Types of physiological occlusion. Central occlusion

Occlusion called the closure of individual teeth-antagonists or dentition completely.

Articulation- these are all kinds of movements and positions of the lower jaw relative to the upper, which are carried out with the help of masticatory muscles. This is a chain of occlusions that quickly replace each other. Specialists distinguish 5 types of occlusion: anterior, central, right, left and posterior.

Central occlusion is called the closure of the dentition with the maximum number of interdental contacts. In this case, the head of the lower jaw is located at the very base of the articular tubercle, and the small muscles that set the lower jaw in motion are evenly and simultaneously reduced. From this position, lateral movements of the lower jaw are possible.

With anterior occlusion, the lower jaw is pushed forward. If at the same time a normal bite is observed, then the midline of the face coincides with the midline located between the incisors, as in central occlusion. However, in this case, the heads of the lower jaw are located closer to the articular tubercles and are shifted forward. Lateral occlusions occur when the lower jaw is displaced to the left or right. In this case, the head of the lower jaw, moving, remains at the base of the joint, and on the opposite side it shifts upward.

In the case of posterior occlusion, the mandible is displaced. She loses her central position. In this case, the heads of the joints are shifted upwards, and the posterior temporal muscles are constantly tense. The lower jaw loses the ability to move sideways.

In addition to physiological occlusions, which are considered normal, there are pathological ones. In this case, the teeth are closed in such a way that they violate all the functions of the chewing apparatus. A similar condition is typical for periodontal diseases, loss of teeth, various kinds of malocclusion and jaw deformities, as well as increased tooth wear. With pathological occlusion, overload of the masticatory muscles, periodontium, jaw joints, as well as blocking the movement of the lower jaw are possible.

Bite anomalies

Bite- this is the nature of the closing of the teeth with central occlusion. Normally, this concept is almost identical to the term "central occlusion". Occlusion is the ratio of the teeth of the lower and upper jaws with central occlusion.

Types of bite are divided into normal and abnormal. Moreover, there is no sharp boundary between these 2 concepts, since in practice there are such bites that can no longer be considered normal, but still cannot be attributed to abnormal ones. These are borderline or transitional forms.

Orthognathic bite is considered normal bite, which provides full-fledged functions of chewing, swallowing, speech and is an aesthetic norm. With an abnormal form, such deviations are observed not only in the closing of the teeth, but also in appearance, such as deep, medial, distal, cross and open bites.

With each physiological type of bite, each individual tooth must merge with 2 of its antagonists. This rule does not apply to wisdom teeth and central incisors, which are connected with only 1 opposing tooth. Orthognathic bite is considered a reference: the lower front incisors with their edges are in contact with the dental tubercle of the upper incisors. In this case, the latter should overlap them by about a third of the height.

The buccal tubercles of the upper molars and premolars "cover" the lower teeth of the same name. In this case, the antagonist of each upper tooth is the tooth of the same name, located on the lower jaw, and part of the surface of the tooth standing behind it.

For a direct bite, it is characteristic that the upper and lower incisors are closed by their cutting edges. With a biprognathic bite, the lower and upper incisors are tilted forward, but the contact between them is maintained.

Physiological progeny is characterized by a moderate protrusion of the lower jaw. With physiological prognathism, on the contrary, protrusion of the upper teeth is observed. However, bite is considered normal if the dentoalveolar system fully performs its functions.

Bite anomalies are deviations from the normal interaction of the teeth of the lower and upper jaws. Abnormal occlusion is congenital or acquired as a result of gum disease - such as periodontitis, periodontal disease, etc. Its main differences from normal occlusion are violations of the closing of teeth in different directions or its complete absence in certain areas of the gums.

For example, with a distal bite, the normal ratios of the dentition are violated due to the excessive development of the upper jaw or the underdevelopment of the lower jaw. In this case, a deep overlap or gap appears between the teeth of the upper and lower rows.

If the upper prognathism is pronounced, then the edges of the lower incisors, when chewing, can sink into the mucous membrane located behind the bases of the upper incisors and injure it. Outwardly, this is expressed in the protrusion of the upper jaw, which pushes the upper lip, exposing the edges of the teeth. At the same time, the lower lip sinks, because of which speech functions may be impaired.

With a medial occlusion, the ratio of not only the anterior, but also the lateral teeth is disturbed. The anterior lower teeth are pushed forward and overlap the upper dentition. A severe form of medial occlusion is characterized by the development of the jaws in different directions. In this case, a gap is formed between the front teeth, biting off food is difficult, therefore it is partially transferred to the premolars and canines.

Sometimes with a medial occlusion, a traumatic occlusion is observed due to the inverse relationship of the anterior teeth. The appearance of the owner of the medial occlusion is disturbed: the chin is pushed forward, against the background of the protruding lower lip, the upper lip seems sunken (mainly in the area located near the wings of the nose).

