J Indian Prosthodont Soc (Oct-Dec 2014) 14(4):344–351 DOI 10.1007/s13191-014-0374-y

REVIEW ARTICLE

Occlusal Concepts in Full Mouth Rehabilitation: An Overview

Bhawana Tiwari • Komal Ladha • Aaruti Lalit • B. Dwarakananda Naik

Received: 17 December 2013 / Accepted: 25 May 2014 / Published online: 25 June 2014 Indian Prosthodontic Society 2014

Abstract Restoration of in patients with and variable. Careful assessment of the patient’s diet, eat- severely worn dentition is a challenging situation as every ing habits and/or gastric disorders, along with the present case is unique in itself. There is great apprehension state of occlusion is essential for appropriate treatment involved in reconstructing debilitated dentition due to planning [2]. widely divergent views concerning the choice of an Various classifications [3, 4] have been proposed to appropriate occlusal scheme for successful full mouth classify patients requiring full mouth rehabilitation, how- rehabilitation. This article is an overview of the various ever, the classification most widely adopted is the one occlusal concepts/philosophies in full mouth rehabilitation given by Turner and Missirlian [5]. which will help the clinician select an appropriate occlusal According to them, patients with occlusal wear can be scheme for an individual case. broadly classified as follows: Category-1: Excessive wear with loss of vertical Keywords Full mouth rehabilitation Á Occlusal concepts/ dimension of occlusion (VDO) philosophies Á Occlusion The patient closest speaking space is more than 1 mm and the interocclusal space is more than 4 mm and has some loss of facial contour and drooping of the corners Introduction of the mouth. All teeth of one arch must be prepared in a single sitting once the final decision is made. This makes The objective of full mouth rehabilitation is not only the the increase in VDO less abrupt and allows better control reconstruction and restoration of the worn out dentition, but of esthetics. also maintenance of the health of the entire stomatognathic Category-2: Excessive wear without loss of VDO but system. Full mouth rehabilitation should re-establish a state with space available of functional as well as biological efficiency where teeth Patients typically have a long history of gradual wear and their periodontal structures, the muscles of mastication, caused by bruxism, oral habits, or environmental factors and the temporomandibular joint (TMJ) mechanisms all but the occlusal vertical dimension (OVD) is maintained function together in synchronous harmony [1]. Proper by continuous eruption. It might be difficult to achieve evaluation followed by definitive diagnosis is mandatory as retention and resistance form because of shorter the aetiology of severe occlusal tooth wear is multifactorial length and gingivoplasty may be needed. Enameloplasty of opposing posterior teeth may provide some space for the restorative material. B. Tiwari Á K. Ladha (&) Á B. Dwarakananda Naik Department of , ESIC Dental College & Hospital, Category-3: Excessive wear without loss of VDO but New Delhi, India with limited space e-mail: [email protected] There is excessive wear of anterior teeth over a long A. Lalit period, and there is minimal wear of the posterior teeth. House No. 463 Sector-4, Gurgaon, India Centric relation and centric occlusion are coincidental 123 J Indian Prosthodont Soc (Oct-Dec 2014) 14(4):344–351 345

with a closest speaking space of 1 mm and an interoc- Choice of Occlusal Concepts and Philosophies clusal distance of 2–3 mm. In such cases vertical space must be obtained for restorative materials. This can be There has been a search for the ideal occlusal scheme to be accomplished by orthodontic movement, restorative followed during full mouth rehabilitation that would pro- repositioning, surgical repositioning of segments, and vide optimal muscle and joint function besides aiming at programmed OVD modification. restoring the occlusal surfaces of teeth. Many concepts and techniques have been discussed till now in order to reha- After evaluating and classifying the patient’s existing bilitate dentition with fixed prosthodontics. clinical situation but before beginning the reconstruction The article overviews