OCCLUSION IN FIXED PARTIAL DENTURE .pptx

Long- term success of a restoration is dependent on maintenance
of occlusal harmony between the various components.

In health, the occlusal anatomy of the teeth functions in harmony with structures controlling the movements patterns of the mandible.

Stomatognathic system is designed to dissipate the forces of mastication to the supporting structures.

1. OCCLUSION IN FIXED PARTIAL DENTURES PRESENTER: DR. KRUTIKA CHIKORDE. 2 nd YEAR POSTGRADUATE DEPT. OF PROSTHODONTICS, AND CROWN AND BRIDGE COLLEGE OF DENTAL SCIENCES, DAVANGERE . STAFF INCHARGE: DR. VEENA PRAKASH MAM. PROFESSOR, DEPT. OF PROSTHODONTICS AND CROWN AND BRIDGE, COLLEGE OF DENTAL SCIENCES, DAVANGERE .

2. CONTENTS : Introduction Definitions and Terminologies Evolution of Occlusion Ideal occlusion Optimal occlusion Organization of occlusion Occlusal determinants Occlusal schemes

3. Planning of Occlusion Methods to evaluate occlusal relationship. Normal versus pathogenic occlusion Occlusal interferences Occlusion development by different techniques Summary Conclusion References

4. INTRODUCTION- Long- term success of a restoration is dependent on maintenance of occlusal harmony between the various components. In health, the occlusal anatomy of the teeth functions in harmony with structures controlling the movements patterns of the mandible. Stomatognathic system is designed to dissipate the forces of mastication to the supporting structures. Requirements of ideal occlusal contact relationships- a) It should be within the adaptive capacity of the patient. b) To restore and maintain heath and function of the stomatognathic system. c) Simultaneous bilateral contact of opposing posterior teeth must occur in centric occlusion.

5. Most dentists are aware of the importance of the good marginal adaptation of their crowns and bridges. Many dentists do not appreciate the potential consequences of poor occlusal contacts. To maintain an occlusion that will function in harmony with the other components of masticatory mechanism, thereby preserving their health at the same time providing optimum masticatory function .

6. DEFINITIONS AND TERMINOLOGIES- OCCLUSION (GPT-9) -The act or process of closure or of being closed or shut off. -The static relationship between incising or masticating surfaces of the maxillary or mandibular teeth or tooth analogues. ARTICULATION (GPT-9) The static and dynamic contact relationship between the occlusal surfaces of the teeth during function.

7. CENTRIC RELATION (GPT-9) - The maxillomandibular relationship in which the condyles articulate with the thinnest avascular portion of their respective disks with the complex in the anterior-superior position against the slopes of the articular eminencies. - This position is independent of tooth contact. - This position is clinically discernible when the mandible is directed superiorly and anteriorly.

8. CENTRIC OCCLUSION (GPT-9) -The occlusion of opposing teeth when the mandible is in centric relation. -This may or may not coincide with the maximum intercuspation.

9. MAXIMUM INTERCUSPATION (GPT-9) -The complete intercuspation of the opposing teeth independent of condylar position , sometimes referred to as the best fit of the teeth regardless of the condylar position - called also maximal intercuspation. Normal Occlusion -Normal occlusion implies a situation commonly found in the absence of disease . -It should include not only a range of anatomically acceptable values but also physiological adaptability. -It is always a range never a point. Physiologic Occlusion -A static and dynamic relationship of the teeth combining minimum stress on TMJ, optimal function of the orofacial complex, stability and esthetics of the dentition and protection and health of periodontium.

10. Traumatic Occlusion -An occlusion judged to be causative factors in the formation of traumatic lesions of disturbances in the orofacial complex . Therapeutic Occlusion -It is a treated occlusion employed to counteract structural inter-relationship related to traumatic occlusion. Pathogenic Occlusion -A pathogenic occlusion is defined as an occlusal relationship capable of producing pathologic changes in the stomatognathic system.

11. EVOLUTION OF OCCLUSION- Bonwill (1858) - Concept of Bilateral Balanced occlusion and developed an articulator that applied his 4-inch triangular theory. Balkwill (1866) - The translating condyle moved medially during lateral jaw movement. Von Spee (1890) - Occlusal plane of the teeth followed a curve in the sagittal plane.

12. Christensen (1901) - Observed the opening of the posterior teeth in mandibular protrusion (Christensen phenomenon). Bennet (1908) - Described the immediate side shift (Bennet movement). Alfred Gysi (1927) - Balanced occlusion on a Removable Denture. Stuart and McCollum (1955) - Fully Balanced Occlusion on fixed partial dentures .

