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An Appraisal on Occlusal Philosophies in Full-Mouth10.5005/Jp-Journals-10019-1163 Rehabilitation: a Literature Review REVIEW ARTICLE

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An Appraisal on Occlusal Philosophies in Full-Mouth10.5005/Jp-Journals-10019-1163 Rehabilitation: a Literature Review REVIEW ARTICLE IJOPRD An Appraisal on Occlusal Philosophies in Full-mouth10.5005/jp-journals-10019-1163 Rehabilitation: A Literature Review REVIEW ARTICLE An Appraisal on Occlusal Philosophies in Full-mouth Rehabilitation: A Literature Review 1Ankita Parmar, 2Vivek Choukse, 3Umesh Palekar, 4Rajeev Srivastava ABSTRACT An understanding of occlusion must be based on Restoration of occlusion in patients with mutilated dentition is knowledge and understanding of physiology of mastica- 2 a challenging situation as every case is unique in itself. There tory system and insight into the dysfunctional adaptation. is a great apprehension involved in reconstructing worn-out After thorough clinical examination and diagnosis dentition due to widely divergent opinions regarding the choice of patient with worn-out dentition, appropriate occlusal of an appropriate occlusal scheme. A critical assessment and scheme should be chosen that would not only restore the subsequent scientific validation of available literature on occlusal occlusal surface of teeth but also provide optimal muscle philosophies in full-mouth rehabilitation require an understand- ing of their evolution in the formative years and the subsequent and joint function. development of effective models for clinical practice. This study A critical assessment requires a review of the histori- overviews the various occlusal concepts/philosophies in full- cal evolution of concepts and philosophies of full-mouth mouth rehabilitation, which will help the clinician to select an rehabilitation in formative years and its subsequent appropriate occlusal scheme for an individual case. scientific validation, which is the aim of this review Keywords: Centric occlusion, Centric relation, Functionally (Flow Chart 1). generated path, Occlusal vertical dimension, Pankey-Mann- This study critically analyzed the existing literature Schuyler concept, Temporomandibular joint disorder. about various occlusal concepts to help absolve the dif- How to cite this article: Parmar A, Choukse V, Palekar U, ficulties related to the treatment planning for patients Srivastava R. An Appraisal on Occlusal Philosophies in Full- requiring full-mouth rehabilitation. mouth Rehabilitation: A Literature Review. Int J Prosthodont A PubMed/MEDLINE search was performed to iden- Restor Dent 2016;6(4):89-92. tify English-language peer-reviewed literature along with Source of support: Nil hand search. Electronic searches of the literature were Conflict of interest: None performed in MEDLINE using the following keywords: Occlusal concepts/philosophies in full-mouth rehabilita- tion, occlusion in worn-out dentition, dental occlusion, INTRODUCTION dental occlusion research, centric relation (CR), occlusal The restoration of normal healthy function of masticatory vertical dimension (OVD), and occlusion, in various apparatus is the ultimate aim of full-mouth rehabilitation. combinations to obtain potential references for review. Full-mouth rehabilitation seeks to convert all unfavorable Many of these articles were duplicates due to multiple forces on the teeth, which inevitably induce pathological searches and were subsequently eliminated. Articles other conditions into favorable forces that permit normal func- than in English language and articles other than reviews tion and therefore induce healthy conditions.1 Occlusion were excluded. plays a key role in establishing the synchronous harmony between the components of stomatognathic system, i.e., VARIOUS OCCLUSAL CONCEPTS teeth, muscles of mastication, and temporomandibular The early concepts of occlusal philosophies originated joints. So, the selection of proper occlusal scheme is the from gnathological concept. The term gnathology was most important step in prosthetic rehabilitation of a first coined by Stallard in 1924. McCollum3 founded patient with mutilated dentition. gnathological society in 1926; Stuart became associated with gnathological society and published their classic 1Student, 2,4Professor, 3Professor and Head “research report” in 1955. The fundamentals of gnatho- logy included the concepts of CR, anterior guidance, 1-4Department of Prosthodontics, Crown and Bridge and Implantology, Modern Dental College & Research Centre, Indore OVD, the intercuspal design, and the relationship of the Madhya Pradesh, India determinants of mandibular movements to the occlusion 4 Corresponding Author: Ankita Parmar, Student, Department in fixed dental prosthesis. of Prosthodontics, Crown and Bridge and Implantology, Modern The early gnathologist believed CR as the most Dental College & Research Centre, Indore, Madhya Pradesh