the various occlusal concepts to procedure, the clinician must decide upon the occlusal help absolve the complexities related to treatment planning approach and choose an appropriate occlusal scheme. and rehabilitation of patients requiring full mouth reconstruction. Occlusal Approach An early concept of comprehensive dentistry originated from the gnathologic society founded by McCollum in Occlusal approach for restorative therapy can be either 1926 [7]. McCollum together with Stuart published their conformative approach (often advisable) or a reorganised classic ‘‘Research Report’’ in 1955 and gave the Gnatho- approach. logical Concept. In conformative approach [6], occlusion is reconstructed Their observations led to the development of mandibular according to the patient’s existing intercuspal position. It is movements, transverse hinge axis, maxillomandibular rela- adopted when small amount of restorative treatment is tionships, and an arcon fully adjustable articulator. They undertaken. believed that anterior guidance was independent of the It includes two situations: condylar path and described condylar path as a fixed entity 1. Occlusion is untouched prior to tooth preparation in adults [8]. The concept of balanced occlusion which although small changes can be made on restorations included the idea that the most posterior position of the such as elimination of the non-working contacts. condyles was the optimal functional position for restoring 2. Occlusion is modified by localized occlusal adjust- denture occlusion was applied to restoration of the natural ments before tooth preparation that is shortening of an dentition by McCollum [9], Schuyler [10] and others. opposing cusp, elimination of non-working side inter- Schuyler supported balanced occlusion during his early ferences and removal of a deflective contact on tooth to clinical years but later began to observe clinical failures be restored. [11]. Similar failures were observed by Stuart due to unequal wear of the buccal and lingual cusps causing deflective In reorganised approach, new occlusal scheme is estab- occlusal contacts with a loss of centric-related closure, lished around a suitable condylar position which is the causing patients to bite their cheeks and tongue [12]. centric relation position. The patient’s occlusion may be Stuart and Stallard [12] observed that the upper lingual reorganised if the existing intercuspal position is unaccept- cusps stamp into lower fossae and lower incisors, canines able and needs to be changed or when extensive treatment is and buccal cusps stamp into the upper fossae. They to be undertaken to optimize patient’s occlusion. observed that canines discluded all other teeth in latero- Indications for reorganised approach are loss of vertical trusive (working) excursion which was similar to the dimension, repeated fracture/failure of teeth or restorations, observation of D’Amico [13]. In their report in 1960 [14], severe bruxism, lack of interocclusal space for restorations, they adopted the concept of mutually protected occlusion trauma from occlusion, unacceptable function and esthet- (canine-protected [15] /organic occlusion [16]) which ics, presence of temporomandibular disorders or develop- replaced the concept of balanced occlusion. In mutually mental anomalies. protected articulation, the anterior teeth protect the pos- terior teeth in eccentric movements and conversely have Occlusal Schemes the posterior teeth protect the anterior teeth in maximal intercuspation without any deflective occlusal contacts or The ideal occlusion for eccentric movements can be classified interferences in speech [15, 16]. by three schemes according to the tooth contact condition; Requirements for a mutually protected occlusion inclu- mutually protected articulation, group function, and balanced ded that the cusps of posterior teeth should close in centric articulation. The balanced occlusion concept is applied to occlusion with the mandible in centric jaw relation, while, complete denture patients while mutually protected occlusion in lateral excursions only opposing canines should contact and group function are applied for natural dentition. and in protrusion only the anterior teeth should contact [15].

