Occlusion Final

Front 1

what are the effects of occlusal forces? what are its components?

Back 1

teeth
periodontium
tmj
muscles of mastication

Front 2

injury resulting in tissue changes within the attachment apparatus as a result of occlusal forces

Back 2

occlusal trauma

Front 3

any contact that inhibits the remaining occluding surfaces from acheiving stable and harmonious contacts

Back 3

occlusal interference

Front 4

any contact of opposing teeth that occurs before the desirable intercuspation

Back 4

occlusal prematurity

Front 5

injury resulting from EXCESSIVE occlusal forces applied to a tooth or teeth with NORMAL support. (normal bone and attachment levels)

Back 5

primary occlusal trauma

Front 6

excessive occlusal force
tooth with normal support

Back 6

primary occlusal trauma

Front 7

injury resulting from NORMAL or EXCESSIVE occlusal forces applied to a tooth or teeth with REDUCED support. (bone/ attachment loss present)

Back 7

secondary occlusal trauma

Front 8

normal or excessive occlusal force
tooth with reduced support

Back 8

secondary occlusal trauma

Front 9

Stage of Occlusal Trauma: dependent on direction, degree and location of occlusal forces

Back 9

stage 1: injury

Front 10

Stage of Occlusal Trauma: a dynamic process of adaptive remodeling of the following:

1.pdl
2.bone
3.cementum

Back 10

stage 2: repair

Front 11

what is the effect of occlusal trauma on the periodontium in the absence of periodontal inflammation

Back 11

1. trauma to attachment apparatus
2. adaptive repair
3. widened PDL
4. possible radiographic vertical bone loss
5. no loss of periodontal attachment
INCREASED MOBILITY WITHOUT AL AND INCREASED PD

Front 12

1. inflammation follows the course of blood vessels into the alveolar bone marrow spaces

2. defect morphology depends on location of blood vessels and thickness of bone

3. spread of inflammation into PDL is secondary in periodontititis

Back 12

Pathway of Inflammation:Weinmann

Front 13

1. excessive occlusal forces alter the normal pathway of inflammation

2. inflammation enters PDL directly

3. development of angular bony defects with intrabony pockets

Back 13

Theory of Co-destruction: Glickman

Front 14

evidence that vertical osseous defects are not caused by occlusal trauma

1. bony defects are result of apical plaque progression in areas of sufficient bony thickness

2. angular defects occur in both the presence and abscence of occlusal trauma

Back 14

Vertical Defect Formation: Waerhaug

Front 15

Results of Animal Studies

Back 15

1. excessive occlusal force on a healthy periodontium results in physiologic adaptation

2. includes increased mobility, PDL width and loss of bone

3. no loss of ct attachment

4. changes are reversible when force is removed

Front 16

Clinical Signs of Occlusal Trauma

Back 16

1. increased mobility
2. fremitus
3. wear facets
4. tooth migration
5. tooth fracture
6. pulpal symptoms

Front 17

radiographic signs of occlusal trauma

Back 17

1. widened pdl
2. thickening of lamina dura
3. vertical bone loss
4. furcation bone loss
5. root resorption
6. alveolar radiolucency and or condensation

Front 18

indications for occlusal therapy

Back 18

1. parafunctional habits
2. occlusal interferences
3. tooth hypermobility
4. increased width of pdl
5. reduced alveolar bone support
6. inflammatory periodontal disease

Front 19

when should occlusal therapy begin and with what?

Back 19

after resolution of periodontal inflammation?
1. SCRP
2. may reduce/resolve signs of trauma
3. if not then proceed to treat the occlusion

Front 20

when is it okay to bypass inflammation and immediately treat the pt with occlusal therapy?