A deep bite is such a ratio of the front teeth, in which the upper incisors cover the lower ones almost to the height of the crown. The lower incisors, when chewing, slip past the anterior ones and come into contact with the surface of the palate at their base. In severe cases, the front lower teeth injure the hard palate. In this case, the upper and lower rows diverge in the sagittal direction.

An open bite is considered a vertical anomaly, characterized by a lack of contact in the dentition in the lateral or anterior areas. With a crossbite, the intersection of the lower and upper dentition occurs, and it can be both bilateral and one-sided.

A direct bite is characterized by the fact that the front incisors of the lower and upper jaws are closed by their edges. At the same time, their cutting surfaces are subjected to increased abrasion. However, worn teeth are little susceptible to caries, and in the event of inflammatory processes in the tooth, the gums practically do not suffer.

Orthognathic bite is considered a variety of normal if the overlap of the lower teeth with the upper ones does not exceed half the height of their crowns. In the event that the front teeth tilt forward, they speak of an orthognathic bite with protrusion. If the front teeth are tilted back or set vertically, this phenomenon is called orthognathic bite with retrusion.

Prognathia is referred to as sagittal anomalies, which is expressed by a discrepancy between the shape, size and position of the lower and upper jaws. The degree of displacement in the sagittal direction is determined by the frontal plane. People with prognathia have a peculiar face shape: the upper lip, together with the upper jaw, protrudes forward. Often the lip is shortened, and teeth look out from under it.

At the same time, the lower lip and lower jaw are pushed back, and the lips do not close, so the facial expression seems tense. The functions of speech, breathing and swallowing, biting and chewing food are difficult. Diseases of the jaw joint are also possible.

There is also the so-called reducing bite, which is formed as a result of erasure or loss of teeth. At the same time, the face in the lower third is shortened, the distance between the teeth increases, the corners of the mouth fall, and the nasolabial folds are sharply defined.

If the posterior teeth were lost during childhood or adolescence, distal jaw displacement occurs. Decreasing bite leads to changes in the temporomandibular joint, which is manifested by pain in the joint area, asymmetry and difficulty in the movement of the lower jaw. This may cause cracking or clicking when the jaw moves, as well as tinnitus and headaches.

Occlusion and bite are key concepts in dentistry. The location of the teeth, as well as the work of the joints and muscles of the jaw apparatus, depends on the correctness of the occlusion. This concept is much broader than the concept of occlusion, so occlusion anomalies have a much stronger effect on the functioning of the whole organism and are more difficult to treat.

Occlusion is the closing of the upper and lower teeth, which occurs with a simultaneous contraction of the masticatory muscles. With age, the principle of closing the teeth changes, there are occlusion of milk teeth, at the stage of changing teeth and permanent occlusion. Depending on the position of the lower jaw, there is a central, anterior, posterior and lateral occlusion.

Bite is the habitual closing of teeth in a static position of the lower jaw, that is, in a state of occlusion. If the patient has problems with the closing of the teeth, they speak of an anomaly of bite. In this case, the closure is still there, but it is broken. When there is no closure at all, this is another problem - disocclusion or lack of bite.

Dangers of abnormal occlusion: increased incidence of caries, gum damage, improper functioning of muscles and joints, negative effects on the digestive system.

Normal occlusion

Central occlusion is recognized as an ideal, although in life it is almost unattainable. To achieve it, it is necessary to perfectly combine the dental, articular and muscular factors. This is the most difficult task, since the closing of the teeth, the position of the jaws, the condition of the bones of the skull and even the spine are taken into account, because all these units are interconnected.

Components of an ideal occlusion:

The dental factor consists in a clear and consistent closure of all teeth.
The articular factor is embodied if the articular heads of the temporomandibular joint are level. In this position, the lower jaw occupies an ideal position relative to the upper.
The heads of the lower jaw can be placed exactly in the articular fossa of the bone only with the most balanced work of the muscles of the maxillofacial region. This is the muscular factor of central occlusion.

When the habitual closing of the teeth coincides with the central occlusion, they speak of a physiological (healthy) bite.

Abnormal occlusion

Types of abnormal occlusion:

back. The mandibular region is pronounced underdeveloped, the incorrect position of the teeth visually increases the upper jaw and nose. There is no lip closure, there are chin folds. Posterior occlusion is skeletal and dentoalveolar.
Front. The lower jaw is visually pushed forward, the anterior teeth are in close contact with the cutting edges, the dentition is characterized by tubercular touch. The anterior one differs from the central one in the proximity of the location of the mandibular head to the tubercles of the joints and forward displacement. With anterior occlusion, a normal bite is possible.
Lateral jaw. There are right and left types, when the lower jaw is shifted to the side. The shift of the dentition will provoke contact between the tubercles of the chewing teeth. The jaw head remains mobile: on the one hand, it is not fixed at the articular base, and on the other, it is shifted upward. Lateral jaw occlusion is characterized by compression of the lateral pterygoid muscle. The central line and the line of the anterior incisors are shifted to the side.
Deep occlusion of the incisors. There are two degrees of violation: incisors in cutting-tubercular contact or lack of contact.

