts at all times.
A balancing contact of the posterior teeth in both the protrusive position and
on the balancing side are essential to the success of a full prosthesis. In some
partial restorations they are very desirable. In the natural dentition I fail to see
the real value of contacts on the nonfunctioning side, as they do not reduce the
application of stress being applied to the teeth on the working side, and their
contact may be a contributing factor to traumatic injury.
Excessive or premature contact of balancing cusp inclines must be avoided.
They are most injurious and destructive in all phases of dentistry. In the full
denture, it contributes to tissue irritation and tissue changes. In the partial
denture, it is not only a contributing factor to tissue irritation and ridge resorption,
but it is a most destructive factor contributing to the premature loss of abutment
supports. In the natural dentition, it is a most destructive factor contributing
to the loss of alveolar support of the teeth involved. It is also one of the most
common contributing factors to temporomandibular joint pathology, lack of
smoothness in functioning, and clicking of the joint, subluxation, etc. The prema-
ture contact is a fulcrum causing abnormal movements of the condyle. When
balancing contacts are found to exist in the natural dentition, they must be scru-
tinized carefully to avoid the possibility of trauma to the teeth involved, or injury
to the temporomandibular articulation. The general practitioner, the orthodontist,
the periodontist, and the prosthodontist should be alert constantly to the potential
dangers associated with premature balancing contacts. At times, it is extremely
difficult to differentiate nondestructive contacts from the destructive contacts. In
treating the natural dentition, the potenial destructive possibilities of excessive
balancing contacts would seem to be more serious than no contacts on the balanc-
ing side, or no contacts of the posterior teeth in protrusion.

THE FACE-BOW

When casts are being mounted in an articulating instrument for oral recon-
struction or diagnostic purposes, they should be mounted upon an axis articulator
with a face-bow, and every effort to reproduce the axis most accurately is com-
mendable’. Bruce Clark is showing a sample procedure for locating the approximate
axis. The ideal is seldom if ever obtained, and the meticulous use of an axis
face-bow should lead no one to believe that there is a degree of safety in obtaining
centric relation records with the jaws separated beyond the normal rest position
 J, Pros. Den.
778 SCHUYLER November, 1953

(Figs. 3 to 8). The least amount of closure of the mounted casts, from the position
at which the centric relation record was obtained to the position of occlusal contact,
minimizes possibilities of error. In endeavoring to locate the axis, no two operators
will select exactly the same point. Probably no operator could relocate the same
axis point without the aid of a tatoo mark ; therefore we should use the term ap-
proximate axis, not exact axis.

Fig 3. Fig. 4.

Fig. 5. Fig. 6.

Fig. 3.-Whether we use an axis face-bow as advocated by McCollum, or the Snow face-bow
positioned by arbitrary measurements, centric maxillomandibular relation records should be
obtained at as near the desired occlusal position as possible without cusp contact or interference,
thus requiring the minimum closure of mounted casts about the axis of the articulating instru-
ment.
A, in circle, represents the exact axis. B and C points above and below the axis. The dis-
tance between I and II represents the amount of closure in the instrument from the vertical
position at which the centric relation record was obtained to occhrsal contact. Arcs A, B, and
C are arcs drawn from points A, B. and C. It will be noted that there would be only slight
separation of the arcs or paths of closure in closing one or two millimeters even though the
Pace-bow has been positioned above or below the exact axis.
Fig. 4.Shows the negligible discrepancy in the arc of closure if the face-bow has been
positioned in front or back of the axis.
Fig. Z-Shows the great discrepancy in the arc of the closure if the centric relation record
has been obtained several millimeters open from the normal occlusal contact position and the
exact axis not obtained.
Fig. &--Shows that even though the exact axis is missed only two or three millimeters, the
closing of the relation several millimeters would cause more disharmony in centric intercuspa-
tion than would be produced if the axis was less accurately obtained and the closure limited as
in Fig. 3.
2/;:;“6 FACTORS OF OCCLUSION APPLICABLE TO RESTORATIVE DENTISTRY 779