13. Mann and Pankey (1960) - Group function occlusion D’Amico (1961) - Cuspid Guidance Gutierrez MF, - Preservation of Natural Cavada G, Valenzuela S (2010) Occurring Occlusion . Frank Spear (2013) - Occlusion defined by Patient’s Physiologic Capability of Compensation

14. IDEAL OCCLUSION- Ideal Occlusion - Hobo (1978) -Ideal occlusion can be defined as an occlusion which is compatible with stomatognathic system providing efficient mastication and good esthetics without creating physiologic abnormalities. Importance of Ideal Occlusion- Use it as a benchmark for the assessment of pre-treatment records and examination (diagnostic cast). Correcting the TMD and occlusal interferences (if they exist) before commencing restorative procedures. For final prosthodontic rehabilitation – a confirmative and re-organized approach.

15. OPTIMAL OCCLUSION- In the placement of restorations , one must strive to produce for the patient an occlusion that is as nearly optimum as his or her skills and the patient’s oral condition will permit. The criteria for such an occlusion have been described by Okeson- , In closure , the condyles are the most super-anterior position against the discs on the posterior slopes of the eminences of the glenoid fossa.

16. 2. The posterior teeth are in solid and even contact and the anterior teeth are in slightly light contact. 3. Occlusal forces are in the long axes of the teeth. Shillinberg HT, Hobo S, Whitsett LD, Fundamentals of FPD.3 rd ed.Chicago;1997.p.85-86

17. 4. In the lateral excursions, working side contacts (preferably on canines) disocclude or separate the non- working teeth instantly. 5. In protrusive excursions , anterior tooth contacts will disocclude the posterior teeth. 6. In an upright posture, posterior teeth contact more heavily than do anterior teeth.

18. ORGANIZATION OF OCCLUSION- Three recognized concepts- Bilateral Balanced Occlusion Unilateral Balanced Occlusion Mutually protected Occlusion Rosenstiel, Land, Fujimoto .Contemporary Fixed prosthodontics.5 th ed. However, since restorative treatment requirements vary, the clinician should understand possible combinations of occlusal schemes and their advantages, dis advantages and indications.

19. BILATERAL BALANCED OCCLUSION In 1935 , Schuyler developed the first detailed technique for occlusal adjustment. By 1953 he began to observe failure of natural dentition restored with balance. His observations and suggestions effectively signaled the end of BALANCE as an acceptable treatment approach for the dentulous patient. Stuart and Stallard (1960) noted that balanced occlusion in reconstructed natural dentitions 1.Often required injudicious increase in occlusal vertical dimension to achieve balance. 2. Often led to instability of occlusion. 3. Frequently showed increased wear of teeth and restorations Thus the concept of a unilateral balanced occlusion (group function) evolved.

20. B. UNILATERAL BALANCED OCCLUSION Multiple contact relations between the maxillary and mandibular teeth in lateral movements on the working-side whereby simultaneous contact of several teeth acts as a group to distribute occlusal forces. Here excursive contact occurs between all opposing posterior teeth on the laterotrusive (working) side only. On the mediotrusive (non-working) side, no contact occurs until the mandible has reached centric relation. Glossary of Prosthodontic Terms, Edition Nine, J Prosthet Dent 2017;117 (5S):e1-e105 (GROUP FUNCTION OCCLUSION)

21. ADVANTAGES: Group function of the teeth on the working side distributes the occlusal load. The absence of contact on the nonworking side prevents those from getting subjected to destructive ,obliquely directed forces found in nonworking interferences. It also saves centric holding cusps that is mandibular buccal cusps and maxillary palatal cusps from excessive wear. In the presence of anterior bone loss or missing canines, mouth should be restored to group function.

22. C. MUTUALLY PROTECTED OCCLUSION (CANINE GUIDED OCCLUSION) Rosensteil SF, Land MF, Fujimoto J. Contemporary fixed prosthodontics. 3 rd ed.St.Louis : Elsevier;2000.p.110-144 During the early 1960s, an occlusal scheme called as mutually protected occlusion was advocated by Stuart and Stallard, based on the earlier work by D’Amico. In this arrangement, centric relation coincides with maximum intercuspation position. The six anterior maxillary teeth, together with six anterior mandibular teeth, guide excursive movements of mandible, and no posterior occlusal contacts occurs during any lateral or protrusive excursions.