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Centric relation was the rearmost, uppermost, and posteriors do not experience any interference on lateral midmost position of condyle in the glenoid fossa, which no excursive movements, antero-posterior freedom of move- longer holds true. The Point Centric concept was proposed ment should be provided which is achieved by having wherein the condyles should seat in a rearmost position in concave internal slopes on the cusps of posterior teeth [29]. the mandibular fossae exactly at the time when maximum This technique helps maintain vertical dimension and intercuspation of the teeth occurs in the retruded contact allows chewing due to cusp-fossa relation. The overall position. In this concept, supporting cusps must make numbers of occlusal contacts are reduced and it can be used occlusal contact at a point when the condyles are only, and for small as well as extensive restorations. This design precisely, in centric relation [17–19]. ensures occlusal stability and satisfies esthetic demands. von Spee in 1890 had referred to the vertical overlap The system can be adapted to most anterior guidances and ‘‘overbite’’ of the cuspids which was overlooked entirely varying degrees of group function. Occlusal adjustment is [20]. In 1915, Gysi described the masticating functions of simple [29]. the teeth and he was the first to describe the scheme of An organized approach to oral rehabilitation was intro- canine-protected occlusion [21]. D’Amico in 1958 studied duced by Pankey [30, 31] utilizing the principles of the significance of cuspid teeth and presented the Concept occlusion advocated by Schuyler [11], known as the Pan- of Canine Guidance (Canine disclusion) in which the key–Mann–Schuyler (PMS) Philosophy of Oral Rehabili- maxillary canine teeth serve to guide the mandible during tation [26]. Their philosophy was pertinently based on the eccentric movements and when in functional contact with spherical theory of occlusion, the ‘‘wax chew-in’’ tech- the lower canines and first premolars, determine both lateral nique described by Meyer [32] and Brenner [33], and on and protrusive movements of the mandible. Thus prevent- the importance of cuspid teeth as discussed by D’Amico ing any force other than along the long axis to be applied to [13, 22]. As a modification of canine disclusion, the PMS the opposing incisors, premolars and molars [13, 22]. philosophy [30] was to have simultaneous contacts of the Schuyler first introduced the Concept Of ‘Freedom in canine and posterior teeth in the working excursion (group Centric’’ and supported the theory that centric relation was function), and only anterior teeth contact in the protrusive rather a biological area of the TMJ than a point. excursive movement [31, 34]. In this concept, ‘‘there is a flat area in the central fossae The PM instrument [26] was based on Monson’s upon which opposing cusps contact which permits a degree spherical theory of occlusion and Monson articulator. It of freedom (0.5–1 mm) in eccentric movements uninflu- was used to establish functional occlusal plane on the enced by tooth inclines’’. It relies on cusp-to-surface mandibular teeth [30]. The ‘‘wax chew-in’’ technique was mechanics [23]. Schuyler suggested that incisal guidance modified and the occlusal scheme was developed by without freedom of movement from a centric relation intraoral recording of the functional occlusal path [32, 33]. occlusion to a more anterior tooth intercuspation will In this, both maxillary cuspids had to be in good functional ‘‘lock-in’’ the posterior occlusion [11, 24, 25]. Dawson used contact in centric and eccentric positions before beginning the term ‘long centric’ for freedom in centric. Long centric the reconstruction of the posterior teeth. If not it must be accommodated changes in head position and postural clo- obtained by reconstruction of the cuspids even if there is no sure. The measurable amount of long centric needed is the caries [31]. difference between centric-related closure and postural In PMS technique, the incisal guidance was the devel- closure which is rarely more than 0.5 mm [26]. oped intraorally with acrylic resin to satisfy esthetic and Ash and Ramfjord [27] also advocated the horizontal functional requirements. Optimal occlusal plane is selected ‘‘long centric’’. Pullinger et al. [28] suggested that an int- as dictated by the curve of Monson and mandibular pos- ercuspal position anterior to the retruded contact position in terior teeth are restored in harmony with the anterior