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Developing occlusion Facial form analysis Mixed dention analysis Angle’s classification Adult occlusion Occlusal wear trauma Bruxism Examination of the edentulous and partially edentulous

mouth Faculty.ksu.edu.sa/Prof.Hamam

The examination should begin with a complete history and an

evaluation of the patient’s past & present systemic diseases

There is a close relationshipe between the development of occlusion and the development of the face.

When a facial disharmony is present,it does not necessary follow that there will be disturbance in the development of the occlusion.

An analysis of facial form will serve to appraise the harmony of growth and development of the facial skeleton as it relates to support of the dentition.

A-The examination should show the presence or absence of abnormal anteroposterior relationships and asymmetries of the dentofacial parts.

B-The examiner should not base his entire evaluation of malocclusion on the relationshipe of the first permanent molars or the relationship of the opposing arches,since the reminder of the face and muscles are often intimiately related to malocclusion

*An appraisal of the profile may be made by use of the Frankfort horizontal ( eye – ear)plane and a plane perpendicular to the Frankfort plane that passess through the nasion, called the anterior facial plane.

* An appraisal of facial symmetry may be made by using the midsagital plane;this is perpendicular to a plane through the orbital and verticle divides the face and head into two equal parts.

Four points of reference may be used to evauate changes in the anteroposterior relationship of of the parts

Making up the facial profile . 1- subspinal (midfacial region) ; The ala of the nose meets the cheek 2- the prostheon for the maxillary alveolar region 3- the infradental for the mandibular alveolar

region -deepest point of the mentolabial sulcus. 4- pogonion ; (chain point )

Displacement of the mandible may be :- Skeletal , dental or fuunctional Retrognathism;positive posterior

displacement of chin point Prognathism; an anterior displacement of

chin point The points of reference should be

observed when the mandible is in :- 1-rest position 2- centric relation 3- the

teeth are in complet occlusion

Visual inspection of the space occupied by the nose,upper lip,lower lip & chin while the lips are brought together lightly usually indicates that nasal height constitutes about 43% of vertical height while the region below constitutes 57%.

Proportionate lengths of the body and ramus of the mandible should also be evaluated

Asymmetries of the frontal facial form are best considered relative the midsagital plane

Systematic comparison of definite areas should be carried out:-Frontal bones, orbital regions,malar regions,maxillary region & mandibular region .

The typical adenoid facies is characterized by thin face,pinched nose,high arched palate& often retrognathia

The typical mouth breather shows a shortupper lip and a lower lip that rests between

the maxillary and the mandibular incisors.

Hatched face,flat face,mouse face,dish face,are obvoius

indications for an analysis of the facial form

In children 8-12 years of age The angle made by the base of the

mandible and the ascending ramus should be an obtuse angle of about 140 degrees

1- the primary dentition 2- The mixed dentition 3- The occlusion of the permanent teeth

in young adult 4- The changes in occlusion that result

from wear

3-5 year More stable, ovoid archFewer anomalies than either the mixed or

permanent dentitionsIt does show a wide range of normal variationNo essential change in the occlusionGrowth in the height of alveolar process sagital

to the dentition Spacing of the anterior teeth mesial to the

maxillary cuspids & distal to the mandibular cuspids

The length of the arch, from the distal surface of the second primary molar around to the distal surface of the opposite second primary molar , decrease after the eruption of the second primary molars

This decrease continues untile the completion of the primary dentition and.It is caused by the mesial migration of (E)

The primary dentition is characterized by a straight axial inclination of the incisors with an

almost edge to edge relationship of these teeth

The mandibular teeth occlude one cusp anteriorary to the corresponding tooth in the maxilla .

Deviations from this pattern are suggestive of malocclusion .

1-Early loss of primary teeth2-Prolonged retention of the primary teeth 3-Oral habits ( sucking)

Where the anterior relationship is normal,an open-bite of this type may be self-correcting,provided that the child ceases his sever sucking habit by the age of 4 years

The first permanent molar erupt at 6-7 y. Crowded & rotated position Tooth eruption has preceded the growth of

the jaw ( dental age exceeds skeletal age) The crowding may be self-correcting

because vertical growth of the alveolar processes up to the age of 9-10 years.

Eruption of permanent teeth(choronology.)

Prediction of malocclusion based on :- sequence of eruption without a

consideration of such factors as endocrine disturbance ,familial

tendencies, density of bone,scare tissue ,and

keratinization of the epithelium may lead to malocclusion

Crowded,permenent incisors erupt lingually to decideus teeth,Diastema – leeway space

Etiologic factors that can contribute to a loss of space :-

1-the premature loss of primary teeth 2-retention of primary teeth 3-congenital absence of teeth 4- dental anomlies 5- ectopic eruption 6- abnormal diastema

A harmonious balance between the oral and facial musculature and the teeth are very important .