23. Advantages- Patients tolerance Ease of construction Disadvantages- Periodontally weak anterior teeth Missing canine Class II and class III situations Cross-bite situations.

24. Features of mutually protected occlusion- Uniform contact of all teeth around the arch when the mandibular condylar processes are in their most superior position. Stable posterior tooth contacts with vertically directed resultant forces. Centric relation coincident with maximum intercuspation ( intercuspal postion ). No contact of posterior teeth in lateral or protrusive movements . Anterior tooth contacts harmonizing with functional jaw movements.

25. Anterior teeth are suited for guidance by the virtue of – Canines having longest, strongest roots. Good crown to root ratio The load being reduced by distance from the fulcrum as the lever arm increases. Location is far from the TMJ thus receiving less stress. The proprioceptive threshold and concomitant reflexes reducing the load. Surrounded by dense compact bone which tolerates forces better. It has many receptors in the periodontal ligament so it controls lateral pressure by directing vertical masticatory movements. Dawson P. Evaluation and Diagnosis of Occlusion.St.Louis:Mosby Elsevier;2007 The farther anterior a tooth is located, the less the influence of the TMJ and the greater the influence of the anterior guidance (AG).

26. D. OTHER CONCEPTS OF OCCLUSION Gnathological concept (1960) Organic Occlusion by THOMPSON (1967) BEYRON’S Occlusal Concepts Biologic or Physiologic Occlusion Neuromuscular concept or Myocentric Concept

27. OCCLUSAL DETERMINANTS Posterior controlling factor (CONDYLAR GUIDANCE) Anterior controlling factor (ANTERIOR GUIDANCE) The anatomic determinants of mandibular movements i.e., anterior guidance and condylar guidance have a strong influence on the occlusal surface morphology of the teeth being restored.

28. CONDYLAR GUIDANCE / POSTERIOR DETERMINANT- The angle at which the condyle moves away from a horizontal reference plane is referred to as the CONDYLAR GUIDANCE ANGLE. As the condyle moves out of centric relation it descends along the articular eminence. The condylar movements depends on the steepness of eminence. If the articular eminence is steep, the condyle describes a steep vertically inclined path and if flatter, the path is less vertically inclined.

29. Right & left TMJ & associated structures. Posterior determinants of occlusion-A) Angle of the articular eminence (condylar guidance angle). 1. Flat; 2. average; 3. steep. - B) Anatomy of the medial walls of the mandibular fossae. 1. Greater than average; 2. average; 3. minimal sideshift .

30. Mandibular lateral translation - Immediate mandibular lateral translation Gradual mandibular lateral translation In immediate lateral translation (side shift) ,the cuspal height is shorter or the fossa width wider . In gradual lateral translation (no side shift), the cuspal height is longer or the fossa be narrower. Ridges and groove direction are affected by the condylar path, particularly the lateral translation. Working Condyle

31. 2. ANTERIOR GUIDANCE / ANTERIOR DETERMINANT- PROTRUSIVE INCISAL PATH- The track of the incisal edges from the maximum intercuspation to edge- edge occlusion is termed as PROTRUSIVE INCISAL PATH. It ranges from 50-70 degrees and is often 5-10 degrees steeper than the sagittal condylar guidance.

32. Anterior guidance which is linked to the combination of vertical and horizontal overlap of the anterior teeth, can affect the occlusal morphology of the posterior teeth. a) Vertical Overlap and cuspal height b) Horizontal Overlap and cuspal height

33. The occlusal scheme can be classified by the location of the occlusal contact made by the functional cusp on the opposing tooth in the centric relation. They are mainly four types - Cusp- fossa Cusp –Marginal ridge Surface-surface contact Tripod contacts OCCLUSAL SCHEMES

34. C USP FOSSA OCCLUSAL SCHEME CUSP-MARGINAL RIDGE OCCLUSAL SCHEME

35. SURFACE -TO-SURFACE CONTACT TRIPODIZATION

36. CLASSIFICATION OF OCCLUSAL SCHEMES- CUSP-FOSSA CUSP –MARGINAL RIDGE LOCATION OF OCCLUSAL CONTACT ON OPPOSING TEETH Occlusal fossae only Marginal ridges and occlusal fossae RELATION WITH OPPOSING TEETH Tooth-to- tooth Tooth-to-two teeth Advantages Occlusal forces are directed parallel with the long axis of the tooth; these forces are near the centre of the tooth. Most natural type of occlusion and is found in 95 % of all adults ; it can be used for single restorations . Disadvantages Used only when restoring several contacting teeth and the tooth opposing them. Food impaction and the displacement of the teeth may arise if the functional cusps wedge into lingual embrasure. Application Full –mouth rehabilitations Most Cast Restorations

37. PLANNING OF OCCLUSION Whether to take - Centric occlusion (or) MIP (or) Long centric (Freedom from centric) ?? Centric occlusion (CO) is the position of choice: When there are insufficient occlusal contacts to relate the mandible to the maxilla (to relate the diagnostic casts) in a stable consistent relationship. When eccentric contacts are to be made.