Back 20

gross interferences should be treated at onset of therapy

Front 21

Methods of Occlusal therapy

Back 21

1. limited occlusal adjustment
2. comprehensive occlusal adjustment
3. removable occlusal splint
4. fixed occlusal splint

Front 22

Occlusal adjustment Indications

Back 22

increasing mobility or fremitus
discomfort during furnction
parafunctional habits
soft tissue injury
food impaction
occlusal interferences

Front 23

Occlusal Adjustment CI

Back 23

as treatment for periodontal disease
without pretreatment diagnosis
as primary therapy for bruxism
severe extrusion or malposition
when periodontal inflammation has not been controlled

Front 24

removeable splint indications

Back 24

treat bruxism/parafunction
stabilize occlusion during periodontal treatment
maintain occlusion after treatment

Front 25

fixed splint indications

Back 25

mobility interferes with patient comfort
mobility interferes with patient function
prevent tipping of drifting of teeth
prevent extrusion of unopposed teeth
following ortho therapy
following acture trauma to teeth
esthetic and prosthetic demands

Front 26

Miller Classification: Tooth can be moved less than 1mm in the buccolingual or mesiodistal direction

Back 26

Class 1

Front 27

Miller Classification:Tooth can be moved 1mm or more in the buccolingual or mesiodistal direction
No mobility in the occlusoapical direction (vertical mobility)

Back 27

Class 2

Front 28

Miller Classification:Tooth can be moved 1mm or more in the buccolingual or mesiodistal direction
Mobility in the occlusoapical direction is also present

Back 28

Class 3

Front 29

Miller Classification: Normal (physiologic) movement when force is applied.

Back 29

Class 0

Front 30

Signs of Occlusal Disease

Back 30

1 .pathologic tooth wear
2. abfractions, notches between teeth and gum
3. fremitus which may cause fractured teeth or fillings
4. headaches and tmj pain
5. tooth sensitivity to cold and hot
6&7. bone loss and mobility with perio disease

Front 31

when the teeth are not in harmony with the joints and movements of the mandible
an underseriable occlusal contact that may produce mandibular deviation during closure to maximum intercuspation or may hinder smooth passage to and from MIP

Back 31

occlusal interference

Front 32

occlusal contact that interrupts the harmonious closure of the teeth along the CR arc

Back 32

occlusal prematurity

Front 33

An interference between posterior teeth on the side of the dental arches to which the mandible is moving laterally in excursion, usually involving a stamp cusp against a shear cusp. Synonym: Laterotrusive Interference.

Back 33

working interference

Front 34

An interference between posterior teeth on the side of the dental arches away from which the mandible is moving laterally in excursion, usually involving stamp cusp against stamp cusp.

Back 34

nonworking interference

Front 35

An interference between posterior teeth on ether side of the dental arches caused by a protrusive movement of the mandible.

Back 35

protrusive intereference

Front 36

An interference involving exclusively a maxillary lateral incisor against its opponent during a lateral protrusive excursion of the mandible. This interference is observed as a "trip" by the lateral incisor during which the anterior guidance is momentarily borne by a lateral incisor without help from other maxillary anterior teeth.

Back 36

Lateral protrusive interference.

Front 37

An interference between posterior teeth when the mandible has translated laterally beyond the guidance of the cuspid. The incisors, not the posterior teeth, should provide anterior guidance after "crossover".

Back 37

Crossover interference.

Front 38

form of occlusal treatment in which the occlusal surfaces of one or more teeth are adjusted or modified by grinding with rotary dental instruments.

Back 38

Occlusal Equilibration/adjustment

Front 39

Forms of Occlusal Equilibration

Back 39

1.Equilibration
2.Selective grinding
3.Limited adjustment
4.Coronaplasty
5.Coronal reshaping
6.Occlusal correction or recontouring
7.Spot grinding

Front 40

The Basic Principles of Occlusal Equilibration

Back 40

•Primary Purpose: To eliminate deflective occlusal contacts that interfere with the physiologic function of the Tempromandibular Joint.
•Goal: A comfortable occlusion

Front 41

_______ __________is designed to eliminate all premature or deflective tooth contacts that prevent the condyle-disk assembly from complete seating in their respective fossa (centric relation) when the jaw closes to maximum intercuspation (MIP).