association with bilateral occlusal stability may be guidance such that they will not interfere with the condylar protective. guidance. Maxillary posterior occlusal surfaces are devel- According to Wiskott and Belser, in natural dentition, oped after the completion of mandibular restorations by the occlusal contacts are few and not ideally placed. Also functionally generated path technique (FGP) [32]. The functional and parafunctional forces are not directed along definitive restorations are equilibrated into a centric rela- the long axis of the tooth. Based on this, they proposed a tion position with mandibular buccal cusps onto a flattened simplified occlusal scheme in which; one occlusal contact fossae–marginal ridge contact, with ‘‘long centric’’ incisal per tooth usually a cusp-fossa relation is sufficient instead guidance and group function in working excursion. Use of of a tripod contact, all interproximal contacts should be FGP records allows eliminating all occlusal interferences proper and tight as they stabilize the tooth mesio-distally, and establishing functional form of the occlusal surfaces of anterior disclusion mechanics should be applied so that the restoration. The PM philosophy was developed and its

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Table 1 Amount of disclusion of molars for each occlusal scheme Table 3 Articulator adjustment values for group function (degree) length of condylar path = 3mm Condition Condylar path Anterior guide table Mutually protected Group Balanced articulation function articulation Sagittal condylar Bennett Sagittal Lateral path inclination angle inclination wing Protrusion 1.0 1.0 0.0 angle Nonworking 1.0 0.5 0.0 Condition 1 25 15 25 10 side Without Working 0.5 0.0 0.0 anterior side teeth Source from [40] Condition 2 40 15 45 0 With anterior Table 2 Articulator adjustment values for mutually protected artic- teeth ulation (degree) Source from [40] Condition Condylar path Anterior guide table Sagittal condylar Bennett Sagittal Lateral path inclination angle inclination wing Table 4 Articulator adjustment values for balanced articulation angle (degree) Condition Condylar path Anterior guide table Condition 1 25 15 25 10 Without Sagittal condylar Bennett Sagittal Lateral anterior path inclination angle inclination wing teeth angle Condition 2 40 15 45 20 Condition 1 25 15 25 10 With Without anterior anterior teeth teeth Source from [40] Condition 2 25 15 25 10 With anterior teeth use advocated on a non-arcon articulator, which may not accept interocclusal records made at increased OVD [35]. Source from [40] Early gnathologic concepts focussed primarily on the condylar path and it was believed that anterior guidance was independent of the condylar path [8]. However, considered as the most reliable determinant of occlusion Hobo and Takayama [36] in their study revealed that [40] as cusp angle does not deviate and is 4 times more anterior guidance influenced the working condylar path reliable than the condylar and incisal path which show and concluded that they were dependent factors. Hobo deviation [41, 42]. Though independent of condylar path as adopted the concept of posterior disclusion and gave the well as incisal path, a standard value for cusp angle was Twin-tables Technique. According to him, posterior dis- determined such that it may compensate for wear of natural clusion is dependent on; the angle of hinge rotation dentition due to caries, abrasion and restorative works. By created by the angular difference between anterior guid- using the standard cusp angle, it was possible to establish ance and condylar path, and on inclination and shape of the standard amount of disclusion (see Table 1). Different posterior cusps which helps in controlling harmful lateral adjustment values of an articulator were determined for forces. In this technique, molar disclusion is achieved by each occlusal scheme to reproduce the standard amount of the use of two incisal tables. The first incisal guide table disclusion (see Tables 2, 3, 4)[40]. termed as the incisal table without disclusion is used to On literature review it was found that occlusal schemes fabricate restorations for posterior teeth. The second were also formulated for oral rehabilitation in patients incisal table termed as the incisal table with disclusion is with periodontal diseases. Youdelis in 1971 proposed an used to achieve incisal guidance with posterior disclusion occlusal scheme for advanced periodontitis cases. The [37–39]. aim was to achieve simultaneous interocclusal contact The