38. MIP is the position of choice: When stable, the maximal occlusal contacts exist with no evidence of pathosis . After any anterior or mediolateral deflection from centric relation have been adjusted. Long centric (Freedom from centric) According to Peter Dawson “ it is the freedom to close the mandible either into centric relation or slightly anterior to it without varying the vertical dimension at the anterior teeth”.

39. ASSESSMENT OF OCCLUSION - Clinical examination- This is done to reveal signs and symptoms of occlusal pathosis .

40. Radiographic Survey - There are certain radiographic signs that are indicative of pathologic changes that may be caused by the occlusion . Radiographic signs of occlusal pathosis are : a) Widening of PDL space b) Angular bony defects Thickening c) Changes in lamina dura Thinning

41. Mounted Diagnostic casts - Occlusal plane and occlusal contacts study to facilitate and aid in the designing the Occlusal scheme of FPD. Factors to be studied on the Mounted diagnostic Casts - Centric occlusion(CO),MIP and initial tooth contacts. Plane Of Occlusion.

42. Plane of Occlusion - The plane of occlusion of the natural dentition can be visualized as an imaginary \curved plane that connects the incisal edges of the anterior teeth with the cusp tips of the posterior teeth. The curvatures of anterior teeth are determined by: Esthetically correct smile line. The relationship of the mandibular incisal edges to the anterior guidance & phonetics.

43. Anteroposterior curve (curve of spee ) – First described by Ferdinand Spee, in 1890 The anatomic curve established by the occlusal alignment of the teeth, as projected onto the median plane, beginning with the cusp tip of the mandibular canine and following the buccal cusp tips of the premolar and molar teeth, continuing through the anterior border of the mandibular ramus, ending with the anterior most portion of the mandibular condyle. Assists in obtaining protrusive balance.

44. Mediolateral curves – Curve of Wilson : George Wilson , in 1911. The curve that is convex downwards. The lower teeth are inclined lingually, giving prominence to the buccal cusps and bringing them into heavy occlusal contact with the upper buccal cusp during lateral movements on the working side. 2. Reverse curve or anti-Monson curve: A curve of occlusion that is convex upwards. This is usually used to arrange the first premolars.

45. 3. Curve of monson : George S. Monson Curve of occlusion in which each cusp and incisal edge touches or conforms to a segment of the surface of a sphere 8 inches in diameter with its centre in the region of the glabella. Combination of ‘curve of spee and curve of Wilson. 4. Pleasure curve: In excessive wear of the teeth, the obliteration of the cusps and formation of either flat or cupped-out occlusal surfaces, associated with the reversal of the occlusal plane of the premolar, first and second molar teeth, (the third molars being generally unaffected), whereby the occlusal surfaces of the mandibular teeth slope facially instead of lingually and those of the maxillary teeth incline lingually. Combination of monson and anti- monson curves

46. NORMAL OCCLUSION V/S PATHOLOGIC OCCLUSION A pathogenic occlusion is defined as an occlusal relationship capable of producing pathologic changes in the stomatognathic system . (GPT-9) In such occlusions sufficient disharmony exists between the teeth and the TMJs to result in symptoms that require intervention. Signs and symptoms of pathogenic occlusion: Teeth Mobility Open contacts Abnormal wear like fracture or chipping of incisal edges.

47. Periodontium Chronic periodontal diseases Widened PDL space (radiographically) Tooth movement and a compromised C:R ratio. Musculature Acute and chronic muscular pain due to the bruxism Trismus due to no relaxation of elevator muscle TMJ Pain, clicking or popping due to muscular origin or internal derangement of joint. Unilateral clicking with midline deviation due to displaced disc Shillingburg HT, Hobo S, Whitsett LD, Jacobi R, Brakett SE. Shillinburg's Fundamentals Of Fixed Prosthodontics.4th ed. Chicago: quintessence;2012

48. Short term treatment- Occlusal splints /devices Serve to deprogram the occlusion such that future restoration in centric relation is easily accomplished. Acts as a diagnostic tool determining if a proposed change in the occlusal scheme tolerated by patient. Definitive treatment- Compromising individually or in combination. Elimination of deflective occlusal contacts through elective grinding of interfering inclines. Replacement of missing teeth to produce a more favourable distribution of force. PATHOGENIC OCCLUSION TREATMENT -

49. OCCLUSAL INTERFERENCES Working interferences Non-working interferences Centric interferences Protrusive interferences Shillinberg HT, Hobo S, Whitsett LD, Fundamentals of FPD.3 rd ed.Chicago;1997.