Back 41

proper equilibration

Front 42

Maximum distribution of occlusal stress in centric relation.
Forces of occlusion should be borne as much as possible by the long axis of the teeth.
When there is surface to surface contact of flat cusps, it should be changed to a point to surface contact.
Once centric occlusion is established, never take teeth out of centric occlusion.

Back 42

The Basic Principles of Occlusal Adjustment

Front 43

Indications for occlusal adjustment

Back 43

1. periodontal bone loss
fremitus, and mobility
2. restorative prosthetic
3. abfractions
4. implants
5. adjunct to ortho tx
6. orthognathic surgery
7.limited movement of the mandible
8.endodontics

Front 44

REMEMEBER THAT EQUILIBRATION IS NOT:

Back 44

•REVERSIBLE
•BENIGN
•A ROUTINE PROPHYLACTIC MEASURE
•SURE FIX FOR BRUXISM

Front 45

CONTRAINDICATIONS FOR EQUILIBRATION

Back 45

Patient is symptomatic
•Just because interferences exist
•Just because a joint clicks
•Lack of general physical and emotional stability of the patient
•Lack of interest, concern, or compliance by the patient
•Lack of maxillomandibular or dental stability of the patient

Front 46

Indications for equilibration of tmd patients

Back 46

•ONLY FOLLOWING SUCCESSFUL OCCLUSAL APPLIANCE THERAPY AND AFTER OCCLUSION IS CLEARLY INDICATED IN THE ETIOLOGY OF THE TMD - muscle origin
•INTERFERENCES ARE PRESENT
•DISCS ARE IN PLACE
•SYMPTOMS ARE RESOLVED

Front 47

OCCLUSAL ADJUSTMENT IS NOT INDICATED FOR

Back 47

AS A CURE FOR BRUXISM
TO PREVENT FUTURE TMD

Front 48

Goals of Occlusal Adjustment Technique

Back 48

•Promote Masticatory Comfort and Efficiency
•Allow Proper Esthetics and Phonetics
•Be Compatible With Periodontal Health
•Provide Stable Contacts From CO to MIP
•Provide Smooth Excursive Movements
•Directs Occlusal Forces Axially

Front 49

Guidelines of the Occlusal Adjustment Technique:
1. Equilibrate Teeth After:

Back 49

•RESOLVING SYMPTOMS (Splint
•or minor adjustment).
•PROVING FEASIBILITY ON DIAGNOSTIC CASTS
•LOADING OF CONDYLES WITHOUT TENSION/TENDERNESS

Front 50

Guidelines of the Occlusal Adjustment Technique:
2. treatment planning

Back 50

CONSERVATION -- MINIMIZE ALTERATIONS TO THAT WHICH WILL MEET TX GOALS
•PERFORM ON DIAGNOSTIC CASTS FIRST!

Front 51

Guidelines of the Occlusal Adjustment Technique:
3. NEFF’S RULE OF THIRDS
(CUSP TIP TO CENTRAL GROOVE)

Back 51

•NEAR GROOVE -- OKAY
•MIDDLE THIRD -- CAUTION
•NEAR CUSP TIP – STOP
•Clarifies if adjustment is doable or should you consider other tx options such as ortho, restorative or surgery.

Front 52

Guidelines of the Occlusal Adjustment Technique
4:Maintain ________ dimension of occlusion

Back 52

vertical

Front 53

Principles of the Occlusal Adjustment Technique
5. ADJUST SHEAR CUSPS – SPARE STAMP CUSPS

Back 53

Don’t shorten stamp cusps! Narrow stamp cusps before reshaping fossae.