Twin-Stage Procedure was developed as the of posterior teeth in centric relation position (usually advanced version of the Twin-Table technique. Hobo and coincident with intercuspal position) with forces directed Takayama in their research concluded that cusp angle be axially. Anterior disclusion is provided for protrusive 123 348 J Indian Prosthodont Soc (Oct-Dec 2014) 14(4):344–351 excursions and canine disclusion for lateral excursions. intercuspation will ‘‘lock-in’’ the posterior occlusion and Cuspal anatomy is so arranged that if the canine disclusion proposed the freedom in centric concept [11, 24, 25]. is lost through wear or tooth movement, the posterior teeth In 1960, an organised clinical approach to full mouth drop into group function. Both fully and semi adjustable rehabilitation was given by Pankey and Mann [30, 31] articulators can be used [43]. based on the principles of occlusion advocated by Schuyler According to Nyman and Lindhe Scheme for extremely [11]. The PMS occlusal scheme, unlike the gnathologic advanced periodontitis cases even contact should be pro- concept, encouraged multiple occlusal contacts during vided in the intercuspal position, although no great lateral movements (group function or wide centre) and emphasis is placed upon the type of contacts. When distal during protrusive movements (long centric, an essential support is present, anterior disclusion should be provided. feature of this technique). This may have the effect of When there are long tooth-borne cantilevered restorations, increasing tooth wear. The concept of posterior disclusion aim is to achieve simultaneous working and non-working has made the use of FGP technique advocated by PMS side contacts on the cantilever as in balanced occlusion. unnecessary in most occlusal restorations. As FGP tech- All restorations should be fabricated on semi-adjustable nique utilizes wax to obtain the record there is great articulators with average settings and supragingival margin potential for errors. Furthermore, PMS technique cannot be placement [44]. used if the teeth are periodontally weak as FGP cannot be Before beginning the treatment procedure, one must accurately recorded. decide whether there is need for full mouth simultaneous Hobo and Takayama [36] in their study made observa- technique which advocates simultaneous restoration of tions similar to those of Schuyler [25] that anterior guid- both arches [45–49], or quadrant/segment technique, where ance and condylar guidance were dependent, not completion of restorations of one quadrant in a pro- independent factors. They believed in posterior disclusion grammed sequence is done before proceeding to the next in eccentric movements unlike the PMS philosophy where [3, 30, 31, 50–52]. In case of segmented simultaneous group function is achieved on the working side [31]. They technique, a combination of the desired characteristics of did not include freedom in centric. In the twin-stage pro- the full mouth simultaneous rehabilitation and the pro- cedure, as cusp angle was the main determinant of occlu- grammed quadrant approach into a single reconstructive sion, the need to record condylar path was not necessary. technique is done [53]. This technique simplifies the Therefore, complicated instruments such as the pantograph essential basic procedures for reconstructions while per- and fully adjustable articulators are not required. This mitting the dentist to use a suitable occlusion for a par- procedure is much simpler than the standard gnathological ticular patient. procedure, yet it follows gnathological principles. Wiskott and Belser [29] combined anterior disclusion mechanics and antero-posterior freedom with the advan- Discussion tage of one occlusal contact per tooth. Instead of tripod contacts, cusp-fossa relation was achieved which facilitated Of all the concepts discussed in the literature, two have mastication. This design provided occlusal stability and found acceptance for natural dentitions and fixed prosthesis: esthetics and could be adapted to anterior guidances and the ‘‘gnathologic’’ and the ‘‘freedom-in-centric’’ concepts. group function. The occlusal concepts discussed for peri- The bilateral balanced occlusion scheme was applied for odontally weak teeth can be applied in similar clinical natural dentition by McCollum [9] but later mutually pro- situations [40, 41]. tected occlusion was adopted by Stuart and Stallard [14]as After reviewing the various occlusal concepts, we are of clinical failures were observed with bilateral balance [12]. the