Real World Occlusion: It’s Not Just the Teeth

A dentist’s guide to function, esthetics and stability of the Maxillomandibular and Craniofacial Complex



Noshir R. Mehta, D.M.D., M.D.S., M.S. Associate Dean of International Relations, Professor and Chairman General Dentistry, Director Craniofacial Pain Center Tufts University School of Dental Medicine

Gerard Kugel, D.M.D., M.S., Ph.D. Associate Dean for Research and Professor of Prosthodontics and Operative Dentistry, Tufts University School of Dental Medicine

In most dental occlusal concepts the primary difference is one of condylar versus muscular positions. This is consistent with the textbook images of saggital condylar positions or the diamond shapes of the lateral excursive movements according to Posselt. However, these concepts do not take into account the three dimensional structures of the craniofacial skeleton due to the relative difficulty of many dentists in visualizing how the muscles, TM Joints and the teeth all function in harmony. Risk indicators of occlusal disharmony include parafunction, trauma, posture, sleep architrecture, psychological and neurologic inputs to the neuromuscular pathways. Finally, management of patient with Temporomandibular and Cranio- Cervical dysfunctions often require the use of intra-oral appliance therapy. Studies however have reported variable results.

Historical perspective suggests that different appliances and different mandibular positions be needed for different types of disorders and that the “one for all” appliance may not be an effective strategy to pursue.

The course will cover:

  • Review of the evidence on occlusal concepts currently in vogue
    • CR, CO and neuromuscular occlusion as it relates to the three dimensional concepts of biologic function, when and how to choose
    • Biologic principles of dental occlusion
  • Role of parafunction and sleep disorders on the longevity of dental stability
  • Risk indicators of TMD that “call out to you” from your patient’s mouth before beginning any dental treatment
  • How and why dental changes can affect the head and neck stability of an individual
  • Merging esthetics and function for long-term stability and health
  • How, when and why to use occlusal splints in the development of a stable occlusion regardless of whether the patient has TMD

Hands-on component will cover:

  • A step-by-step guide to three dimensional examination of the occlusion
  • Hands-on record taking for transfer from the mouth to the articulator that accurately records the position you have chosen
  • Splint fabrication