welcome to the University of Michigan dentistry podcast series promoting oral Healthcare worldwide the clinical oclusal examination includes evaluation of tooth contacts and Centric occlusion left and right working left and right balancing in straightforward protrusion and lateral protrusive Mand movements the teeth are in Centric occlusion when there are maximum contacts between all the opposing teeth the contacting areas on all the teeth should be studied this can be done on the articulated cast but time does not permit for such a thorough examination of the patient on this TV tape the Centric occlusion contacts on the three teeth that will be used for the diagnostic waxing exercise and their antagonist will be checked Centric occlusion stops are located on supporting cus tips in FY and marginal ridges the supporting cusps are the lingual cusps of the maxillary posterior teeth the Buckle cusps of the mandibular posterior teeth and the incisal edges of the mandibular anterior teeth the supporting cusps contact the Centric stops which are usually located on the FY and marginal Ridges of the maxillary and mandibular posterior teeth and the marginal ridges or singul of the maxillary anterior teeth Centric stops are important for providing a stable jaw position with the teeth in occlusion Centric stops also establish and maintain contact vertical dimension for maximum stability all the teeth should contact InCentric occlusion also the supporting cus tips should olude on flat surfaces rather than inclined planes Centric stops are usually present on all the teeth and can be reproduced on correctly articulated casts small variations on the articulated cast are acceptable but substantial differences are indicative of improperly mounted casts observation of the patient's tooth contacts in different functional positions is important for evaluating the accuracy of cast mounted on an articulator and to ascertain the best function when doing a diagnostic waxing a diagnostic waxing will be done on the maxillary right first molar cuspid and Central inzer articulating paper is used to Mark the contacting areas the markings on the lingual cusps of the maxillary first Moler are the supporting cusp contacts that olude with the Centric stops of the mandibular teeth the supporting cusps of the mandibular teeth olude on the misum marginal Ridge the oblique Ridge and the distal marginal Ridge the examination of the mandibular first Moler shows areas of contact on the Buckle supporting cusps the Centric stops for the maxillary lingual cusps are located just distal to the Centric faasa against the distal lingual cusp and on the distal marginal Ridge the location of centric stops can be improved when waxing teeth into functional occlusion the Centric stops on the maxillary right cusped are located on the lingual Ridge and the distal marginal Ridge the slight counterclockwise rotation of the maxillary cusped is responsible for positioning the Centric stop of the mandibular cusped on the lingual Ridge rather than the mesial marginal Ridge the supporting cusp contact on the mandibular cuspid is located on the labial surface of the distal cusp Rd the worn spot on the cus tip is not the supporting contact InCentric the nature of the flat cus tip will be studied when the working contacts are evaluated the maxillary Central inzer is viewed with a mirror the Centric stops are located on the misal and distal marginal ridges the position of the Centric stops on maxillary anterior teeth vary due to the depth of the overbite stable contacts are located on the singul or along the mark marginal ridges the mark on the mandibular Central inzer is the supporting cusp contact with the misal marginal Ridge of the maxillary Central inzer the mark on the lateral inzer contacts with the distal marginal Ridge of the same Central inzer wear facets are flat areas on teeth that are worn Smooth by contact with opposing teeth in function and parap function these areas are useful in the diagnosis of normal function accusal traumatism bruxism and other habits accusal prematures and interferences can often times be diagnosed by wear facets the wear facets are useful for checking the accuracy of mounted casts although Dental restoration should not replace accusal prematures and interferences they should not prevent the patient from contacting functional wear facet the wear facets should be examined on all the teeth for function and parap function four wear facets will be demonstrated the first wear facet is on the mandibular right first Moler since we facets are smooth and flat they do not Mark well with articulating paper light reflects from wear facets and will be used for demonstrating the areas of Interest the wear facet on the dist Buckle incline of the dist Buckle cusp contacts the opposing tooth in Centric occlusion and during the first part of the right working movement the second we facet is on the lingual Ridge of the maxillary left cusped this facet demonstrates the direction that the mandibular cusped moves during the working movement the third wear facet is on the maxillary right Central inzer this facet is located on the incisal edge and is interesting because it is formed by several mandibular movements part of this wear facet is formed in straight protrusion part in right lateral protrusive position and in wide right working Excursion the relationship of this wear facet with functional occlusion will be observed later a diagnostic waxing will be done on this tooth and the wax tooth must not eliminate functional tooth contacts in the different mandibular excursions anterior guidance is important for normal function and the elimination of posterior inter ances the fourth wear facet is examined in the mirror the facet is located on the distal Buckle cusp of the mandibular left second Moler this facet exists because of contact with the maxillary left second molar when the mandible moves to the right the left side becomes the nonfunctioning idling or balancing side contacts between teeth on the balancing side are often accusal interferences because they prevent smooth mandibular movements balancing side interferences occur between the lingual cusps of the maxillary teeth and the Buckle cusps of the mandibular teeth when the mandible moves to the right the right side is known as the working side and the left side is the balancing side the teeth are observed throughout the movement for contact or lack of contact the smoothness with which the Mand moves is observed a smooth movement is a requirement of Ideal function uneven or restricted lateral movements are diagnostic of accusal dysfunction caused by accusal interferences TMJ Andor muscle disturbances and or neuromuscular disharmony the maxillary and mandibular cuspids are contacting during the first portion of the working movement the we facet on the cus tip of the mandibular cuspid is explained by the cont ATT in the edgo edge relationship during the working movement as the cuspids come into an edgo edge position the lateral incizors start contacting soon the central incizors are Incorporated the maxillary Central inzer contacts both mandibular Central enzers note how the wear facet seen earlier on the maxillary right Central inzer is partially