posterior relation of mandible to maxilla. Further inves- India, Phone: +9630482859, e-mail: [email protected] tigations led them to believe that CR is the rearmost, International Journal of Prosthodontics and Restorative Dentistry, October-December 2016;6(4):89-92 89 Ankita Parmar et al Flow Chart 1: Evolution of occlusion uppermost, and middlemost position of condyles in the A simplified occlusal design was given by Wiskot and glenoid fossa. Belser11 based on the philosophy that in natural dentition, The gnathological concept believes in concentricity occlusal contacts are few and not ideally placed. Accor- of CR and maximum intercuspation coinciding with CR. ding to them, one occlusal contact per tooth usually a The treatment of patients with worn-out dentition starts cusp–fossa relation is sufficient instead of a tripod contact, with the cast metal provisional restorations. Mutually all interproximal contacts should be proper and tight protected occlusal scheme with point-centric concept is as they stabilize the tooth mesiodistally, anterior disoc- used in this philosophy. Cast metal provisionals have clusion mechanics should be applied so that posteriors limitations related to cost, inability to increase the OVD, do not experience any interference on lateral excursive and change in mandibular position that cannot be equili- movements, and anteroposterior freedom of movement brated easily to a newer position.5 should be provided which is achieved by having concave D’Amico6 suggested the concept of canine guidance internal slopes on the cusps of posterior teeth. as a part of mutually protected occlusion where anterior One of the most practical and organized philosophies teeth protect the posterior teeth in excursions, and pos- is originally organized into a workable concept by Dr LD terior teeth protect the anterior teeth in maximum inter- Pankey utilizing the principles of occlusion espoused cuspation. In canine guidance concept, maxillary canine by Dr Clyde Schulyer.12,13 This philosophy is based on serve to guide the mandible during eccentric movements, spherical theory of occlusion by Monson and function- thus preventing off axis forces on other teeth. ally generated path (FGP) technique described by Meyer The development of OVD is due to growth of maxilla in 1933.14 and mandible along with eruption of teeth and growth of The Pankey-Mann-Schuyler (PMS) philosophy aims alveolus. Desjardins7 noted that vertical dimension of rest at achieving the following principles of occlusion advo- and occlusions are some of the most difficult positions to cated by Schuyler: record. Thompson8 and Dawson9 advocated that OVD can • Maximum number of contacts on posterior teeth never be lost; it is compensated by alveolar bone expansion, in CR. muscle action, and tooth eruption. Muscles tend to restore • Posterior teeth disocclusion during protrusion. the OVD to its original level by tooth intrusion or extrusion. • Functionally harmonious anterior guidance. Schuler described the concept of “freedom from • Absence of interferences on the nonworking side centric” considering CR as biological area rather than a during lateral excursions. point. Dawson9 used the term “long centric” for the same • Group function occlusion on the working side during and said that it is rarely more than 0.5 mm. lateral excursions. Becker and Kaiser10 had given the concept of bio- In order to accomplish these goals, the sequence advo- logical occlusion to maintain the health and function of cated by the PMS philosophy15 is as follows: stomatognathic system. According to this concept, there • Part I: Examination, diagnosis, treatment planning, should be no interferences between centric occlusion and prognosis. CR, no balancing contacts, cusp to fossa occlusal scheme, • Part II: Harmonization of the anterior guidance for cuspid protected or group function occlusion, no contacts best possible function, esthetics, and comfort. in posteriors during protrusion, no cross tooth balancing • Part III: Restoration of the mandibular posterior occlu- contacts, and elimination of all possible fremitus. sion after selecting an acceptable occlusal plane so that 90 IJOPRD An Appraisal on Occlusal Philosophies in Full-mouth Rehabilitation: A Literature Review it will not interfere with condylar guidance and is in Table 1: Salient features of popular occlusal concepts in full harmony with anterior guidance. mouth rehabilitation • Part IV: Restoration of maxillary posterior occlusion Occlusal philosophy Salient features so that it is in harmony with anterior and condylar Gnathological Bilateral balanced occlusion guidance. The FGP is an important aspect of this concept Point centric technique and is often considered a part of it. Tripod contacts Pankey-Mann- Group function occlusion Early gnathological concepts focused primarily on the Schuyler concept Absence of nonworking contacts condylar path and it was believed that
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