At no time, regardless of the type of face-bow used, is it safe to make centric

relation records at an opening greater than the rest position of the mandible.
A patient may be trained to open on an axis for several millimeters. However,
this may be a strained unnatural opening, and we have no way of determining
when one or both of the condyles may move from their normal rest position in
the glenoid fossae. Some authorities on the temporomandibular articulation tell
us that there is normally a posterior movement of the condyles in the glenoid fossae
even during a closure from the rest position to the normal occlusal contact. The

Fig. 7.-Shows a disharmony of posterior tooth intercuspation that would result if the face-
bow was positioned below the exact axis as point C in Fig. 5. A slightly forward movement
of the mandible as tooth contact is made would partially compensate for this error. This
slightly forward movement of the mandible when tooth contact is made, though undesirable, is
common in a large percentage of natural dentitions.
Intercuspation in the lateral movement of the mandible is also important. Similar eccentric
conditions might be caused by a failure to record a posterior Bennett movement, or by the
use of an articulating instrument with lateral axis posts too far apart. A slight degree of
protrusion associated with the lateral movement would compensate for the disharmony.

Fig. S.-Shows a disharmony of posterior tooth intercuspation that would result If the
face-bow was positioned at point. B in Fig. 5. This contact of tooth inclines would have a
tendency to force the mandible into an undesirable retrusive position. A similar disharmony
in eccentric cuspation would result if an articulating instrument with axis posts too close to-
gether were used, or if the instrument were set to record an erronerous posterior Bennett move-
ment. These errors cannot be compensated for by the patient. A similar condition may occur
due to resorption of the ridges supporting full dentures. A desirable degree of freedom in
both centric and eccentric positions can be obtained by advancing the mandible a half milli-
meter after occlusion has first been corrected in the normal centric and eccentric positions,
and then again correcting to this advanced position.
face-low mounting of casts is essential as an aid in securing I>roper lateral inter-
cuspation in function ( Fig. 9). l‘hc lateral axis of rotation is also a factor in
Ataining proper inlcrcuspation ill lateral ccwntric niovwietitk T\S a safety meas-
ure. instruments slic~uld he set \vitli a slightI!. excessive lateral movement to give
a greater degree of freedom of intercuspation in lateral movements.
We have been told that the face-how as advocated IJy Snow is valueless.
Careful use of it would seem to accomplish at least 90 per cent of the require-
1ne11ts. An &ort tn rqxoduce most ncrlirately the axis is commendal~lr.

l;ig. :+.-If :i fwe-lxc,xv is not tw~d in I)wili0nin~ thr r3st II) an axis articulating instrument,
the (USIS III;~.V lw rotatcrl lawrally in the instrument. this woulrl materially lntluence the coor-
dination of intwwspat ion in ~~wcnt riv fun~~tional movements. Each cusp transcribes a Gothic
;lrrh upon the opposing toolh In function. ami may make functional contact anywhere within
the horders of the arvh. The arches trans(~rihetl by the cusps in the instrument shoulcl corre-
spond to those tr;~nwribetl in the mouth. ‘The lateral rotational axis is an important factor in
thcsr wwntrir movements. An equilibration of thv stccpncss and the smoothness of all eccentric,
grinding inclines is impcr;ltivc, in thr discrilncf 1011 of wcwltriv str’rw3. (Courtesy of the New
York Statt Dental .lournnl I.