Occlusion disorders develop in the presence of a genetic predisposition, chronic diseases of the ENT organs, or bad habits in a child (thumb sucking). In adults, anomalies can appear in the absence of teeth, periodontal disease and other disorders in the dental system.

The Importance of Normal Occlusion

Correct occlusion is very important for the functioning of the dentition. With the normal position of the teeth, a uniform load is provided, the temporomandibular joint and facial muscles work correctly. The first thing that is affected by malocclusion is the aesthetics of the face. Teeth are also erased, joints become inflamed, muscles are overstrained, and even the digestive tract is disrupted.

What is dangerous wrong occlusion:

Suppression of emotions. Bite defects become more noticeable when emotions are shown, so many people try to hide them.
Complexes. External defects cause complexes and even mental disorders.
Improper functioning of the joints. Alarm signals - clicks or pain when moving the jaw.
Increased risk of dental and gum disease. People with impaired occlusion are more likely to develop caries, periodontitis and other diseases. If the bite is broken, it is not possible to sufficiently clean the teeth from all sides.

Treatment of malocclusion

Mild deviations of occlusion do not require treatment. In severe cases of violation of chewing or speech functions, it is necessary. The main method of correcting occlusion is the installation of orthodontic systems. Complex and traumatic cases are subject to surgical treatment.

Since children's teeth are still developing, until the age of 18, doctors try to limit themselves to orthodontic methods. At this age, plates, caps and braces are still able to correct the bite and position of the jaw. Adult patients whose dentition has long been formed require serious therapy.

Orthodontic systems for bite correction:

The plate is a removable device designed to correct bite in children. A fairly cheap and effective method at an early stage of the formation of disorders. Disadvantages of the disc include its size, changes in taste perception and diction disorders.
Elastopositioners are a group of silicone mouthguards (myofunctional trainers). They train muscles and fix the lower jaw correctly. Trainers are worn for 2 hours during the day and all night.
- a type of mouthguard that allows you to align your teeth and eliminate the diastema (gap between the teeth). Correction of one dentition with aligners can take 6-12 months, and treatment of two jaws at once from 15 or more. Aligners are removable, they do not injure the gums and are not noticeable.
functional devices. Such designs work due to the actions of the jaw muscles, excluding the influence of mechanical force. You need to wear a functional device for the maximum number of hours a day, and this is a rather large and uncomfortable design. The effectiveness of the functional apparatus and the speed of alignment of the dentition will depend on the time it is worn.
Bracket system 2×4. Braces of this type are fixed on the four front teeth (incisors) and on two molars. Braces allow you to achieve a good result as quickly as possible, although they also have their drawbacks. Since the braces are not removable, the process of brushing your teeth becomes more complicated. The risk of cavities and gum disease increases. It is inconvenient to eat hard food in braces, you have to grind everything into pieces or bring it to the consistency of gruel.

Surgical correction

Orthognathic surgery is indicated in cases where anomalies of the dentition and facial skeleton cannot be corrected by any standard orthodontic method. Usually conservative methods are ineffective in the treatment of adult patients in whom the growth plates of the bones are already closed.

Orthognathic operations allow restoring the anatomically correct position of the teeth in case of congenital anomalies of the facial skeleton, developmental defects, post-traumatic deformities of the jaws. For different cases, they choose the appropriate technique, technique, and even individual techniques in order to recreate the natural aesthetics of the face as much as possible.

In addition to correcting deformities and asymmetries, the doctor eliminates all functional disorders. Restoration of occlusion improves diction, chewing and swallowing.

Basic orthognathic techniques

Split osteotomy of the lower jaw - dissection of the bone, displacement of the fragment forward or backward and fixing it with titanium plates. Such treatment is effective for underdevelopment or excessive development of the lower jaw.
Osteotomy of the upper jaw - displacement of the bone fragment and the dentition. The amount of work depends on the type of pathology and the degree of deformation of the facial skeleton.
Segmental osteotomy - dissection of the bone with subsequent reposition. The doctor moves the jaw segment along with a fragment of the dentition.
Mentoplasty is a chin correction. Anomalies of the chin develop with insufficient or excessive development of the chin region of the lower jaw bone. The operation consists in cutting the bone and repositioning the chin in the chosen direction.
Corticotomy - dissection of the jaw bone without displacement, which simplifies the correction of the position of the dentition. Usually this technique acts as an addition to conservative treatment.

An optimal aesthetic result can be achieved with the help of additional mandibudoplasty, genioplasty, zygomatic bone plasty. Specifically, according to aesthetic indications, facial plastic surgery is performed: rhinoplasty, frontoplasty, cheiloplasty, removal of Bish's lumps, chin correction.