opinion that it is best to achieve posterior disocclusion It was believed that condylar path does not change in full mouth rehabilitation to avoid harmful lateral forces during adulthood and that determination of anterior guid- as was suggested by Hobo [37]. Although, the concept of ance is in the hands of the dentist. Anterior guidance was gnathology provides stable long-term results due to mutu- considered independent of the condylar path [8]. The ally protected occlusion and tripod contacts, in some importance of anterior guidance on functional occlusion of patients, freedom in occlusion may be required and there- natural teeth was recognized by Schuyler. He stated that fore the PMS concept cannot be out rightly dismissed. anterior guidance had equal or greater influence on occlusal Indeed, some of the PMS concepts such as establishing an morphology than TMJ’s and that unfavourable incisal acceptable occlusal plane prior to occlusal rehabilitation guidance may tend to produce abnormal functional move- are incorporated into everyday occlusal practice [30, 31]. ments of the condyles [25]. He further suggested that Furthermore, as the tripod contacts are very difficult to incisal guidance without freedom of movement from a equilibrate [26] it is recommended that cusp-to-fossa con- centric relation occlusion to a more anterior tooth tacts be achieved in the reconstructed occlusion. 123 J Indian Prosthodont Soc (Oct-Dec 2014) 14(4):344–351 349

Table 5 Summarizes various occlusal concepts in full mouth rehabilitation S. Occlusal concept/ Salient features Limitations No. philosophy

1. Gnathological • Mutually protected occlusion • Point centric and cusp-to-fossa tripodization concept • Point centric concept complicate the need to obtain precise gnathologic restorations (McCollum, • coincides with centric Stuart, Stallard) relation (RUM position) • Need for a fully adjustable articulator • Cusp to fossa relationship with tripodism • Cast metal transitional restorations had limitations related to cost, inability to increase occlusal vertical • Narrow occlusal table dimension, and changes in mandibular position that cannot be equilibrated easily to a new maximum intercuspal relation 2. Freedom in centric • Balancing contacts are deleterious and must be avoided • According to gnathologists, the task of adjusting concept in natural dentition maximum intercuspation contacts in two different (Schuyler) • Incisal guidance is a predominating factor for selection positions on an articulator to achieve freedom in of posterior guiding tooth inclines than condylar centric may result in a lack of precision in both guidance so it should be the first step of occlusal positions rehabilitation • Cusp-to-surface rather than cusp-to-fossa relation • Antero-posterior freedom of movement must be affects chewing efficiency incorporated in the restoration 3. Simplified occlusal • Cusp-fossa relation with only one occlusal contact per • design (Wiskott tooth and Belser) • Anterior disclusion during all eccentric movements • Freedom in centric occlusion • Can be adapted to most anterior guidances and varying degrees of group function 4. Pankey, Mann and • Maxillary cuspids in good functional contact • Cusp to fossae marginal ridge contact Schuyler • Group function on working side • Use of wax functionally generated path techniques can Philosophy • Absence of nonworking side contacts. cause errors (1960) • Freedom of movement in centric occlusion is necessary • The PM philosophy was developed and its use advocated on a non-arcon articulator, which may not • Long centric is incorporated in the lingual surfaces of accept interocclusal records made at increased maxillary incisors occlusal vertical dimension 5. Twin Table • Incisal guidance and condylar path are dependant • The cusp angle was fabricated parallel to the measured technique-Hobo factors condylar path, and the cusp angle became too steep (1991) • Posterior teeth are restored using two customised • To obtain a standard amount of disclusion with such a incisal tables: without disclusion; and with disclusion steep cusp angle, the incisal path had to be set at an angle that was extremely steep. This made the patient uncomfortable • The customised guide tables were fabricated by means of resin molding. It was technique sensitive 6. Twin Stage • Since cusp angle is the main determinant of occlusion, • Contraindicated for malocclusion cases Procedure- the measurement of the condylar path is not necessary Hobo and • The procedure can be indicated for single crowns, fixed Takayama