Functional Occlusion: A Comprehensive Guide to Articulators, Diagnostic Waxing, and Occlusal Splints

Table of Contents

1. What is Functional Occlusion?
2. The Importance of Articulators in Functional Occlusion
   1. Types of Articulators
   2. Using the Hanau H2-PR Articulator
3. Diagnostic Waxing: Restoring Occlusal Function
   1. Steps in Diagnostic Waxing
4. Occlusal Bite Splints: A Key Tool in Managing Occlusal Dysfunction
5. Conclusion

Content summary:

Unit 1: Concepts of Occlusion

• Unified Concept of Occlusion: The chapter introduces the term “occlusion” beyond just the contact between teeth surfaces. It emphasizes that occlusion is a comprehensive concept that includes all functional and dysfunctional relationships between the teeth, supporting structures, joints, and neuromuscular components. This broader definition includes both physiological and psychological aspects of function and dysfunction.
• Functional Occlusion: Definition and Scope: Functional occlusion is defined as the harmonious relationship between the teeth that allows for smooth movements of the mandible without interferences. It emphasizes maximum intercuspation and freedom in centric relation and occlusion. The concept is practical, aiming to improve or restore the function of the masticatory system through occlusal adjustment or restorative procedures.
• Jaw Positions and Movements: This section discusses centric occlusion, centric relation, and mandibular border movements. It explains how the mandible moves within certain boundaries in sagittal and horizontal planes, introducing terms like working side and balancing side movements, and the significance of condylar movement.
• Centric Occlusion: Centric occlusion is defined as the maximum intercuspation of teeth. The chapter explains how this position is essential for mastication and swallowing and highlights the challenges in replicating centric occlusion on casts due to the absence of natural occlusal forces.

Unit 2: Adjustable Articulators: Parts and Functions

• Types of Articulators: The chapter outlines different types of articulators, including hinge and semi-adjustable articulators, and discusses their uses in simulating mandibular movements.
• Hinge Axis: The hinge axis concept is explained, with emphasis on its role in articulator adjustments. The Hanau H2-PR articulator is specifically highlighted, showing its features and how it can be adjusted for various occlusal studies.
• Adjustment of the Articulator: Step-by-step procedures for adjusting the articulator, including checking for zero settings, are covered. Both arcon and condylar articulators are discussed in detail.

Unit 3: Semi-Adjustable Articulators: Anterior Guide

• Anterior Guidance: Biological considerations of anterior guidance are discussed, focusing on its role in guiding mandibular movements and protecting posterior teeth from excessive forces.
• Anterior Guide Table and Pin: The chapter goes into the setup of an adjustable anterior guide and the use of a Schuyler pin and table for customizing guides.
• Customized Guides: The importance of customizing anterior guides for individual patients is emphasized, ensuring accurate simulation of mandibular movements.

Unit 4: Face Bow: Parts and Function

• Face Bow Definitions and Parts: This chapter defines a face bow and its components, explaining its role in transferring the spatial relationship of the maxillary arch to the articulator.
• Use of the Face Bow: The procedure for using a face bow is discussed, from capturing the patient’s hinge axis to transferring this information to an articulator. Various techniques for face bow registration are also covered.

Unit 5: Simple Articulators

• Limitations of Simple Articulators: Simple articulators’ inability to simulate complex mandibular movements is discussed. The chapter highlights that while they are useful for some procedures, they lack the precision needed for comprehensive occlusal analysis.
• Interocclusal Registration: Techniques for recording centric occlusion and centric relation using simple articulators are explained. The limitations of these records in accurately reproducing mandibular movements are noted.

Unit 6: Occlusal Examination and Articulation of Casts

• Premature Contacts in Centric Relation: The chapter discusses common premature contacts that may occur in centric relation and their impact on occlusal harmony.
• Working and Balancing Side Contacts: It explains how to identify contacts on the working and balancing sides during lateral movements of the mandible and the significance of these contacts in maintaining occlusal balance.

Unit 7: Mounting of Casts

• Impressions and Casts: This unit provides detailed steps for taking impressions, preparing casts, and mounting them on an articulator.
• Face Bow Transfer: The process of transferring the maxillary arch to the articulator using a face bow is covered, along with techniques for locating the hinge axis.
• Mounting of Mandibular Cast: The chapter details how to mount the mandibular cast in relation to centric relation and centric occlusion.

Unit 8: Evaluation of Mounted Casts and Potential Errors in Mounting Procedures

• Evaluation of Mounting: This section discusses how to evaluate the accuracy of mounted casts on an articulator. It explains potential errors that can occur, such as those related to the hinge axis, interocclusal records, and condylar paths.
• Troubleshooting Errors: The chapter provides guidance on identifying and correcting common mounting errors that can affect the accuracy of occlusal analysis.

Unit 9: Occlusal Adjustment

• Theoretical Considerations: This chapter covers the principles of occlusal adjustment, explaining the goals of achieving harmonious occlusal contacts and preventing interferences.
• Adjusting Study Casts: Practical steps for adjusting study casts are provided, with an emphasis on how to use these casts to guide clinical adjustments.