It must be understood that orthognathic surgery is a serious surgical treatment. This procedure requires deep anesthesia and can last up to 6 hours. To minimize the risk of complications, it is necessary to eliminate bad habits a month before the operation and discuss with the doctor the use of drugs that affect blood clotting.

Contraindications for otrognathic surgery

age up to 18 years;
diabetes;
blood clotting disorder;
chronic endocrine and somatic diseases;
cardiovascular disorders;
inflammatory process of an autoimmune, infectious or allergic nature (on the skin in the jaw area);
acute infections;
malignant formations.

Parents should control the process of formation of the child's dental system and treat all anomalies in time to avoid persistent disorders. It is necessary to check not only the teeth, but also the joints, muscles and bones of the skull. It is very important to monitor your posture, protect yourself from injuries and avoid habits that can negatively affect the development of the oral cavity.

Sources used:

Gross M. D., Matthews J. D. Occlusion normalization = Gross M. D., Mathews J. D. Occlusion in restorative dentistry. Churchill livingstone, 1982.
Klineberg I., Jaeger R. Occlusion and clinical practice. - 2nd ed. - M. : MEDpress-inform, 2008.
Khvatova V. A. Clinical gnathology. - M.: Medicine, 2005.

This term originates from Latin and means "closing".

Central occlusion is a state of evenly distributed tension of the jaw muscles, while ensuring a one-time contact of all surfaces of the elements of the dentition.

The need to determine the central occlusion is to correctly make a partial or removable denture.

Main features

Experts have identified the following indicators of central occlusion:

Muscular. Synchronous, normal contraction of the muscles responsible for the functioning of the lower jawbone.
Articular. The surfaces of the articular heads of the lower jaw are located directly at the bases of the slopes of the articular tubercles, in the depth of the articular fossa.
Dental:

full surface contact;
opposite rows are brought together so that each unit is in contact with the same and the next element;
the direction of the upper frontal incisors and the similar direction of the lower ones lie in a single sagittal plane;
overlapping elements of the upper row of fragments of the lower one in the front part is 30% of the length;
the anterior units are in contact in such a way that the edges of the lower fragments rest against the palatine tubercles of the upper ones;
the upper molar comes into contact with the lower one so that two-thirds of its area is combined with the first, and the rest with the second;

If we consider the transverse direction of the rows, then their buccal tubercles overlap, while the tubercles on the palate are oriented longitudinally, in the fissure between the buccal and lingual lower rows.

Signs of proper row contact

the rows converge in a single vertical plane;
incisors and molars of both rows have a pair of antagonists;
there is a contact of the same units;
the lower incisors in the central part of the antagonists do not have;
the upper eighths have no antagonists.

Applies to front units only:

if we conditionally divide the patient's face into two symmetrical parts, then the line of symmetry should pass between the front elements of both rows;
overlapping of the upper row of fragments of the lower one in the anterior zone occurs to a height of 30% of the total size of the crown;
the cutting edges of the lower units are in contact with the tubercles of the inner part of the upper ones.

Applies only to the side

the buccal distal tubercle of the upper row is based in the interval between the 6th and 7th molars of the lower row;
the lateral elements of the upper row merge with the lower ones in such a way that they fall strictly into the intertubercular furrows.

Methods Used

Central occlusion is determined at the stage of manufacturing prosthetic structures with the loss of several units.

Of great importance in this case is the height of the lower third of the face. However, in the absence of a large number of units, this indicator may be violated and must be restored.

If the patient has partial adentia, several options for determining the indicator are used.

The presence of antagonists on both sides

The method is used when antagonists are present in all functional areas of the jaws.

In the presence of a large number of antagonists, the height of the lower third of the face is preserved and is fixed.

The occlusion index is determined based on the largest possible number of contact zones of the same-named units of the upper and lower rows.

This option is the simplest since it does not require the additional use of occlusal rollers or specialized orthopedic templates.

The presence of three occlusal points between antagonists

This method is used if the patient has retained antagonists in the three main contact areas of the rows. At the same time, a small number of antagonists does not allow normal positioning of plaster casts of the jaw in the articulator.

In this case, the natural height of the lower third of the face is violated, and occlusal wax or thermoplastic polymer ridges are used to correctly compare the casts.

The roller is placed on the bottom row, after which the patient reduces the jaws. After the roller is removed from the oral cavity, imprints of the contact zones of the antagonists remain on it.

These prints are subsequently used by technicians in the laboratory to position the impressions and create a fully functional and correct, from an orthopedic point of view, prosthesis.

Absence of antagonistic pairs

The most time-consuming variant of the development of events is the complete absence of elements of the same name on both jaws.

In this situation, instead of the position of central occlusion determine the central ratio of the jaws.

The procedure includes the following steps:

Work on the formation of the prosthetic plane, which is positioned along the chewing surfaces of the side units and is parallel to the beam. It is built from the lower point of the nasal septum to the upper edges of the auditory canals.
Determination of the normal height of the lower third of the face.
Fixation of the mesiodistal ratio of the upper and lower jaw due to wax or polymer bases with occlusal rollers.