prosthodontics, implants, complete-mouth reconstructions, and complete • Suitable for transmandibular disorder patients • It can be incorporated easily with commonly used clinical techniques such as facebow transfer, various centric recording methods, and cusp-fossa waxing 7. Youdelis Scheme • Cuspal anatomy is so arranged that if the canine • Used in advanced periodontitis cases disclusion is lost through wear or tooth movement, the posterior teeth drop into group function 8. Nyman and Lindhe • When there are long tooth-borne cantilevered • For extremely advanced periodontitis cases Scheme restorations, balanced occlusion must be achieved • Type of contacts not specified • When distal support is present, anterior disclusion is provided

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Finally, it is dependent on the clinician to choose an 11. Schuyler CH (1953) Factors of occlusion applicable to restorative appropriate occlusal scheme for a particular reconstruction dentistry. J Prosthet Dent 3:772–782 12. Stuart CE (1973) The contributions of gnathology to prostho- case after comprehensively reviewing the existing clinical dontics. J Prosthet Dent 30:607–608 condition so as to achieve predictable long term results and 13. D’Amico A (1958) Canine teeth-normal functional relation of the a functional occlusion. Table 5 summarizes the various natural teeth of man. J South California Dent Assoc 26:6–23, occlusal concepts that have been discussed. 49–60, 127–142, 175–182, 194–208, 239–241 14. Stuart CE, Stallard H (1960) Principles involved in restoring occlusion of the natural teeth. J Prosthet Dent 10:304–313 15. Schwartz H (1986) Occlusal variations for reconstructing the Conclusion natural dentition. J Prosthet Dent 55:101–105 16. Elkins WE (1973) Gold occlusal surfaces and organic occlusion in denture construction. J Prosthet Dent 30:94–98 The principles of treatment are universal, all the functional 17. Stuart CE, Stallard H (1969) Oral rehabilitation and occlusion, factors are interrelated, and all efforts should be made to vol II. University of California, CE Stuart Instruments, San construct an occlusal interface such that the periodontium Francisco, Ventura, pp 1–6 of teeth, muscles of mastication, and TMJ’s function in 18. Pokorny PH, Jonathan PW, Litvak H (2008) Occlusion for fixed prosthodontics: a historical perspective of the gnathological harmony with each other. This requires accurate diagnosis influence. J Prosthet Dent 99:299–313 regarding the etiology of the deranged condition, intra-oral 19. Stuart CE, Stallard H (eds) (1959) Principles involved in restor- changes and other adverse effects on jaw relations. Optimal ing occlusion to natural teeth. A syllabus on oral rehabilitation occlusion according to the needs of the patient should be and occlusion, vol 1. University of California, CE Stuart Instru- ments, San Francisco, Ventura, pp 1–11, 5, 1–9 attained in rehabilitation procedures. Chewing efficiency 20. von Spee FG (1890) The condylar path of the mandible in the can exist over a wide range of occlusal forms and types of glenoid fossa, read at Kiel, Germany occlusal schemes, so no set rule can be applied to all the 21. Gysi A (1915) Masticating efficiency in natural and artificial patients. teeth. Dent Digest 21:74 22. D’Amico A (1961) Functional occlusion of the natural teeth of Occlusal rehabilitation is a radical procedure and should man. J Prosthet Dent 11:899–915 be carried out in accordance with the dentist’s choice of 23. Schuyler CH (1969) Freedom in centric. Dent Clin North Am treatment based on his knowledge of various philosophies 13:681–686 followed and clinical skills. A comprehensive study and 24. Schuyler CH (1959) An evaluation of incisal guidance and its influence on restorative dentistry. J Prosthet Dent 9:374–378 practical approach must be directed towards reconstruction, 25. Schuyler CH (1963) The function and importance of incisal restoration and maintenance of the health of the entire oral guidance in oral rehabilitation. J Prosthet Dent 13:1011– mechanism. 