James C. Kessler - Fundamentals of Fixed Prosthodontics

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Table 1-1 Correlation between HbA1c and mean plasma glucose29

Unfortunately, the occlusion is frequently overlooked or taken for granted in providing restorative dental treatment to patients. This may be due in part to the fact that the symptoms of occlusal disorders are often hidden from the practitioner untrained to recognize them or to appreciate their significance. Long-term successful restoration with cast metal or ceramic restorations is dependent on the maintenance of occlusal harmony.

While it is not possible to present the philosophies and techniques required to render extensive occlusal reconstruction in this limited space, it is essential that the reader develop an appreciation for the importance of occlusion. The perfection of skills required to provide sophisticated treatment of complex occlusal problems may take years to acquire. However, the minimum expectation of the competent practitioner is the ability to diagnose and treat simple occlusal disharmonies and to produce restorations that will not create iatrogenic occlusal or temporomandibular disorders.

In restorative treatment, the goal is to create occlusal contacts in posterior teeth that stabilize the mandibular position instead of creating deflective contacts that may destabilize it. In restorative treatment, the occlusion should be in harmony with the optimum condylar position, centric relation, which is an anteriorly, superiorly braced position along the articular eminence of the glenoid fossa, with the articular disc interposed between the condyle and eminence. 1This position is the most orthopedically stable position, and because it is a result of activated elevator muscles, it is also the most musculoskeletally stable position. 2

This position of the condyles in the glenoid fossae has been discussed and debated for years. It is used in dentistry as a repeatable reference position for mounting casts in an articulator. 3,4The term attempts to define the optimum relative position between all of the anatomical components. Ideally, that condylar position is also coincident with maximal intercuspation of the teeth. 4,5

For the concept of centric relation to be meaningful, the basic anatomy of the temporomandibular joint (TMJ) must be understood ( Fig 2-1). The bone of the glenoid fossa is thin at its most superior aspect and is not suited to be a stress-bearing area. However, the slope of the eminence in the anterior aspect of the fossa is composed of thick cortical bone that is capable of bearing stress.