Checking the central occlusion with the existing pairs of elements of the same name is performed by closing the teeth and is carried out as follows:

a thin strip of wax is placed on the already prepared and fitted contact surface of the occlusal roller, glued;
the resulting structure is heated until the wax softens;
heated templates are placed in the patient's mouth;
after bringing the jaws together, the teeth leave imprints on the wax strip.

It is these prints that are used in the process of modeling central occlusion in the laboratory.

If the surfaces of the upper and lower rollers meet during the determination of occlusion, the specialist corrects their contact surfaces.

On the top, wedge-shaped cuts are made, and a certain amount of material is cut off from the bottom, after which a wax strip is glued onto the treated surface. After the rows are brought together again, the strip material is pressed into the cutouts.

Products are removed from the patient's oral cavity and sent to the laboratory for the subsequent manufacture of the prosthesis.

Calculations for orthopedic purposes

In the process of creating prosthetic structures for malocclusion, an orthopedic specialist measures the heights of the lower third of the patient's face using the anatomical and physiological method.

To do this, the bite height is measured in a state of complete reduction of the jaws, with central occlusion and in a state of physiological rest.

Calculation procedure:

At the bottom of the nose, at the level of the nasal septum, the first mark is placed strictly in the center. In some cases, the specialist puts a mark on the tip of the patient's nose.
In the center of the chin, a second mark is placed in its lower zone.
Measurement is performed between the applied marks height in a state of central occlusion of the jaws. To do this, bases with bite rollers are placed in the patient's oral cavity.
Re-measuring between marks, but already in a state of physiological rest of the lower jaw. To do this, the specialist must distract the patient so that he really relaxes. In some cases, the patient is offered a glass of water. After a few sips, the muscles of the lower jaw really relax.
The results are recorded. However, the standardized normal bite height, which is 2-3 mm, is subtracted from the resting height. And if after that the indicators are equal, we can talk about the normal bite height.

If, when measuring the height, according to the results of the calculations, a negative result is obtained - the lower third of the patient's face is understated. Accordingly, if the result deviates in a positive direction - overbite.

Receptions for the correct setting of the lower jaw

Correct positioning of the patient's jaw in the position of central occlusion involves the use of two methods of setting: functional and instrumental.

The main condition for correct setting is myorelaxation of the jaw muscles.

Functional

The procedure for this method is as follows:

the patient takes his head back a little until the muscles of the neck tense, which prevents the protrusion of the jaw;
touches the tongue to the back of the palate, as close to the throat as possible;
at this time, the specialist places the index fingers on the patient's teeth, slightly pressing on them and at the same time slightly pulling the corners of the mouth in different directions;
the patient imitates swallowing food, which in almost 100% of cases leads to muscle relaxation and prevents jaw protrusion;
when reducing the jaws, the specialist touches the surfaces of the teeth and holds the corners of the mouth until it is completely closed.

In some cases, the procedure is repeated several times until complete muscle relaxation and correct convergence of both rows is achieved.

Instrumental

It is performed using specialized devices that copy the movements of the jaw. It is used only in extremely serious situations, when bite deviations are significant and it is necessary to correct the position of the jaw using the physical efforts of a specialist.

Most often, this method the apparatus Larina is used and special orthopedic rulers that allow you to fix the movements of the jaw in several planes.

Permissible mistakes

The creation of a prosthetic structure in conditions of malocclusion is the most complex orthopedic procedure, the quality of which is 100% dependent on the qualifications of a specialist, a responsible approach to work.

Violations in determining the position of the central occlusion can lead to the following problems:

overbite

The folds of the face are smoothed out, the relief of the nasolabial zone is weakly expressed;
the patient's face looks surprised;
the patient feels tension when closing the mouth, during the reduction of the lips;
the patient feels that during communication the teeth knock against each other.

underbite

The folds of the face are strongly pronounced, especially in the chin area;
the lower third of the face visually becomes smaller;
the patient becomes like an elderly person;
the corners of the mouth are lowered;
lips sink;
uncontrolled salivation.

Permanent anterior occlusion

There is a noticeable gap between the front incisors;
the lateral elements do not contact normally, tubercular convergence does not occur.

Permanent lateral occlusion

overbite;
offset side clearance;
shifting the bottom row to the side.

Reasons for such problems

Incorrect preparation of wax templates.
Insufficient softening of the material for taking impressions and impressions.
Violation of the integrity of wax forms due to their premature removal from the oral cavity.
Excessive jaw pressure on the rollers during impression taking.
Errors and violations on the part of a specialist.
Errors in the work of the technician.

The video provides additional information on the topic of the article.

conclusions

The procedure for determining the position of the central occlusion is only one step in a complex and lengthy procedure for creating a prosthetic structure for the patient. But this stage can certainly be called the most significant and responsible.