1029 26. Dawson PE (ed) (1989) Evaluation, diagnosis, and treatment of Conflict of interest None. occlusal problems, 2nd edn. Mosby, St. Louis, p 265 27. Ramfjord SP, Ash MM (1966) Occlusion. W. B. Saunders, Philadelphia 28. Pullinger AG, Seligman DA, Solberg WK (1988) Temporoman- References dibular disorders. Part II: occlusal factors associated with tem- poromandibular joint tenderness and dysfunction. J Prosthet Dent 1. Kazis H, Kazis AJ (1960) Complete mouth rehabilitation through 59:363–367 fixed partial denture prosthodontics. J Prosthet Dent 10:296–303 29. Wiskott HWA, Belser UC (1995) A rationale for a simplified 2. Lerner J (2008) A systematic approach to full mouth recon- occlusal design in restorative dentistry: historical review and struction of the severely worn dentition. Pract Proced Aesthet clinical guidelines. J Prosthet Dent 73:169–183 Dent 20:81–87 30. Mann AW, Pankey LD (1960) Oral rehabilitation: part I. Use of 3. Jones SSM (1963) The principles of obtaining occlusion in the P-M instrument in treatment planning and in restoring lower occlusal rehabilitation. J Prosthet Dent 13:706–713 posterior teeth. J Prosthet Dent 10:135–150 4. Brecker SC (1958) Clinical procedures in occlusal rehabilitation. 31. Pankey LD, Mann AW (1960) Oral rehabilitation: part II. W. B. Saunders Co, Philadelphia Reconstruction of the upper teeth using a functionally generated 5. Turner KA, Missirlian DM (1984) Restoration of the extremely path technique. J Prosthet Dent 10:151–162 worn dentition. J Prosthet Dent 52:467–474 32. Meyer FS (1938) Can the plain line articulator meet all the 6. Celenza FV, Litvak H (1976) Occlusal management in confor- demands of balanced and functional occlusion in all restorative mative dentistry. J Prosthet Dent 36:164–170 works? J Colo Dent Assoc 17:6–16 7. Stuart CE, Golden IB (1981) The history of gnathology. CE 33. Brenner GP (1940) A functional denture technic. J Am Dent Stuart gnathological instruments, Ventura, p 15 Assoc 27:1873–1883 8. McCollum BB, Stuart CE (1955) A research report. Scientific 34. Mann AW, Pankey LD (1963) Concepts of occlusion; the P.M. Press, South Padasena philosophy of occlusal rehabilitation. Dent Clin North Am 9. McCollum BB (1939) Fundamentals involved in prescribing 9:621–636 restorative dental remedies. Dent Items Interest 61:522, 641, 724, 35. Schillinburg HT, Hobo S, Whitsett LD, Brackett S, Jacobi R 852, 942 (1997) Fundamentals of fixed prosthodontics, 3rd edn. Quintes- 10. Schuyler CH (1929) Principles employed in full denture pros- sence, Chicago, p 28 thesis which may be applied to other fields of dentistry. J Am 36. Hobo S, Takayama H (1989) Effect of canine guidance on the Dent Assoc 16:2045–2054 working condylar path. Int J Prosthodont 2:73–79

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37. Hobo S (1991) Twin-tables technique for occlusal rehabilitation. 45. Bailey EE (1936) A master model technique for the construction Part I: mechanism of anterior guidance. J Prosthet Dent of inlays, crowns and bridgework. Dent Digest 42:119–123 66:299–303 46. Grubb HD (1938) Occlusal reconstruction. J Am Dent Assoc 38. Hobo S (1991) Twin-tables technique for occlusal rehabilitation. 25:372–383 Part II: clinical procedures. J Prosthet Dent 66:471–477 47. Linkow LI (1961) An oral rehabilitation technique utilizing 39. Hobo S, Takayama H (1997) Oral rehabilitation, clinical deter- copper band impressions. J Prosthet Dent 11:716–721 mination of occlusion. Quintessence Publishing Co., Inc, Carol 48. Sendax VI (1962) Master impression technique for fixed and Stream, pp 32–33 precision removable restorations. Dent Digest 68:554–556 40. Hobo S, Takayama H (1997) Twin-stage procedure. Part 1: a new 49. Kazis HK (1948) Complete mouth rehabilitation through resto- method to reproduce precise eccentric occlusal relations. Int J ration of lost vertical dimension. J Am Dent Assoc 37:19–39 Periodontic Restor Dent 17:113–123 50. Nuttall EB (1963) The principles of obtaining occlusion in 41. Sekikawa M, Akai J, Nanbu A, Kanazawa E, Ozaki T (1983) occlusal rehabilitation. J Prosthet Dent 13:699–705 Three-dimensional measurements of the occlusal surface of lower 51. Granger ER (1963) The principles of obtaining occlusion in first molars in a modern Japanese population. Jpn J Oral Biol occlusal rehabilitation. J Prosthet Dent 13:714–718 25:737–744 52. Brown K (1980) Reconstruction considerations for severe dental 42. Kanazawa E, Sekikawa M, Ozaki T (1984) Three-dimensional attrition. J Prosthet Dent 44:384–388 measurements of the occlusal surface of upper first molars in a 53. Binkley TK, Binkley CJ (1987) A practical approach to full modern Japanese population. Acta Anat 116:90–96 mouth rehabilitation. J Prosthet Dent 57:261–265 43. Schluger S, Youdelis RA, Page RC (1971) Periodontal disease. Lea & Febiger, Philadelphia 44. Nyman S, Lindhe J (1977) Considerations on the design of occlusion in prosthetic rehabilitation of patients with advanced periodontal disease. J Clin Periodontol 4:1–15

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