Front 54

Guidelines of the Occlusal Adjustment Technique
6.MAINTAIN AT LEAST ONE _________STOP FOR EACH TOOTH

Back 54

stabilizing

Front 55

Guidelines of the Occlusal Adjustment Technique
7. PROVIDE _____________STOPS - WHEN POSSIBLE

Back 55

anterior

Front 56

Guidelines of the Occlusal Adjustment Technique
8. PRESERVE OR IMPROVE __________

Back 56

esthetics

Front 57

Guidelines of the Occlusal Adjustment Technique
9. LOAD THE MANDIBLE DURING EXCURSIONS WHEN MARKING ______________ (Bilateral manipulation)

Back 57

interferences

Front 58

Principles of the Occlusal Adjustment Technique
10. A FULL __________MAY TAKE LONGER THAN ONE VISIT.

Back 58

equilibration

Front 59

Where to Grind?

Back 59

Adjust inclines, not stamp cusp tips.

Front 60

The Three Golden Rules of Occlusion

Back 60

1.The first Golden Rule is to have bilateral and even occlusal contact.
2.The second Golden Rule is posterior teeth disclusion, or anterior and canine guidance.
3.the third Golden Rule of Occlusion is an unobstructed envelope of function.

Front 61

any deviation from normal occlusion

Back 61

malocclusion

Front 62

Class 1 Malocclusion

Back 62

crossbite
anterior crowding
open bite
midline deviation
loss of posterior support
bruxism

Front 63

crossbite anterior tx

Back 63

selective grinding
limited ortho
extensive rehab

Front 64

crossbite bilateral posterior tx

Back 64

ortho
restorative
-pallative
-provide canine guidance
orthognathic surgery

Front 65

open bite-anterior tx

Back 65

provisional plateau on lingual surface of maxillary anterior teeth guidance
extraction of third molars can help
occlusal reduction of lateral teeth
create canine guidance , resin or porcelain on lingual
invasive: vrown lengthening, endo, complex rehab

Front 66

Class 2-1 maloccclusion tx

Back 66

alleviate/eliminate interferences, favor the anterior portion
restorative
orthognathic surgery

Front 67

class 2-2 malocclusion tx

Back 67

centric contact in anterior region
selective grinding or restorative

Front 68

class 3 malocclusion tx

Back 68

stable occlusion posterior guidance
extraction of lower 3rd molars may help
orthognathic surgery and or restorative
possibly do nothing

Front 69

determinants of occlusion

Back 69

1.two condyle/disc assemblies
2. teeth
3. neuromuscular system

Front 70

posterior/fixed determinates
produces axises for rotation, translation and other mandibular movements

Back 70

condyle/disc assembly

Front 71

anterior determinate
Consist of the inter-occlusal contacting points and inclines of cusps of the opposing arches
They are variable:
(1) Modified by nature through Occlusal Wear, Drifting, Loss of Teeth, Extrusion
(2) Modified by man:
(a) Occlusal reshaping
(b) Occlusal restoration

Back 71

teeth

Front 72

Programmed by the teeth, more specifically the proprioceptive fibers in the PDL.
Conscious response: 1. Protective 2. Physiologic activity (chewing, swallowing, speech)
Subconscious response:
Pathologic
1.Bruxism
2.Other Parafunctional Habits

Back 72

neuromuscular system

Front 73

1. The anterior determinant of mandibular movement.
2. It is the effect of tooth inclines on the envelope of motion and the envelope of function.
3. Can be defined as the dynamic relationship of the mandibular anterior teeth against the maxillary anterior teeth through all ranges of function
4. It is completely independent of condylar guidance, and is more important than condylar guidance as a determinant of posterior occlusal form.