It is on the qualifications, professionalism and experience of an orthopedic specialist that the comfort of further operation of the product by the patient and the absence of problems from the temporomandibular joint depend.

After all, various violations in his work, although they can be treated, take a significant period of time, causing discomfort, pain and inconvenience to the patient.

Take care of your teeth, contact your dentist’s office for help in a timely manner in order to maintain the health of the oral cavity and dentition for many years. In addition, taking care of your teeth and gums will help you avoid such unpleasant procedures described in our article.

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Parfenov Ivan Anatolievich

Occlusion is the ratio of the dentition during the contraction of the facial muscles and the movement of the lower jaw.

Proper closure of the chewing surfaces ensures the formation of a normal bite, reducing the load on the mandibular joints and teeth. With pathological types of occlusion, crowns are erased and destroyed, the periodontium suffers, and the shape of the face changes.

What is occlusion?

Central occlusion of teeth

This is the interaction of the components of the chewing system, which determine the relative position of the teeth.

The concept includes the complex functioning of the masticatory muscles, temporomandibular joints and crown surfaces.

Stable occlusion is provided by multiple fissure-cusp contacts of the lateral molars.

The correct arrangement of the dentition is necessary for the uniform distribution of the masticatory load and the elimination of damage to periodontal tissues.

Symptoms of pathology

With deep occlusion, the incisors of the lower row injure the mucous membranes of the oral cavity, the soft palate

If the occlusion of the teeth is violated, a person has problems with chewing food, pain and clicking in the temporomandibular joints, migraine may be disturbing.

Due to improper closure, crowns are worn out and destroyed faster.

This leads to the development of periodontal disease, gingivitis, stomatitis, loosening and early loss of teeth.

With deep occlusion, the incisors of the lower row injure the mucous membranes of the oral cavity, the soft palate. It is difficult for a person to chew solid food, there are problems with articulation, breathing.

External manifestations

Violation of occlusion leads to a change in the shape of the face. Depending on the type of pathology, the chin decreases or moves forward, the asymmetry of the upper and lower lips is observed.

During visual examination, there is an incorrect arrangement of the dentition, the presence of diastema, crowding of the incisors.

At rest, between the chewing surfaces of the teeth there is a gap of 3–4 mm, which is called the interocclusal space. With the development of pathology, the distance increases or decreases, the bite is disturbed.

Types of occlusion

There are dynamic and static forms of occlusion. In the first case, the interaction between the dentition during the movement of the jaws is considered, and in the second, the nature of the closing of the crowns in a compressed position.

In turn, statistical occlusion is classified into central, pathological anterior and lateral:

Types of dental occlusion	Location of the jaws	Changing face proportions
Central occlusion	Maximum intertubercular, the upper crowns overlap the lower ones by a third, the lateral molars have a fissure-tubercle contact	normal aesthetic appearance
Anterior occlusion	Anterior displacement of the lower jaw, the incisors touch butt, there is no closure of the chewing teeth, gaps in the form of a rhombus form between them (deocclusion)	The chin and lower lip protrude slightly forward, the person has an "angry" facial expression
Lateral occlusion	Displacement of the lower jaw to the right or left, contact falls on one canine or chewing surfaces of molars on one side	The chin is shifted to the side, the midline of the face does not coincide with the gap between the front incisors
Distal occlusion	A strong anterior displacement of the lower jaw, the buccal tubercles of the premolars overlap the units of the same name of the upper row	The chin is strongly pushed forward, the "concave" profile of the face
Deep incisal occlusion	The anterior incisors of the upper jaw overlap the lower ones by more than 1/3, there is no cutting contact	The chin is reduced, the lower lip is thickened, the nose is visually enlarged, the bird's face

Causes

Occlusion can be congenital or acquired, which is formed in the course of a person's life. Malocclusion is most often diagnosed in children in adolescence during the change of milk teeth to permanent ones.

Pathology can be caused by the following factors:

Occlusion can be temporary or permanent. At the time of birth, the lower jaw of the child is in the distal position.

Until the age of 3, an active growth of the bone structure takes place, milk teeth occupy an anatomical position and a correct bite is formed with a central closure of the dentition.

Diagnostic methods

The instrumental diagnostic method is carried out with a special device that fixes the movements of the lower jaw

Examination of patients in dentistry is carried out by a dentist and an orthodontist.

The doctor visually assesses the degree of violation of the closure of the dentition, makes a cast of the jaws from the alginate mass.

According to the obtained sample, a more thorough diagnosis of the pathology is carried out, the size of the interocclusal gap is measured.

Additionally, an occlusiogram, orthopantomography, electromyography, teleradiography in several projections may be required.

According to the results of TRG, the state of bone structures and soft tissues is assessed, which allows you to correctly plan further orthodontic treatment.

How in dentistry determine the central occlusion in the partial absence of teeth

Diagnosis of central occlusion plays an important role in the prosthetics of patients with partial or complete absence of crowns.