Unit 10: Waxing Functional Occlusion – 1

• Waxing Techniques: This unit introduces the basics of waxing techniques for functional occlusion, including how to mount casts and the equipment and materials needed for waxing.
• Goals for Waxing: The chapter explains the goals of waxing, such as achieving proper occlusal contours and functional cusp contacts.
• Occlusal Analysis: The importance of performing an analysis of occlusal relationships before waxing is emphasized. This ensures that the resulting restorations will be functionally optimal.

Unit 11: Occlusal Splint (Bite Plane)

• Rationale for Splints: The chapter discusses the rationale for using occlusal splints, particularly in cases of occlusal dysfunction or temporomandibular joint (TMJ) disorders.
• Goals for Splint Therapy: The goals of splint therapy, such as alleviating occlusal interferences and stabilizing the TMJs, are outlined.
• Fabrication of Occlusal Splints: Detailed steps for fabricating an occlusal bite plane splint, including waxing, processing, and insertion, are provided.

Unit 12: Waxing Functional Occlusion – 2

• Advanced Waxing Techniques: This chapter builds on the concepts from Unit 10, providing more advanced techniques for waxing functional occlusion.
• Functional Waxing: The emphasis is on achieving occlusal harmony in complex cases where multiple teeth or entire arches are involved.

What is Functional Occlusion?

Functional occlusion refers to the harmonious relationship between the upper and lower teeth, allowing for smooth and efficient movements of the jaw during actions like chewing and speaking. It encompasses not just the contact between teeth but also the complex interactions between the teeth, supporting structures, temporomandibular joints (TMJ), and neuromuscular components.

For dental professionals, understanding and restoring functional occlusion is critical to preventing occlusal dysfunction, which can lead to discomfort, tooth wear, and temporomandibular joint disorders (TMD).

The Importance of Articulators in Functional Occlusion

Types of Articulators

An articulator is a mechanical device that simulates the movements of the jaw. It allows dentists to study and replicate the patient’s bite outside of the mouth, enabling precise adjustments to restorations like crowns, dentures, and bridges.

There are several types of articulators, each varying in complexity:

• Simple articulators: These are basic devices that simulate only limited jaw movements.
• Semi-adjustable articulators: These offer more precision, allowing for adjustments in the horizontal and vertical planes.
• Fully adjustable articulators: These devices replicate nearly all jaw movements, providing the highest level of precision.

Using the Hanau H2-PR Articulator

One of the widely used semi-adjustable articulators in dental practice is the Hanau H2-PR Articulator. This device allows for the simulation of lateral and protrusive jaw movements, making it ideal for diagnostic waxing and occlusal splint fabrication.

Some of the key features include:

• Hinge axis adjustment: Allows for precise replication of the patient’s mandibular movements.
• Customizable settings: The ability to adjust the horizontal and lateral condylar inclinations ensures accurate mounting of casts.

With this articulator, dentists can ensure that restorations are designed to meet the patient’s specific occlusal needs, minimizing the risk of occlusal interference.

Diagnostic Waxing: Restoring Occlusal Function

Diagnostic waxing is an essential part of the occlusal restoration process. It involves creating a wax model of the desired occlusal surfaces, which serves as a blueprint for the final restoration.

Steps in Diagnostic Waxing

1. Mounting the casts: First, the upper and lower dental casts are mounted on an articulator in the correct occlusal relationship.
2. Waxing the occlusal surfaces: Using dental wax, the occlusal surfaces of the missing or damaged teeth are sculpted to restore functional occlusion.
3. Analyzing occlusal contacts: The wax-up is checked for proper occlusal contacts and freedom in centric relation. Adjustments are made to ensure that the patient will have a smooth, functional bite.

Diagnostic waxing is particularly useful in complex cases where multiple teeth are involved, as it allows the dentist to visualize and plan the final outcome before committing to irreversible procedures.

Occlusal Bite Splints: A Key Tool in Managing Occlusal Dysfunction

Occlusal bite splints are custom-made devices that fit over the teeth to help manage occlusal dysfunctions, such as bruxism (teeth grinding) or TMJ disorders. They provide a temporary but effective solution for patients suffering from occlusal-related pain or discomfort.

Key Benefits of Occlusal Splints

• Protection from bruxism: Splints protect teeth from excessive wear by distributing occlusal forces more evenly.
• Alleviation of TMJ pain: By stabilizing the jaw, occlusal splints reduce strain on the temporomandibular joints.
• Improvement of occlusal function: Splints allow the mandible to move freely without interference, promoting a more functional bite.

Fabrication of an Occlusal Splint

The process of creating an occlusal bite splint involves several key steps:

1. Impression taking: A detailed impression of the patient’s upper and lower arches is taken.
2. Mounting casts on an articulator: The casts are then mounted on a semi-adjustable articulator.
3. Waxing and processing the splint: The splint is waxed to ensure proper occlusal contact and then processed using durable materials like acrylic.
4. Post-insertion adjustments: After the splint is fitted, minor adjustments are made to ensure comfort and functionality.

Conclusion

In summary, achieving and maintaining functional occlusion is essential for the long-term health of the masticatory system. Articulators, diagnostic waxing, and occlusal bite splints are invaluable tools in diagnosing, treating, and preventing occlusal dysfunctions. By using these techniques, dental professionals can ensure that patients enjoy a comfortable, functional bite free of interferences.