formed by the tooth contacts during the working movement movement there is anterior guidance throughout the entire working movement an examination of the right posterior teeth demonstrates contact between the first MERS until the cuspids are ended to end working contacts between the Buckle cusps can be observed directly shimstock can be used to verify the contacts contacts between the lingual cusps must be marked with articulating paper observation of the lingual cusps can also be made on cast mounted correctly on an adjustable articulator a close-up of the first mullers demonstrates the working contacts between the distal bual cusps close examination of the maxillary first Moler helps to explain this kind contact the misal angulation of the Moler drops the distal Buckle cusp below the plane of occlusion formed by the Buckle cusp tips in this position the dist Buckle cusp is longer than the other buckle cusps and will be in contact unless the guidance on the cuspids is very steep the teeth on the left balancing side are examined in the mirror for contact or lack of contact if the teeth are not in contact then the amount of disclusion is observed the amount of disocclusion or separation of the teeth is important for assessing the accuracy with which the horizontal and lateral guidances are set on the articulator if contacts are present the articulated cast should contact in the same areas it is important to observe whether or not the contacts interfere with smooth mandibular movements prevent teeth from contact ing on the working side or cause mobility of either tooth if these conditions exist the balancing contacts are considered interferences contact can be observed between the misol lingual cusps of the maxillary second molar and the distal bual cusp of the mandibular second molar carefully examine the Conta lines of these cusps and relate to the we facets examined earlier the working contacts are examined on the left side the cuspids are contacting during most of the movement again note the uding inclines and compare with the wear facets examined earlier in a wide working Excursion the inzer contact working contacts that shift from the cuspids to the enzers are usually in harmony with smooth mandibular movements anterior guidance is a desirable concept of occlusion in working excursions the cuspids do not include InCentric occlusion individual tooth position and working wear facets are responsible for the lack of centric contacts anterior tongue position during swallowing prevents hyper eruption of the teeth and therefore maintains the disclusion InCentric the posterior teeth on the left working side are examined in the mirror the first molers are contacting simultaneously with the cuspids the rest of the teeth dis include contact or lack of contact can be verified with shim stock articulating paper or accusal indicator wax examine the mandibular movement for unevenness causing by posterior contacts some posterior working contacts can interfere with smooth lateral excursions cause tooth Mobility or prevent anterior teeth from uding under such conditions these contacts would be interferences and require adjusting not all posterior working side contacts are interferences but a single by cusped or molar contact without simultaneous occlusion on the cusped is not desirable acceptable type types of working guidance are cuspids only group function which is the cuspids and all the posterior teeth or partial group function which is the cuspids and several of the posterior teeth the right balancing side is examined using the mirror balancing side contacts require careful examination since the most posterior molers are the teeth frequently inclusion pour light in the back of the mouth saliva and the drape of the cheeks make visual examination difficult verification of contacts can be done with shimstock articulating paper or accusal indicator wax carefully recording tooth contacts or the lack of contacts in the patient's mouth is necessary for evaluating the accuracy of articulated casts a detailed analysis of the balancing side occlusion can be made on correctly articulated cast since the teeth can be viewed from both the Buckle and the lingual note the contact between the misol lingual cusp of the maxillary second Moler and the distab Buckle cusp of the mandibular second molar the mandible should be studied for lack of smooth gliding movements caused by the contacts between the second molers or avoidance of these potential contacts the straightforward protrusive Excursion is checked for anterior and posterior tooth contacts as well as for even or uneven movement notice the left and right deviation of the Mand during dur ing the protrusive movement the left and right side lateral protrusive movements are also examined any mandibular Excursion between the straightforward protrusive movement and the straight sideways working movement is considered a lateral protrusive movement note the relationship between wear facets and lateral protrusive movements examination of the anterior tooth contacts during protrusion are helpful for explaining the lack of smooth gliding mandibular movements notice how the guidance shifts from the left maxillary Central inzer with the left mandibular incizors to the right maxillary Central inzer with the right mandibular incizors even contact on all the anterior teeth simultaneously would result in a smoother movement smooth gliding movements can be achieved by a clusel adjustment or correct waxing of anterior teeth that need to be restored the mirror is used to examine the portions of the anterior teeth that are contacting during the protrusive movement the incisal edges of the the mandibular inzer contact the marginal Ridges of the maxillary Central incizors where facets can be demonstrated which correspond to the anterior tooth contacts during the protrusive Excursion these facets and their relationship with the protrusive guidance should be studied on the casts from both the lingual and facial views the posterior teeth on the right side are observed in the mirror during the protrusive movement the supporting cusps of the posterior teeth disclude note the relationship between the supporting cusps and the accusal salside the supporting cusps should disclude since their movement parallels the accusal salside the left side is examined through the mirror during the pertus movement also since the cusps move along the accusal celsi and not towards each other contacts are not observed if the anatomical arrangement of the teeth is normal and the curve of SP is not excessive the posterior teeth will not contact in protrusion the posterior teeth should also be examined in lateral protrusive movements for interferences been listening to a presentation from the University of Michigan School of Dentistry which is dedicated to supporting open learning and open educational resources this recording is licensed under the Creative Commons it may be reused and redistributed for nonprofit use please attribute materials to the University of Michigan School of Dentistry and redistribute under this same license for more information on how this and other University of Michigan School of Dentistry recordings may be used visit www.dent.umich.edu/license