One of the determining factors is the height of the lower facial region. With incomplete adentia, they are guided by the location of antagonist teeth, if there are none, they fix the mesiodistal ratio of the jaws using wax bases.

Methods for determining central occlusion:

If a large number of teeth are missing, there are no pairs of antagonists, the Larin apparatus or two special lines are used. The central occlusal surface should be parallel to the pupillary line, and the lateral surface should be Camper's (nose-ear).

In the complete absence

In the case of adentia, the central occlusion is determined by the height of the lower face.

Several diagnostic methods are used:

anatomical;
anthropometric;
functional-physiological;
anatomical and physiological.

The first two methods are based on the study of the proportions of certain parts of the face, profile. The anatomical and physiological method is the determination of the resting height of the lower jaw.

The doctor, conducting a conversation with the patient, marks the points in the area of the base of the wings of the nose and chin, after which he measures the distance between them.

Then wax rollers are placed in the oral cavity, the person is asked to close his mouth and the distance between the marks is again determined.

Normally, the indicator should be 2-3 mm less than at rest. In case of deviations, a change in the lower part of the face is recorded.

Methods of treatment

Defects of the dental system are treated with the help of special orthodontic constructions. For minor violations, a facial massage is prescribed, removable silicone mouth guards are used, made according to the patient's individual sizes.

Corrective devices are worn during the day, removed before going to bed, eating.

Important! To eliminate pathologies of occlusion in the smallest patients, special facial masks are used. Older children are prescribed to wear vestibular plates, Bynin's kappa. According to indications, Klammt, Andresen-Goipl, Frenkel activators are used.

braces

The duration of wearing braces depends on the severity of the pathology.

Bracket systems are non-removable orthodontic devices designed to correct the dental system.

The device fixes each crown in a certain position, with the help of a fastening bracket, the direction of tooth growth is corrected, and the correct occlusion and bite are formed.

Braces are vestibular, which are fixed on the front surface of the crowns, and lingual, fixed from the side of the tongue.

Designs are made of plastic, metal, ceramics or combined materials. The duration of wearing braces depends on the severity of the pathology, the age of the patient and compliance with all doctor's recommendations.

orthodontic appliances

Andresen-Goypl apparatus

Activators are also used to correct occlusion.

The structures consist of two base plates connected into a monoblock by arcs, rings, and brackets.

With the help of a special device, the position of the lower jaw is corrected, its growth is stimulated with a reduced size, deep bite.

An oblique or body movement of the teeth in the desired direction is performed.

Surgical intervention

Surgical treatment of improper occlusion is indicated for congenital malformations of the jaws and when other therapies fail. The operation is performed in a hospital under general anesthesia.

The bones are fixed in the correct position, fixed with metal screws, and a splint is applied for 2 weeks. In the future, long-term wearing of orthodontic appliances for the correction of dentition is required.

Possible Complications

With untimely correction of a defect in the jaw system, the following complications may develop:

With a crossbite, incomplete closure of the jaws, people often suffer from diseases of the ENT organs. Pathogenic bacteria and viruses easily penetrate the oral cavity, pharynx, upper and lower respiratory tract, causing tonsillitis, laryngitis, sinusitis.

What is palatine occlusion?

This form of pathology is formed when the lateral painters are displaced in the transversal plane. With unilateral palatine occlusion, an asymmetric narrowing of the upper dentition is observed.

Bilateral pathology is characterized by a uniform decrease in the size of the jaw.

The main clinical manifestation of occlusion is a violation of the proportions of the face. Incorrect distribution of the masticatory load leads to the rapid destruction of crowns, periodontal inflammation, and the mucous membranes of the cheeks are often injured due to biting.

Inclusion

The implantation or inclusion of a tooth is a condition in which the crown is hidden in the jaw bone and cannot erupt on its own. If necessary, such units are removed surgically.

Many patients in dental clinics often do not understand the meaning of some terms. For example, the concept of "articulation" arose many years ago, but so far its meaning remains unclear to everyone. Occlusion and bite, as well as articulation, are commonly called different states of the masticatory apparatus. Some authors are of the opinion that occlusion is a kind of derivative of articulation. The term "occlusion" has something similar to the occlusion of the teeth, it implies the ratio of closed dentition.

Articulation and occlusion - what is it?

Occlusion of teeth in dentistry is considered to be a thorough adjoining of the molars and premolars of the dental arches in physiological rest or during chewing. Proper occlusion of the teeth can be considered a long-term and high-quality work of the dentoalveolar system with regular facial features. The contact of the cutting surfaces of the incisal groups of teeth of both jaws contributes to the formation of direct occlusion, but the main signs of articulation are any movement of the jaw when talking, swallowing, singing.