50. There may be an occlusal disharmony (shaded bar) that is not ideal but is tolerated by the patient because it is below his or her threshold of perception and discomfort. If the threshold is lowered, the disharmony that had been previously tolerated may produce symptoms in the patient. Treatment is then rendered by first raising the patient’s threshold and then decreasing or eliminating the disharmony. Shillinberg HT, Hobo S, Whitsett LD, Fundamentals of FPD.3 rd ed.Chicago;1997. PATIENTS ADAPTABILITY -

51. EQUILIBRATION PROCEDURES - Reduction of interferences in Centric Relation Selective reduction of interferences in lateral excursions Elimination of all posterior interferences during protrusive excursions Harmonization of anterior guidance

52. Dawson E.P. Functional Occlusion From TMJ To Smile Design.1st Ed. St. Louis: Elsevier;2009. p. 189-198 Selective Grinding for Occlusal Equilibration

53. CENTRIC RELATION INTERFERENCES CAN BE DIFFERENTIATED INTO TWO TYPES: Interference to the arc of closure Interference to the line of closure Interference to the arc of closure - As the condyles rotate on their centric relation axis, each lower tooth follows an arc of closure Any interference  condyles displaced downward and forward  anterior slide

54. Basic grinding rule to correct anterior slide - MUDL

55. 2. Interference to the line of closure - Primary interferences that cause the mandible to deviate to left or right from first point of contact in CR to most closed position.

56. 1. If the interfering incline causes the mandible to deviate off the line of closure toward the cheek , grind the Basic grinding rules- BULL

57. Basic grinding rules- 2. If the interfering incline causes the mandible to deviate off the line of closure toward the tongue , grind the LUBL

58. LATERAL EXCURSION INTERFERENCES: Dictated by two determinants: 1. The border movements of the condyles 2. The anterior guidance When lateral excursions are being equilibrated, the mandible must be guided with firm upward pressure through the condyles to ensure that all interferences are recorded and eliminated through the uppermost ranges of motion that can occur at true border paths for both the condyles and the anterior guidance.

59. ELIMINATING EXCURSIVE INTERFERENCES Protrusive interferences, Interferences of the working side Interferences of the balancing side

60. PERFECTED OCCLUSION DOTS IN BACK... LINES IN FRONT... This is the ideal result of marking with a red ribbon while the patient grinds the teeth together in all excursions.

61. Note the posterior interferences prevent any excursive contact on the anterior teeth. Grind all red marks on posterior teeth. Do not touch any black marks. Marks that might look insignificant can be potent triggers for activating muscle hyperactivity and can prevent the turning off of the elevator muscles that occurs when posterior disclusion is complete.

62. DUML: Grind the Distal inclines of the Upper or, in some instances, the Mesial incline of the Lower teeth. PROTRUSIVE INTERFERENCES: DUML

63. VERIFICATION OF COMPLETION - Ask the patient to clench the teeth together and squeeze firmly (empty mouth). If the patient can feel any discomfort in any tooth, the equilibration is not complete. T o confirm whether the problem is or is not related to occluso -muscle pain. If the anterior splint completely separates all the posterior teeth, all discomfort will dissipate if the cause of the discomfort is totally related to occlusion.

64. METHODS TO EVALUATE OCCLUSION 1) Quantitative method - Sequence and density of contacts can be differentiated. a) Virtual dental patient b) T-Scan system 2) Qualitative method - Density of the contacts can be evaluated. a)Wax, articulating paper b) Shimstock foils c) Silk strips d) Occlusal tapes Ramakrishna Rajan Babu, Sanjna Vibhu Nayar . Occlusion indicators: A review. J Indian Prosthodont Soc. 2007;7(4):170-174.

65. Articulating paper - Articulating papers are the most frequently used qualitative indicators to locate the occlusal contacts intraorally. They differ in terms of width, thickness and the type of the dye impregnated. They are hydrophobic in nature.