Back 73

Anterior Guidance in the Natural Dentition

Front 74

Function of Anterior Guidance: Anterior tooth position

Back 74

incise food
aid in speech
aid in esthetics
protect the posterior teeth by directing the teeth together in MIP so that the closing forces will be verticall directed onto the posterior teeth

Front 75

anterior guidance is affected by:

Back 75

posterior of the anterior teeth
patients arch relationship
degree of overbite
degree of overjet

Front 76

In patients with normal jaw relationships the vertical and horizontal overlap of anterior teeth and the lingual concavities of the maxillary incisors are highly significant during protrusive movements.

In lateral excursions the tooth contacts normally exists between the canines and those contacts usually dominant that movement.

Back 76

canine guidance and disclussion

Front 77

Pronounced vertical overlap of the anterior teeth:
1. Permits posterior teeth to have _______cusps
2. Greater the degree of separation of the posterior teeth

Back 77

longer

Front 78

Minimum anterior vertical overlap:
1. Require ______cusps
2. Lesser degree of separation of the posterior teeth

Back 78

shorter

Front 79

Pronounced horizontal overlap of the anterior teeth:
Requires _____cusps of the posterior teeth
Lesser degree of separation of the back teeth
A minimum anterior horizontal overlap permits the posterior cusps to be ________.

Back 79

short
longer

Front 80

Customized Anterior Guide Table:
When preparation of anterior teeth is considered, the exact nature of the anterior contact should be _________ to the articulator. Where it can be _______and _________before these teeth are prepared.

Back 80

transferred
studied
stored

Front 81

when is group function viable?

Back 81

1- When it is already present and there are no adverse effects present
2- When Distribution of Excursive Stresses is advisable
Such as:
Presence of Bone Loss around Teeth
Extensively Restored Teeth
Loss of Bony Support around Canine Tooth
Presence of Canine Wear

Front 82

steps in forming an anterior guide table

Back 82

1. raise incisal guide pin 2mm
2. lubricate the pin and acrylic stop table and lingual max incisors with MRA
3. form ball of triad and place on the table. form triad over the sides of the table for stability
4. manipulate the articulator in a hinge and a range of lateral and protrusive movements. *note* make sure the anterior teeth are touching in all movements. make sure each movement include the entire incisal edge to edge
5. excess is trimmed, so table doesnt interfere with the hinge opening-closing arc of the articulator
6. incisal pin should contact the table in all excursive movements

Front 83

Difficulty breathing during sleep due to
obstructed nasal passages or collapsed oral airway

Back 83

sleep disordered breathing

Front 84

Classified as the most moderate
manifestation of sleep disordered breathing
Considered an indication of the existence
or onset of a sleep breathing disorder

Back 84

snoring

Front 85

Complete loss of airway patency
Patients demonstrate inspiration flow levels
while asleep that are 50% less than when they
are awake
Defined by the National Heart Lung and Blood Institute as repeated episodes of no breathing for at least 10 seconds at a time called apneic events

Back 85

obstructive sleep apnea

Front 86

Occurs when soft tissue in the upper
airway collapses causing a blockage
Breathing stops for 10 seconds or longer
Frequently happens hundreds of times per night

Back 86

Obstructive sleep apnea

Front 87

2 types of Apnea

Back 87

Central Sleep Apnea
Obstructive sleep apnea

Front 88

Neurological disorder
Occurs when the brain fails to send the
appropriate signals to the muscles that
initiate respiration

Back 88

Central Sleep Apnea

Front 89

Obstructive Sleep Apnea is a ________ __________ condition. When left
untreated it takes an average of
eight years off a person’s life!

