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Real World Occlusion: It’s Not Just the Teeth
A dentist's guide to function, esthetics and stability of the Maxillomandibular and Craniofacial Complex.
In most dental occlusal concepts, the primary difference is one of condylar versus muscular positions. This is consistent with the textbook images of sagittal condylar positions or the diamond shapes of the lateral excursive movements according to Posselt. However, these concepts do not take into account the three-dimensional structures of the craniofacial skeleton due to the relative difficulty of many dentists in visualizing how the muscles, TM Joints and the teeth all function in harmony. Risk indicators of occlusal disharmony include parafunction, trauma, posture, sleep architecture, psychological and neurologic inputs to the neuromuscular pathways. Finally, management of patient with Temporomandibular and Cranio-Cervical dysfunctions often require the use of intra-oral appliance therapy. Studies however have reported variable results.
Historical perspective suggests that different appliances and different mandibular positions be needed for different types of disorders and that the “one for all” appliance may not be an effective strategy to pursue.
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