66. On occlusal contact, the coloring agent is expelled from the film and the bonding agent binds it on to the tooth surface. The characteristic marking is observed as a central area that is devoid of the colorant and surrounded by a peripheral rim of the dye. This region is called “target” or “iris” owing to their appearance, and it denotes the exact contact point.

67. OCCLUSAL DEVELOPMENT 1) Functionally generated path technique by Meyers (1933) 2) Pankey -Mann- Schulyer Philosophy by L.D.Pankey . 3) Hobo’s Twin Table Philosophy by Sumiya Hobo

68. Pankey –Mann Schyuler Philosophy by LD Pankey - Shetty Et al . PHILOSOPHIES IN FULL MOUTH REHABILITATION – A SYSTEMATIC REVIEW. IJDCR 2013; 3(3): 30-39.

69. Hobo’s Twin Table philosophy by Sumiya Hobo - Shetty Et al . PHILOSOPHIES IN FULL MOUTH REHABILITATION – A SYSTEMATIC REVIEW. IJDCR 2013; 3(3): 30-39.

70. Shetty Et al . PHILOSOPHIES IN FULL MOUTH REHABILITATION – A SYSTEMATIC REVIEW. IJDCR 2013; 3(3): 30-39.

71. DIAGNOSTIC WAX-UP PRINCIPLE - The diagnostic wax-up is the process of converting a programmed treatment plan into a three-dimensional visualization. Steps in the diagnostic wax-up - Step 1: Mount upper and lower casts with centric relation bite record and facebow. Step 2: Verify the accuracy of the mounting. Step 3: Examine the occlusal relationship on the casts.

72. Step 4: Lock the centric latch when observing the casts and determine the correct vertical dimension Step 5: Return the condyles to centric relation and lock the centric lock. Step 6: Observe the teeth that were reshaped, Remove unsavable teeth from the casts. Step 7: Equilibration is the first treatment option to explore. Step 8: Examine the plane of occlusion. Step 9: Establish stable holding contacts on the anterior teeth. Step 10: Correct lower incisal edges if needed. Step 11: Re-evaluate the total occlusion with the upper cast to see how it can be adapted to occlude with the lower arch.

73. SUMMARY RESTORING DIFFERENT COMBINATIONS PROSTHESIS POSITION ICP /CR ARTICULATOR AND RECORDS OCCLUSAL MORPHOLOGY Single Crown ICP Simple Hinge Conform to occlusal morphology FPD-one Quadrant ICP Semi adjustable /anterior guidance Conform to occlusal morphology Several Quadrants Long Centric Fully adjustable /anterior guidance and condylar guidance Group function is desired /cusp to fossa

74. CONCLUSION Occlusion is the integrated relationship of the tooth, periodontium ,TMJ and neuro musculature, and not merely the interdigitation of the tooth. There is a complex interaction of many components of masticatory system. Changes in one component would affect the entire system. One who practices the restorative dentistry should appreciate their significance for the long term successful restorations by maintaining the occlusal integrity. There is no one answer to occlusal problems, the dentist should use the philosophy that works best in his own hands and at the same time do the most good, or better yet, the least harm to the patient.”

75. Dawson; Functional occlusion From TMJ To Smile Design – 1 st edt . Dawson; Evaluation, diagnosis & treatment of occlusal problems Okeson; Management of temporomandibular disorders and occlusion – 8 th edt . Shillingburg , Hobo, Whitsett, Jacobi, Brackett; Fundamentals Of Fixed Prosthodontics – 3 rd edt . Takayama and hobo; Oral rehabilitation: Clinical determination of occlusion. Rosensteil , Land, Fujimoto; Contemporary Fixed Prosthodontics – 5 th edt . REFRENCES TEXTBOOKS -

76. SCIENTIFIC JOURNALS- Ogawa, Ogimoto . Pattern Of Occlusal Contacts In Lateral Position: JPD 1998;80:67-74. Schuyler. Factors of Occlusion As Applicable To Restorative Dentistry; JPD 1953;3: 772-15. Pokorny, Wiens, Litvak. Occlusion For Fixed Prosthodontics – A Historical Perspective of the Gnathological Influence; JPD 2008;99:299-313. Johnson. Variations in Organic Occlusion ; JPD 1979;41:625-629. Clark JR, Evans RD. Functional Occlusion: A Review; JO 2001;28(1):76-81. Babu RR, Nayar SV. Occlusion indicators: A review. J Indian Prosthodont Soc. 2007;7(4):170-174.

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