111 s~uiiniingup 211 of tlww fxt0r.i. it 1~0ultl scciii that in oral reliahilitation
,,i tilt: clciilitic>li, occlusicul5. 1~~11~cc.lltric n11tl c~ccc7ltl.k. Illt1sl l)c c;trcfull\
ll:l1llt-ill
c.l1c7$ctl, :LII~ iikillor fli~~~rt~l~;tIlcit~s u~rw~~1~~~1 11)’ 5l)ot griii(ling ii1 the 111ott111. regartl-
less of tllc. articrilating instrwwnt ~ise~l ii1 lal)oratory lxoccdurcs. Even thotlgh the
difficult proMems of accurately positioning all dies in the cast tnight bc ovcrcomc,
;;‘;re;; FACTORS OF OCCLUSION APPLICABLE TO RESTORATIVE DENTISTRY 781

and even though castings have been fitted accurately to the teeth prior to cementa-
tion, the most painstaking and accurate procedures in cementation could not elimi-
nate the possibility of slight changes during the insertion of the restorative work,
and the necessity of careful checking and corrective procedures. All full dentures
should be mounted upon articulating instruments for the correction of occlusion
after processing.
In all types of restorative dentistry, cusps must pass freely and smoothly over
opposing tooth surfaces while they are in function. Anomalies of occlusion such as
lack of harmony in tooth inclines, or roughness in function are much more serious
than minor discrepancies in condylar adjustments of articulating instruments.

ARTICULATING INSTRUMENTS

Many of our more simple instruments, such as the Hanau or the Swedish
Dentatus, if used to their limits of application, meet practical requirements. In the
past ten years, members of the profession have become more occlusion conscious.
They have developed, and are continuing to develop a better understanding of the
factors controlling occlusion and the fundamental principles in the correction of
occlusal disharmony. With this understanding, they have developed an apprecia-
tion of the fact that the use of the most complicated instrument alone does not
assure satisfactory occlusion of the completed prosthesis, and that the dentist’s,
understanding of occlusion is of much greater importance than the articulating
instrument used.
I would like to correct the fallacy that dentures constructed upon an instru-
ment other than the Gnathoscope will not even occlude properly in the centric
maxillo-mandibular relation upon completion. After processing, all dentures,
whether made upon the Gnathoscope or any other instrument, require occlusal
correction to overcome premature contacts of the posterior teeth and other dis-
crepancies which invariably are the result of processing procedures. Dentures
made upon the Gnathoscope would show no greater or no less degree of accuracy
in tooth intercuspation in the centric maxillo-mandibular position than would
similar dentures made upon the Hanau or Gysi articulators, the Hooper duplicator,
or a barn door hinge, provided the casts have been mounted with the same centric
relation records, and provided the vertical dimension remained unchanged. The
accuracy of occlusion in eccentric positions will be influenced by the positioning
of the casts in the instrument, and by the adjustability of the instrument. Acceptible
restorative dentistry is the result of knowledge, vision, and dexterity. An instru-
ment with maximum adjustability is not infallible. It is subject to gross error
if the operator relies upon the instrument to compensate for his negligible under-
standing of occlusion. While the use of an articulating instrument with the greatest
adjustability is commendable, the greatest good to the greatest numbers will result
not from the universal adoption of such instruments but from the more general
acquisition of a better understanding of the science dealing with tooth coordina-
tion in function.
782 SCHUYLER

1. Jaukelson, Bernard, Hoffman, George M., and Hendron, J. A.: The Physiology of the
Stomatognathic System, J.A.D.A. 46:375-386, 1953.
2. Kurth, L. E. : Mandibular Movements in Mastication, J.A.D.A. 29:1785, 1942.
3. Schuyler, Clyde H.: Full Denture Construction From Obtainin of the Centric Maxillo-
Mandibular Record to Complete Dentures, J.A.D.A. 41 :I%-?3, 1950.
SUITE 1201
400 MMISON AVE.
NEW YORK, N. Y.

TO RELAX PATIENTS AT THE TRY-IN

A simple and effective method of relaxing a patient to study lip and tongue action during
jaw relation and try-in sittings is to have them read a well selected poem (Kipling’s “If”).
While the patient’s mind is so occupied, normal speech patterns can be observed.
--Earl Pound

TO AVOlD LEGAL ENTANGLEMENTS

Do not accept a denture patient that owes money to other dentists, or who is dissatisfied
with previous services rendered without obtaining written evidence from both dentist and
patient that a satisfactory settlement has been reached.
-Earl Pound