Oclusión dental

Journal of Oral Rehabilitation 2008 35; 446–453

Review Article

Dental occlusion: a critical reflection on past, present and future concepts
¨ J. C. TURP*, C. S. GREENE† & J. R. STRUB‡
*Dental School, University of Basel, Switzerland, †College of Dentistry, University of Illinois, Chicago, IL, USA and ‡School of Dentistry, University of Freiburg, Germany

SUMMARY For nearly a century, thediversity of concepts about ‘normal’ and ‘ideal’ dental occlusal relationships has led to confusion in trying to describe the occlusion of any individual patient. In addition, a similar controversy arises when trying to formulate treatment plans for patients who need extensive dental restorations or orthodontic treatment. And finally, the application of occlusal concepts to patients withtemporomandibular pain and dysfunction has created a third area of debate. Over the past few decades, however, an appreciable part of the tenacious dogmatic heritage of this topic has

been challenged. As a result, the acceptance of morphological and functional variability of the stomatognathic system has gained increasing support, and this change has important consequences for modern dental practice. Inthis article, the past, present and future of the subject of occlusion will be considered. KEYWORDS: dental occlusion, centric relation, centric occlusion, temporomandibular disorders, gnathology Accepted for publication 16 April 2007

Introduction
Since the emergence of modern dentistry, the study of dental occlusion has been a subject of major interest (1–4). This is not surprising becauseknowledge about occlusion-related issues is essential to good clinical practice in all dental disciplines (5). Indeed, after a long journey throughout the history of dental practice and science, occlusion has attained its current role as ‘the medium of dentistry’ (6). In a narrow connotation, the term ‘occlusion’ relates to the arrangement of maxillary and mandibular teeth and to the way in whichteeth contact. Thus, a simple definition of occlusion includes such terms as ‘the static relationship’ (7) or ‘any contact’ (8) ‘between the incising or masticating surfaces of the maxillary and mandibular teeth or tooth analogues’ (7). In a broader context, however, the definition of the term ‘occlusion’ is not limited to morphological tooth contact relationships. Rather, it embraces the dynamicmorphological and functional

relationships between all components of the masticatory system – not just teeth and their supporting tissues but also the neuromuscular system, the temporomandibular joints (TMJs) and the craniofacial skeleton (8–10). As most dentists are aware, debates and controversies about issues related to dental occlusion have been prevalent for more than a century. Thesecontroversies have affected dental practice at every level, beginning with orthodontic issues in childhood and progressing to occlusal evaluations of ordinary adults in the dental office. In addition, the need to perform complex restorative dentistry requires some organizing concepts for delivery of optimal results – yet, dentists cannot seem to agree on what those concepts should be, nor even on whatconstitutes a good outcome. Furthermore, for those patients who were unlucky enough to develop pain and dysfunction in the masticatory system (temporomandibular disorders, TMDs), there has been a high probability that their problems would be analysed and treated within some occlusal paradigm.
doi: 10.1111/j.1365-2842.2007.01820.x

ª 2008 The Authors. Journal compilation ª 2008 Blackwell PublishingLtd

DENTAL OCCLUSION
All three of these occlusion topics have been undergoing dynamic (and mostly positive) changes during the past few decades. The general thrust of these changes has been in the direction of broader definitions for acceptable natural and therapeutic occlusal relationships, based more firmly on biological principles. In addition, the recognition that occlusal variables are...