Contributes to :- 1- facial asymmetry 2- TMD 3- disturbances in the teeth & supporting

structures(malposed teeth,cross-bite,faulty restorations,)

Lateral&other abnormal shifts of the mandible ( protrusion) may be observed by the examiner when the patient is requested to occlude the teeth from the rest position of the mandible.

An occlusion that is considered normal at the age of 18 years cannot be considered normal for the same individual at the age of 40 or 50y. Physiologic & pathologic processMamelons(incisal wear),second molars(increse the width of the alveolar arches)

Extraction, replacement of teeth, attration,extrusion,tipping,migration

It is a systematic examination of the anatomy and function of the masticatory system with special consideration given to functional disturbances and pathologic changes in the periodontium,teeth,joint,and muscles of mastication

1- Complete case history 2- Mastictory system

(joints,muscles,psychic factors,fatigue,anaxiety,pain )

3- Radiographic examination of the teeth and periodontal structure&TMJ

4-Analysis of the occlusion with an articulator

A diagnosis of occlusal trauma must be made on the basis of an analysis of the occlusion during empty movement ( such as lateral movements with the teeth in light contact )

Palpation,(abnormal tooth mobility, radiographs) Clinically,(occlusal habits,malocclusion,loss of

teeth&periodontal support, faulty restorations,bridges,p.dentures,occlusal interferrnces,cleching,bruxism

Increased tooth mobility Migration of teeth Root resorption Pain

( TMJ,pulpal,atypical,facial,periodontal ) Atypical occlusal wear Periodontal absceases pulpcalcification

Pain in and around the joints Restriction of mandibular movementsTenderness of masticatiory musclesClicking noises in the joints

Etiologic factors responsible for disharmony of the masticatory system as well as for traumatic TMJ arthritis are :-

discrepancy between centric relation and centric occlusion,abnormal tonicity of

masticatory muscles,local irritation associated with periodontal disease or dental caries,loss of vertical dimention,neurologic disorders,loss of teeth without replacement,bruxism

non-functional grinding of the teeth is an important predisposing factor in occlusal trauma and dysfunctional disturbances of the TMJ.

1-Occlusal interferences 2-Psychic tension 3-Periodontal diseases

1- nonfunctional facets of occlusal wear 2- tenderness of masticatory muscles 3- increased muscle tone & spasms 4- hypertrophy of masticatory muscles 5-TMJ stiffness and pain 6- increased mobility of teeth Treatment 1-remove the cause 2-relaxant drugs 3- elemination of premature contact

Examination of the edentulous and partially edentulous mouth

Sharpnes,flatness,height and relation to the opposing arches, nasal spine,zygomatic process of the maxilla,hamulus,mental foramen, buccal vestibule,retromolar area, genial tubercles,mylohyoid line,tongue,floor of the mouth

The main difference lies in the analysis.the analysis of the areas to recive dentures relates to effective impressions for adequate construction of the denture base wheres the analysis of denture bearing areas relates to dentures already in use .

*Areas required relief *Hard & soft tissue *Dentures already being worn

Bony spines,unerupted teeth,retained roots,hyperplastic tissue,tori,protuberant alveolar ridges,frenula,inadequate buccal vestibule.

Midline ,anterior nasal spine,concavity of the canine fossa,maxillary buttress of zygomatic arch,labial & buccal frenula

Maxillary tuberosity,hamulus notch,vibrating line,platine torus,

Palpation of anterior border of the ramus At rest & during movement of the

mandible Alveolar ridge,retromolar

pad,pterygomandibular raphe,buccinator muscle,vertical dimention,

Tissues that are bear denture(thin,atrophic,…)

External & internal oplique ridge,lingual frenum,buccal vestibule,

The separation of complaints of organic origin from those caused by lack of adjustment often taxes the skull and patience of the examiner

1-sorness of tissues (Break of mucosa,tenderness,ulceration )2-Contact dermatitis(denture material itself )3-Lack of denture stability4-Losseness of denture. Overextention or overpressure of denture Faulty occlusion Excessive vertical dimention Lack of patient adjustment Bony spicules

1-vitality of teeth,caries,attrition 2-condition of the supporting tissues 3-status of edentulous areas 4-arrangement and position of the

remaining teeth 5-occlusal relationships 6-intermaxilly space and vertical dimention 7-oral hygiene

8-form of roots & crowns to be used as abutments

9- relationship of the alveolar ridge to frenula,soft tissues,& bony eminences

10-relationship of free gingival margin to placement of the appliance

11-anteroposterior and lateral relationship of opposing arches

12-ability of the tissues of the edenulous areas to act as a denture-bearing area

DENTUER STOMATITS ACRYLIC RESIN BURN

ATROPHY OF MAXILLARY ALVOLAR RIDGE DENTURE FISSURATUM