Occlusion and functioning occlusion have a close relationship in the practice of the dentist. Genetics affects the correctness of teething, the formation of the state of the jaws relative to each other and the quality of the central occlusion. The absence of burdened heredity in relatives does not negate the obligatory observation of the formation of a milk occlusion. Causes contributing to the pathological formation of bite:

prolonged use of nipples;
diseases of the retropharyngeal space;
finger sucking.

From the age of three, a child develops swallowing skills. The presence of problems in the tonsils, adenoids, sinuses contribute to the acquisition of pathological swallowing skills by the age of four. This, in turn, contributes to the formation of anomalies of occlusion of the teeth. It is important not to miss the moment and go to the orthodontist on time. The specialist will determine the causative factors and prevent the development of the anomaly. In the early stages, the pathology of the development of the dentition is determined by the doctor visually. Follow the advice of your dentist. The earlier the problem is identified, the more successful the treatment will be. Violation of the movement of the jaw and contacts of chewing surfaces, has a negative impact on the process of eating and digestion.

Some scientists are inclined to believe that the contact of the jaws and their movements are closely related. These processes combine the work of both jaws relative to each other, the masticatory apparatus and joints.

Varieties of occlusion

The main development of the dentoalveolar system occurs in the period from four to six years. At this time, speech, eating and swallowing skills are developing, the sacs of the rudiments of the eighth teeth are ripening. Development ends at the age of sixteen.

Dentists distinguish temporary closure of teeth in the process of chewing and physiological rest. Types of occlusions are determined by the specifics of muscle contractions and movements in the joints. The classification is based on the motor function of the movable jaw.

There are the following types:

lateral occlusion is formed by shifting the dental arches to the left or right relative to each other;
central occlusion - the contact surfaces of both dental arches are in contact with opposite teeth at rest;
anterior occlusion - the protruding lower jaw contributes to the tight contact of the incisors of both jaws without movement.

It is easy to prevent the development of pathological closure of teeth in children with central occlusion with the timely detection of deficiencies. The orthodontist will help the child acquire the right skills to talk, eat and swallow.

Proper occlusion occurs in people with central occlusion with a specific location for each member of the dental arch. The contact of dental crowns and their motor function are combined in one dentoalveolar system.

Central

Central occlusion is isolated in the presence of closure of the dental arches with the largest number of tubercles without jaw movement. The vertical facial line is located along the dividing line between the central incisors of both jaws. The muscles of the facial region contract synchronously. The joint at rest is determined without pathology.

The definition of central occlusion is carried out according to the following criteria:

The main indicator of the central state of rest is the close contact of the dental arches along the tubercles of the antagonists. Central occlusion does not exist in a completely edentulous mouth, but there is central balance, the location of one object in relation to another. We are talking about the ratio of the jaws to each other. There may be no central occlusion in the central relationship

In the central ratio, there are no jaw contacts, since there are no teeth. The central ratio is constant for each person and does not change throughout the life path. Central occlusion can be restored with prosthetics using the central ratio of the jaws.

Front

This occlusion is very different from the central one. The closure of the frontal group of teeth in physiological rest occurs when the jaw body is pushed forward. The movable part of the joint is pushed forward - this is the main sign of anterior occlusion.

Characteristic tooth contacts of anterior occlusion:

the median facial line is aligned with the division between the anterior incisors;
characteristic is the contact of the cutting surfaces of the incisors in the frontal area;
there are diamond-shaped gaps along the closure line.

Lateral

The lateral relationship of the dental arches occurs when the movable jaw is shifted to the side. Circular movements occur in the joint, which are not characteristic of central occlusion.

Characteristic conditions of the teeth of the lateral ratio:

displacement of the median facial line;
contact points are formed by tubercles of the same name on the side of the displacement and opposite ones on the opposite side with the dentoalveolar system without movement.

Types of physiological bite

In dentistry, there are different types of occlusions that guarantee the normal functioning of the oral cavity. The same applies to bite. Any kind of physiological bite retains articulation, the process of chewing food, the oval of the face has the correct shape and smile.

It is customary to distinguish the following types of physiological bite:

Orthognathic bite is characterized by careful contact of each crown of the upper tooth with the antagonist from below. At rest, there are no gaps at the points of contact between the teeth. The upper incisal group covers the lower incisal group by a third of the tooth body.
A progenic bite is formed by moving the moving jaw forward. The physiology of the joint is preserved.
Direct bite or direct occlusion is characterized by the contact of the cutting edges of the incisal groups of both jaws. A straight line is when the dental arch of each of the planes runs parallel. A similar arrangement of dentition is considered the norm, but direct occlusion contributes to the development of pathological abrasion.
Biprognathic bite is characterized by the extension of the incisal groups of both jaws towards the vestibular surface. This extension of the anterior teeth maintains a qualitative ratio of the chewing surfaces.

Malocclusion

There are quite a few cases with the presence of direct occlusion, but bite with a change in the classic closing of the teeth is not uncommon. Types of abnormal bite:
(we recommend reading: treatment of mesial occlusion)