Back 89

life threatening

Front 90

Signs and Symptoms OSA

Back 90

Excessive daytime tiredness
Snoring
Hypertension
Morning headaches
Acid Reflux (GERD)
Menopause (Hormone deficiency) in women
Obesity
Large neck circumference

Front 91

apnea hypopnea index

Back 91

number of apneic and hypopneic
events that occur during the night (basically
a count of all the times a patient stops breathing)

Front 92

AHI: 5-15 events is

Back 92

mild

Front 93

AHI: 15-30 events is

Back 93

moderate

Front 94

AHI: >30 events is

Back 94

severe

Front 95

SDB divided into three categories

Back 95

snoring
upper airway resistance syndrome
obstructive sleep apnea-most severe

Front 96

What Causes OSA in Children

Back 96

Large tonsils and/or adenoids
Children with narrow maxillary arch
development
More common in overweight children
Some children with enlarged tonsils/adenoids may be underweight
Younger children with sleep apnea may have
delayed growth because of disruptio

Front 97

High Risk for OSA in Children

Back 97

Narrow facial bone structure
History of cleft palate
Down Syndrome
Children with allergies
Asthma
Reflux
Frequent sinus infections
Family history

Front 98

The pathology behind snoring and OSA is the ______.

Back 98

same

Front 99

An unstable airway causes both what?

Back 99

snoring and osa

Front 100

Not all _______have OSA. It is the most noticeable symptom.

Back 100

snorers

Front 101

How is Sleep Disordered Breathing treated?

Back 101

CPAP
Surgery: 30-50% effective

Front 102

CPAP stands for?

Back 102

Continuous Positive Air Pressure

Front 103

Characteristics of CPAP

Back 103

•The ‘Gold Standard’ for treatment of OSA.
•CPAP is prescribed to nearly 100% of the medically diagnosed OSA patients.
•Efficacy is close to 100% if patient can stand the pressure.
•CPAP delivers room air under pressure through a nasal mask.
•Air pressure creates a pneumatic splint that holds the airway open.

Front 104

ESS score below what is considered normal?

Back 104

8

Front 105

It is well documented there is considerable overlap of ________and _______ in patients with TMD’s and CSD’s , especially those patients with myogenous TMD’s

Back 105

signs
symptoms

Front 106

Cervical Disorders are very _______associated with TM Disorders

Back 106

often

Front 107

Cervical and Central excitation of cervical sensory and motor neurons stimulates trigeminal motor neurons, causing an increase in _________ _________ activity

Back 107

masticatory muscle

Front 108

Reported to be the most common cervical nerve disorder.

Back 108

Lesser Occipital Neuralgia

Front 109

Commonly seen after trauma such as extension/flexion injuries.

Back 109

Lesser Occipital Neuralgia-medications rarely provide any lasting relief

Front 110

Lesser Occipital Neuralgia symptoms

Back 110

1. Occipital pain which may or may not be unilateral.
2. Pain radiating from the occiput in and through the parietal and temporal regions to the anterior temporal, zygomatic and frontal portions of the head.
3. Pain and/or pressure behind the ipsalateral eye
4. Pronounced photophobia on the affected side
5. Nausea when the pain becomes severe
6. Pain radiating into the ipsalateral ear, shoulder, and at times, the arm

Front 111

The cervical sympathetic chain connects with this large nerve

Back 111

Greater Occipital Neuralgia

Front 112

The symptoms of greater occipital neuralgia are ______ yet ________ _________from those of lesser occipital neuralgia

Back 112

similar
distcintly
different

Front 113

As with lesser occipital neuralgia, neuralgia of the greater occipital nerve produces _____ and __________pain that radiates to the vertex, temporal, periorbital regions, and the mandible

Back 113

occipital
suboccipital

Front 114

The pain is characterized as a _______, ________pain which, when severe, is perceived as driving pain on which shock like jabs may be superimposed

Back 114

dull
constant

Front 115

Joint Vibration Analysis allows you to ....

Back 115

view specific vibration patterns
-certain causative/dysfunctions have certain patters

Front 116

Diagnostics for TMD

Back 116

clinical examination
imaging
biometrics
lab studies
photographs

Front 117

biopak components for determining TMDs

Back 117

joint vibration analysis
electrognathology
electromyography
mastication analysis

Front 118

imaging used to help diagnose TMDs

Back 118

plane films
hypocycloidal tomography
ct scans
mri